Anxiety among urban, semi-urban and rural school adolescents in Dhaka, Bangladesh: Investigating prevalence and associated factors.

BACKGROUND: Anxiety disorder is one of the emerging public health problems in many low- and middle-income countries (LMICs). Likewise, in Bangladesh, a growing number of adolescents are experiencing such symptoms though we have very limited research evidence available. The purpose of this study was to investigate the prevalence of anxiety and the factors associated with this condition among urban, semi-urban, and rural school adolescents in Bangladesh. METHODS: This cross-sectional study used a two-stage cluster sampling procedure. A self-administered questionnaire was conveyed to 2355 adolescents from nine secondary schools of Dhaka, Bangladesh. Of the respondents, 2313 completed the seven-item Generalized Anxiety Disorder (GAD-7). Besides, sociodemographic information, self-reported body image as well as modification of Leisure Time Exercise Questionnaire (LTEQ) and WHO Global PA Questionnaire (GPAQ) were used to determine the sociodemographic and lifestyle factors associated with anxiety among adolescents. RESULTS: A total of 20.1% of adolescents were experiencing moderate to severe anxiety; of them, a significantly higher proportion (49.9%) of female adolescents were suffering more than males (40.1%). Furthermore, age, student's grade, father's educational level, number of family members, and residential setting were found to be significantly associated with anxiety among adolescents. In terms of lifestyle factors, irregular physical activity (AOR: 1.31; 95% CI: 1.05-1.63), high screen time (AOR: 1.51; 95% CI:1.21-1.88), sleep dissatisfaction (AOR: 3.79; 95% CI: 3.02-4.76), and underweight body image (AOR: 2.37; 95% CI:1.70-3.28) were found to be significantly associated with anxiety among school adolescents of urban, semi-urban, and rural residential settings. CONCLUSIONS: Anxiety is prevalent among urban, semi-urban, and rural school adolescents in Dhaka, Bangladesh. To lessen this prevalence of anxiety among Bangladeshi adolescents, evidence-based health programs- healthy school trials-and policies should therefore be taken based on the findings of this study.

Association between early menarche and suicidal behaviors in Korean girl adolescents.

ABSTRACT: Early menarche can be the socio-psychological problems. We studied the association between early menarche and suicidal risk behaviors among South Korean girl adolescents using national-wide data.Web-based self-report data from 2006 to 2015 the Korea Youth Risk Behavior Web-based Survey data were used in this study. Menarche status was divided into an "early menarche" group (at <12 years of age) versus "not early" menarche group (at ≥12 years of age).Participants with adolescent girls with early menarche group showed a higher prevalence of substance use, higher levels of stress, poorer self-rated health status, unhappier perceiveness, more frequent depressed mood, inter-sexual kissing or petting, inter-sexual intercourse, homosexual kissing or petting, being the victim or the assailant of sexual assaults, sexual transmitted diseases experience, pregnancy, and abortion experience than the not early menarche group. Adolescent girls with early menarche who had suicidal ideation (25.4% vs 22.2%, P < .001), suicidal plans (4.1% vs 2.6%, P < .001), and suicidal attempts (6.8% vs 5.2%, P < .001) were higher than that in the adolescent girls with not early menarche. A multivariate analysis after adjusting revealed that the odds ratios for suicidal ideation, plans, and attempts were 1.07 (95% confidence interval [CI]: 1.05-1.10), 1.35 (95% CI: 1.28-1.41), and 1.13 (95% CI: 1.09-1.18), respectively.Adolescent girl with early menarche was associated with suicidal behaviors.

Associations between Food Preferences, Food Approach, and Food Avoidance in a Polish Adolescents' COVID-19 Experience (PLACE-19) Study Population.

Food preferences are among the strongest predictors of the food choices of adolescents. These are associated with appetitive traits (food approach and avoidance) to some extent. However, no research has been conducted so far analyzing the association between food preferences and appetitive traits of adolescents. The aim of this study was to evaluate the associations between food preferences and appetitive traits in adolescents (aged 15-20 years) within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study population. The PLACE-19 Study was carried out in a population-based sample of 2448 secondary school students sampled across the country (random quota sampling). Food preferences (including the preference for vegetables, fruit, meat/fish, dairy, snacks, and starches) of the adolescents were assessed using the validated Food Preference Questionnaire (FPQ) while their appetitive traits (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, slowness in eating) were assessed using the validated Adult Eating Behavior Questionnaire (AEBQ). The k-means clustering was performed to identify the homogenous clusters of respondents based on their preferences, and linear regression was performed to determine the relationship between food preferences and appetitive traits with a model adjusted for sex and age. Based on their preferences, three homogenous clusters of respondents were defined: low-preferring respondents (low preference for all food categories), respondents preferring snacking foods (low preference for all food categories, except for fruit and snacks), and high-preferring respondents (high preference for all food categories). The low-preferring respondents showed the lowest values for all appetitive traits (p = 0.0008), as well as the lowest total score (p = 0.0001), except for food fussiness, for which they showed the highest value (p = 0.0008). All preference scores were positively associated with traits such as hunger, food responsiveness, enjoyment of food, and emotional under-eating, while negatively associated with food fussiness (all p < 0.05). The largest amount of variance was observed for preference for dairy (14.6%; R2 = 0.146, p = 0.008) and snacks with respect to enjoyment of food (16.2%; R2 = 0.162, p = 0.008), for vegetable with respect to food fussiness (22%; R2 = 0.220, p = 0.008), and for meat/fish with respect to enjoyment of food (19.9%; R2 = 0.199, p = 0.008) and food fussiness combined (19.1%; R2 = 0.191, p = 0.008). These results support the association of food preferences with both food approach traits and food avoidance traits.

The COVID-19 Pandemic and Adolescents' Experience in Sub-Saharan Africa: A Cross-Country Study Using a Telephone Survey.

The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation strategies on adolescents in sub-Saharan Africa are unclear. This study aimed to examine adolescents' knowledge, perceptions, and practices related to COVID-19 and the impacts of the pandemic on the daily lives of adolescents in sub-Saharan Africa. The survey was conducted in Burkina Faso, Ethiopia, and Nigeria using computer-assisted telephone interviews to enable rapid and remote data collection. Two sites were included in each country, with approximately 300 adolescents per site and 1,795 adolescents in total. Variations across the six sites were noted for the proportions of the adolescents who could correctly identify all key COVID-19 symptoms (4-25%), transmission methods (16-59%), and prevention approaches (33-79%). Most (> 72%) of the adolescents were no longer going to school due to school closures. Many adolescents (23-81%) were not receiving any education during the pandemic. A considerable proportion of the adolescents (44-83%) self-assessed as having less ability to learn during the pandemic; many expected it to be very difficult to catch up on education after the pandemic. Decreases in the consumption of major food groups were common across sites. Urgent actions are needed in sub-Saharan Africa to address the inadequate knowledge of COVID-19 among adolescents and the impacts of the pandemic on adolescent education and nutrition.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

Dá el primer paso y los caminos aparecerán: Percepciones de los/as adolescentes sobre el taller de Orientación Vocacional Ocupacional / Take the first step and the paths will appear: Perceptions of adolescents about the vocational orientation workshop

El Equipo de Psicopedagogía del Área Programática del Hospital Vélez Sarsfield, implementa desde el año 1998 procesos de Orientación Vocacional Ocupacional (OVO) en el marco de la Atención Primaria de la Salud (APS), la cual tiene como objetivo generar la participación, autogestión y responsabilidad en el cuidado de la salud de la población en general. El proceso de OVO busca que los/as estudiantes sean protagonistas de su elección, pudiendo llegar a tomar decisiones autónomas y significativas respecto a su futuro y, de esta manera, optimizar así su calidad de vida. Particularmente en este contexto de pandemia por Covid19, se decidió re-pensar de qué modo continuar con la oferta de esta actividad a pesar del impedimento de llevarlos a cabo de forma presencial; se consideró necesario mantener estos espacios donde se pudiera acompañar a los/as adolescentes ante la incertidumbre de la elección de una carrera o trabajo. Por tal motivo, se pensó en la idea de diseñar y llevar a cabo un Taller de OVO de forma virtual y acotado en cantidad de encuentros. La presente investigación tiene como objetivo analizar las percepciones de los/as adolescentes que iniciaron y culminaron el Taller de Orientación Vocacional Ocupacional, realizado de manera virtual en el periodo de octubre a diciembre de 2020, en relación al dispositivo de Orientación Vocacional Ocupacional. (AU)

Adolescents' mental health concerns, reported with an idiographic assessment tool.

BACKGROUND: Adolescents' self-defined concerns about their mental health are understudied. Yet gaining insight into the individual concerns of this group could be helpful in providing better services to the adolescent population. In this study, an idiographic procedure called Assert was used to increase our knowledge of which concerns are reported by adolescents as the most salient, in a primary mental health care situation. METHOD: 231 unique concerns were reported by 70 adolescents in a primary mental health context in Norway. These concerns were analysed qualitatively by a group of experts, to define categories. The distribution of these categories, and differences in gender and age, were analysed quantitatively. The alleviation experienced on the subjective concerns over the course of counselling was measured. Two linear multilevel models were analysed, to examine whether alleviation on self-defined concerns, as measured with Assert, differed-based on the main category of the concern or the number of times Assert was used. RESULTS: Three main categories of concerns emerged, related to (1) Self, (2) Relationships and (3) Life domains; as well as nine sub-categories: (1a) Autonomy, (1b) Mental health, (1c) Somatic health, (2a) Improving of relationships, (2b) Feeling safe from people around them, (2c) Taking responsibility for others, (3a) School, (3b) Work and (3c) Spare time. Girls reported fewer Life domain concerns than boys. Younger adolescents (12-16) more frequently reported no Self concerns, and older adolescents (17-23) more frequently reported no Relationship concerns. The adolescents felt less bothered by their subjective concerns after counselling, and there were some differences in alleviation depending on the category of concern. CONCLUSIONS: The adolescents defined their own concerns at the start of counselling and were less troubled by these concerns after counselling. The content of the concerns might suggest that these adolescents experienced a need to improve across several arenas: personal, relational and academic. Research to extend the current study, to understand individual adolescent concerns, should include contextual and social factors and personal characteristics-and explore how counselling interventions can best help alleviate these personal concerns.

GHQ-12 in adolescents: contributions to the controversial factorial validity / GHQ-12 en adolescentes: contribuciones a la controversia sobre su validez factorial

OBJECTIVE: The GHQ-12 is one of the most widely used questionnaires in the adult population, but there are not as many studies exploring its applicability in adolescents. The main problem is the diversity of results on its factorial structure, as different studies have shown one, two or three dimensions. The purpose of this study was to explore the GHQ-12 factorial structure for adolescents. METHOD: An observational multicenter cross-sectional descriptive study was designed for schools in the city of Madrid. A random sample of n = 2,171, 14-16-year-olds was stratified by the school's development level and funding (public, private or mixed). Unrestricted factor analysis was applied based on the polychoric or tetrachoric correlations matrix (depending on the test scoring method). RESULTS: The optimized parallel analysis provided an unequivocal one-factor structure, confirmed by unidimensionality assessment. Around 30% of male and 42% of female adolescents were found to be at risk of developing mental health problems. CONCLUSIONS: The GHQ-12 is a one-dimensional test for screening psychological distress, with excellent psychometric properties for its application in an adolescent population. The use of adequate statistical methods can overcome old controversies and promote proper application and interpretation of the results provided by the test

OBJETIVO: El General Health Questionnaire-12 (GHQ-12) es de los cuestionarios más utilizados en la población adulta, pero hay pocos estudios que exploren su aplicabilidad en adolescentes. El principal problema es la diversidad de resultados en su estructura factorial, ya que diferentes estudios han encontrado una, dos o tres dimensiones. El propósito de este estudio fue explorar la estructura factorial del GHQ-12 en adolescentes. MÉTODO: Estudio descriptivo observacional multicéntrico transversal para centros educativos de la ciudad de Madrid. Se estratificó una muestra aleatoria de n = 2171 jóvenes de 14-16 años según el nivel de desarrollo y financiación de la escuela (pública, privada o mixta). Se aplicó un análisis factorial sin restricciones basado en la matriz de correlaciones policóricas o tetracóricas (dependiendo del método de puntuación de la prueba). RESULTADOS: El análisis paralelo optimizado proporcionó una estructura inequívocamente unifactorial. El 30% de los varones y el 42% de las adolescentes presentaban riesgo de mala salud mental. CONCLUSIONES: El GHQ-12 es un test uni-dimensional para el cribado del riesgo de mala salud mental, con excelentes propiedades psicométricas para su aplicación en población adolescente. El uso de métodos estadísticos adecuados puede superar viejas controversias y promover la correcta interpretación de los resultados de la prueba

Congruence Gaps Between Adolescents With Cancer and Their Families Regarding Values, Goals, and Beliefs About End-of-Life Care.

Importance: Lack of pediatric advance care planning has been associated with poor communication, increased hospitalization, poor quality of life, and legal actions. Clinicians presume that families understand adolescents' treatment preferences for end-of-life care. Objective: To examine patient-reported end-of-life values and needs of adolescents with cancer and congruence with their families' understanding of these needs. Design, Setting, and Participants: This cross-sectional survey was conducted among adolescent-family dyads from July 16, 2016, to April 30, 2019, at 4 tertiary care pediatric US hospitals. Participants included 80 adolescent-family dyads (160 participants) within a larger study facilitating pediatric advance care planning. Adolescent eligibility criteria included being aged 14 to 21 years, English speaking, being diagnosed with cancer at any stage, and knowing their diagnosis. Family included legal guardians for minors or chosen surrogate decision-makers for those aged 18 years or older. Data analysis was performed from April 2019 to November 2019. Exposure: Session 1 of the 3-session Family Centered Pediatric Advance Care Planning for Teens With Cancer intervention. Main Outcomes and Measures: The main outcome was congruence between adolescents with cancer and their families regarding adolescents' values, goals, and beliefs about end-of-life care. Prevalence-adjusted and bias-adjusted κ (PABAK) values were used to measure congruence on the Lyon Advance Care Planning Survey-Revised (Patient and Surrogate versions). Results: A total of 80 adolescent-family dyads (160 participants) were randomized to the intervention group in the original trial. Among the adolescents, 44 (55.0%) were female and 60 (75.0%) were white, with a mean (SD) age of 16.9 (1.8) years. Among family members, 66 (82.5%) were female and 65 (81.3%) were white, with a mean (SD) age of 45.3 (8.3) years. Family members' understanding of their adolescent's beliefs about the best time bring up end-of-life decisions was poor: 86% of adolescents wanted early timing (before getting sick, while healthy, when first diagnosed, when first sick from a life-threatening illness, or all of the above), but only 39% of families knew this (PABAK, 0.18). Families' understanding of what was important to their adolescents when dealing with their own dying was excellent for wanting honest answers from their physician (PABAK, 0.95) and understanding treatment choices (PABAK, 0.95) but poor for dying a natural death (PABAK, 0.18) and being off machines that extend life, if dying (PABAK, 0). Conclusions and Relevance: Many families had a poor understanding of their adolescent's values regarding their own end-of-life care, such as when to initiate end-of-life conversations and preference for being off machines that extend life. Pediatric advance care planning could minimize these misunderstandings with the potential for a substantial impact on quality of care.

Divorce and adolescent academic achievement: Heterogeneity in the associations by parental education.

BACKGROUND: The link between parental divorce and adolescents' academic achievement may depend on parental educational levels. However, findings have been inconsistent regarding whether the negative associations between parental divorce and adolescents' academic outcomes are greater or smaller in highly educated families. The present study aimed to investigate the possible heterogeneity in the associations between divorce and adolescents' academic achievement by parental educational levels, within the context of the elaborate Norwegian welfare state. METHODS: The population-based cross-sectional youth@hordaland study of adolescents aged 16-19 years conducted in Norway in 2012, provided information about parental divorce and was linked to national administrative registries (N = 9,166) to obtain high-quality, objective data on the adolescents' grade point average (GPA), and their parents' educational qualifications and income. RESULTS: The negative association between parental divorce and GPA was stronger among adolescents with educated or highly educated parents compared to adolescents with less educated parents. This heterogeneity was driven by maternal educational qualifications, whereby divorce was more strongly and negatively associated with GPA among adolescents with educated mothers compared to those with less educated mothers, independent of paternal educational levels and income measures. CONCLUSIONS: Among adolescents whose parents have low educational qualifications, parental divorce is not associated with their academic achievement. Educated divorced mothers appear less likely to transfer their educational advantages onto their children than nondivorced equally educated mothers, perhaps due to a "double-burden" regarding work pressure and child-rearing responsibilities. There is a need for future studies to detail the mechanisms underlying this finding.

Confidence interval-based sample size determination formulas and some mathematical properties for hierarchical data.

The use of hierarchical data (also called multilevel data or clustered data) is common in behavioural and psychological research when data of lower-level units (e.g., students, clients, repeated measures) are nested within clusters or higher-level units (e.g., classes, hospitals, individuals). Over the past 25 years we have seen great advances in methods for computing the sample sizes needed to obtain the desired statistical properties for such data in experimental evaluations. The present research provides closed-form and iterative formulas for sample size determination that can be used to ensure the desired width of confidence intervals for hierarchical data. Formulas are provided for a four-level hierarchical linear model that assumes slope variances and inclusion of covariates under both balanced and unbalanced designs. In addition, we address several mathematical properties relating to sample size determination for hierarchical data via the standard errors of experimental effect estimates. These include the relative impact of several indices (e.g., random intercept or slope variance at each level) on standard errors, asymptotic standard errors, minimum required values at the highest level, and generalized expressions of standard errors for designs with any-level randomization under any number of levels. In particular, information on the minimum required values will help researchers to minimize the risk of conducting experiments that are statistically unlikely to show the presence of an experimental effect.

The association between role model presence and self-regulation in early adolescence: A cross-sectional study.

PURPOSE: Self-regulation is the capacity to regulate attention, emotion, and behaviour to pursue long-term goals. The current study examined the associations between role model presence and self-regulation during early adolescence, controlling for hopefulness, using a large population-based data set from the Tokyo Teen Cohort study. METHODS: Adolescents, aged 12 years, identified a role model using a single item on a paper questionnaire: 'Who is the person you most look up to?' Level of hopefulness was also assessed using a single question: 'To what extent do you feel hopeful about the future of your life?' Trained investigators evaluated self-regulation. RESULTS: Of 2550 adolescents, 2279 (89.4%) identified a role model. After adjusting for level of hopefulness, identifying a role model was associated with higher levels of self-regulation in comparison to indications of no role model. Hopeful future expectations were also associated with higher self-regulation; however, the beta coefficient was smaller than role model presence in the multivariate linear regression analysis. CONCLUSIONS: Role model presence was significantly associated with higher self-regulation among early adolescents. Educational environments should focus on support for adolescents with no role models.

Parental communication on sexual and reproductive health issues and its associated factors among preparatory school students in Debre Tabor, Northcentral Ethiopia: institution based cross-sectional study.

OBJECTIVE: This study was aimed to assess parental communication on sexual and reproductive health (SRH) issues and its associated factors among preparatory school students in Debre Tabor, Northcentral Ethiopia. Institution based cross sectional study was employed among 394 preparatory school students through self-administered questionnaire. RESULT: A total of 394 students were participated in the study with a response rate of 100%. The magnitude of parental communication on SRH issues was found to be 68.5%, (95% CI (63.7, 72.8)). Low grade (AOR = 0.31, 95% CI (0.17, 0.58)), feel embraced to discuss about SRH issues (AOR = 0.31, 95% CI (0.17, 0.56)), and living with mother/father (AOR = 0.15, 95% CI (0.06, 0.36)) were associated with reduced parental communication on SRH. While, family size < 5 (AOR = 2.46, 95% CI (1.25, 4.84)), and believe on the importance of discussion on SRH (AOR = 10.83, 95% CI (5.07, 23.17) were found to be associated with increased communication about SRH issues. Health education shall be given to preparatory school students on importance of discussion on SRH issues and related consequences of risky sexual behaviors.

Profiles of individual assets and mental health symptoms in at-risk early adolescents.

INTRODUCTION: Few studies investigated the combined patterns of individual assets (e.g., social competence, positive identity) and mental health symptoms (MHS) in adolescents. This study examined the patterns of early adolescents' individual assets and MHS and whether identified patterns were associated with later adolescents' outcomes. METHODS: Participants were 352 (164 boys, 188 girls) adolescents who were primarily African-American and from low socioeconomic status families, participating in a prospective study of the effects of prenatal cocaine exposure from birth in the Midwest United States. Individual assets, using the Developmental Assets Profile, and MHS, using the Youth Self-Report, were assessed at age 12. Substance use, via self-report and biologic assays, early (before age 15) sexual behaviors, and behavioral adjustment were assessed at age 15. RESULTS: Latent profile analysis indicated four distinctive profiles: low assets with elevated MHS (P1, n = 54, 15.3%); adequate assets with thought and social problems (P2, n = 84, 23.9%); low assets without MHS (P3, n = 101, 28.7%); and high assets without MHS (P4, n = 113, 32.1%). Children in the profile with high assets without MHS (P4) were more likely to have a higher IQ and to be in a more optimal environment (higher parental monitoring and less family conflict) than those in other profiles. Although profiles with MHS were associated with adolescent risk behaviors, this relationship was more pronounced for girls than for boys. CONCLUSIONS: Girls in the low assets with elevated MHS (P1) should be a primary concern for preventive intervention. Our study demonstrates the heterogeneity of individual patterns of adaptation and maladaptation.

Suicidal ideation and suicide attempts in subjects aged 15-19 in Lomé (Togo).

OBJECTIVES: The purpose of this study was to study the epidemiological and clinical profile of adolescents with suicidal thoughts, with or without suicide attempts, and to identify associated factors. RESULTS: A total of 155 (16.5%) of the 941 adolescents interviewed had suicidal thoughts. The average age of the respondents was 18 ± 2.1 years. The sex ratio (m/f) was 1.4. With regard to marital status, 70.2% were single and 29.8% were in a relationship with a cohabiting partner. Family history of suicide was reported in 40%. In their personal history, eight were infected with HIV, three were chronic ethylic and two were diabetics. Forty-six (29.7%) of the 155 adolescents who had suicidal ideation had ever had a suicide attempt. Teens affected by suicide lived in a boarding school in 25.8%, with one parent in 23.9% and 50.3% with both parents. Factors associated with suicide attempts were female sex (p = 0.0107), age over 18 years (p = 0.0177), living in a couple (p = 0.0316), underlying immunodepression (HIV infection, p = 0.0059, sickle cell disease, p = 0.0043) and having a family history of suicides (p = 0.0461).

Relationships Between Adolescent Stress, Depressive Symptoms, and Sexual Risk Behavior in Young Adulthood: A Structural Equation Modeling Analysis.

INTRODUCTION: This study examined longitudinal associations between stressful life events and depressive symptoms, assessed during two time points of adolescence, and sexual risk behavior, assessed during young adulthood. METHODS: Structural equation modeling was conducted with three waves of data from the National Longitudinal Study of Adolescent to Adult Health. RESULTS: Analyses revealed bidirectional relationships between stressful life events and depressive symptoms during the two time points of adolescence. Adolescent depressive symptoms indirectly affected young adult sexual risk behavior through adolescent stressful life events. Adolescent stressful life events during late adolescence were directly associated with young adult sexual risk behavior. DISCUSSION: Findings highlight the need to screen for both depression and stressful life events during adolescence, to identify at-risk adolescents and deliver tailored interventions to prevent sexual risk behavior during young adulthood.

Secrecy versus disclosure of mental illness among adolescents: II. The perspective of relevant stakeholders.

BACKGROUND: The burden of mental illness (MI) is exacerbated when adolescents with MI are confronted with stigma and social exclusion. Adolescents face the difficult decision whether or not to disclose their MI. Focus groups (FGs) were conducted with parents of adolescents with MI as well as with teachers, mental health professionals (MHPs) and adolescents without MI. AIM: To collect information from relevant stakeholders on secrecy versus disclosure of MI among adolescents. METHODS: Thirteen FG sessions with 87 participants were recorded, transcribed and analyzed using qualitative content analysis to identify major themes. RESULTS: Selective disclosure and social media as a potential way of disclosure emerged as dominant themes. Negative aspects of disclosure on social media were discussed. Stigma and labeling were seen as disadvantages of disclosure. Social support was perceived as one advantage of disclosure. Distinctive features of adolescence, such as self-discovery, appeared as specific problems. Parents, teachers, MHPs and adolescents without MI were considered important for disclosure. Participants discussed how to help adolescents with their dilemma between disclosure and secrecy. CONCLUSIONS: The findings suggest that disclosure decisions are personal and influenced by the individual's environment. Implications for interventions that aim to support adolescents with MI in this regard are discussed.

Secrecy versus disclosure of mental illness among adolescents: I. The perspective of adolescents with mental illness.

BACKGROUND: Many adolescents with mental illness (MI) struggle with the decision whether to disclose their condition. They may decide to keep their MI secret, whether due to fear of public stigma or due to self-stigma and shame. Secrecy may protect against discrimination, but has often negative long-term consequences such as social isolation. AIM: To explore personal views of adolescents with MI on secrecy and disclosure of their MI. METHOD: Six focus groups consisting of 39 adolescents with MI were recorded, transcribed, and analyzed by qualitative content analysis to identify major themes deductively and inductively. RESULTS: Participants described MI as a stigmatized condition and stressed both the benefits and risks of secrecy. Disadvantages included fear of stigma and loss of friendships, benefits included emotional support and relief. Adolescents underlined the importance of individual disclosure decisions (DDs). The majority preferred selective disclosure. Additionally, the role of other adolescents with and without MI was emphasized. CONCLUSIONS: DDs are individual and depend on social factors since stigma and fear of discrimination remain significant concerns for adolescents with MI. Implications for future interventions to support adolescents with MI are discussed.

Trends in social inequality in loneliness among adolescents 1991-2014.

BACKGROUND: Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness. METHODS: Study population: 11-15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness. RESULTS: Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014. CONCLUSION: The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC.