Adolescent depression and suicide risk: association with sex and drug behavior.

BACKGROUND: Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. METHODS: Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education. RESULTS: Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. CONCLUSIONS: Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.

The potential of coaching as a strategy to improve the effectiveness of school-based substance use prevention curricula.

Research-based substance use prevention curricula typically yield small effects when implemented by school teachers under real-world conditions. Using a randomized controlled trial, the authors examined whether expert coaching improves the effectiveness of the All Stars prevention curriculum. Although a positive effect on students' cigarette use was noted, this finding may be attributed to marked baseline differences on this variable across the intervention and control groups. No effects were found on students' alcohol or marijuana use or on any of several variables thought to mediate curriculum effects. The effects of coaching on teachers may not become evident until future years, when they have moved beyond an initial mechanical delivery of the curriculum.

Feasibility of screening adolescents for suicide risk in "real-world" high school settings.

OBJECTIVES: We evaluated the feasibility of a population-based approach to preventing adolescent suicide. METHODS: A total of 1323 students in 10 high schools completed the Suicide Risk Screen. Screening results, student follow-up, staff feedback, and school responses were assessed. RESULTS: Overall, 29% of the participants were rated as at risk of suicide. As a result of this overwhelming percentage, school staffs chose to discontinue the screening after 2 semesters. In further analyses, about half of the students identified were deemed at high risk on the basis of high levels of depression, suicidal ideation, or suicidal behavior. Priority rankings evidenced good construct validity on correlates such as drug use, hopelessness, and perceived family support. CONCLUSIONS: A simpler, more specific screening instrument than the Suicide Risk Screen would identify approximately 11% of urban high school youths for assessment, offering high school officials an important opportunity to identify young people at the greatest levels of need and to target scarce health resources. Our experiences from this study show that lack of feasibility testing greatly contributes to the gap between science and practice.

Identifying high school students "at risk" for substance use and other behavioral problems: implications for prevention.

Attendance and grade point average (GPA) data are universally maintained in school records and can potentially aid in identifying students with concealed behavioral problems, such as substance use. Researchers evaluated attendance (truancy) and GPA as a means to identify high school students at risk for substance use, suicide behaviors, and delinquency in 10 high schools in San Antonio, Texas, and San Francisco, California, during the spring and fall of 2002. A screening protocol identified students as "high risk" if (1) in the top quartile for absences and below the median GPA or (2) teacher referred. Survey responses of 930 high-risk students were compared with those from a random sample of 393 "typical" students not meeting the protocol. Bivariate and multivariate analyses assessed associations between the screening protocol variables and demographics, risk and protective factors, and problem outcomes. The individual contribution of each of the variables was also assessed. Students identified as high risk were significantly more likely than typical students to use cigarettes, alcohol, and marijuana, evidence suicide risk factors, and engage in delinquent behavior. Norms varied between the two districts; nevertheless, high-risk students showed consistent differences in risk and protective factors, as well as problem behaviors, compared with typical students. Because of site differences in data collection and teacher participation, the comprehensive protocol is recommended, rather than individual indicators alone (e.g., truancy). Strengths of the screening protocol are the ready availability of school record data, the ease of use of the adapted protocol, and the option of including teacher referral. More research is recommended to test the generalizability of the protocol and to ensure that there are no unintended negative effects associated with identification of students as high risk.

How much is enough and who says so?

BACKGROUND: One of the challenges of health-related quality of life research is to translate statistically significant health-related quality of life changes into interpretable clinical or medically important ones. OBJECTIVE: To calculate the minimal important difference of the King's Health Questionnaire, a condition-specific health-related quality of life questionnaire for the assessment of men and women with lower urinary tract dysfunction. METHODS: The King's Health Questionnaire was administered to patients suffering from overactive bladder enrolled in two multinational studies. Minimal important differences were calculated using an anchor-based approach with both a global rating of patient-perceived treatment benefit and one of perceived disease impact. A distribution-based method using effect size was calculated for comparison purposes. RESULTS: Minimal important difference values varied slightly with each method. Using the anchor-based approach, the King's Health Questionnaire minimal important difference ranged between 5-10 points when the calculation factored out patients who reported no change and 6-12 points for patients who experienced a small improvement. The effect size method indicated a minimal important difference of 5 to 6 points for a small effect and 10 to 15 points for a medium effect. CONCLUSIONS: In the case of the King's Health Questionnaire, the anchor-based approaches and the distribution-based approach provide similar results. A change from baseline of at least 5 points on King's Health Questionnaire domains indicates a change that is meaningful to patients and is indicative of a clinically meaningful improvement in health-related quality of life after treatment. Convergence of the estimates using different approaches should give us confidence in the values derived for the quality of life domains measured by the King's Health Questionnaire.