Syed Shabab Wahid1, Katherine Ottman2, Raya Hudhud3, Kamal Gautam4, Helen L Fisher5, Christian Kieling6, Valeria Mondelli7, Brandon A Kohrt8. 1. Division of Global Mental Health, George Washington University, Washington DC, United States. Electronic address: sswahid@gwu.edu. 2. Division of Global Mental Health, George Washington University, Washington DC, United States. Electronic address: keottman@gwu.edu. 3. Department of Environmental and Occupational Health, George Washington University, Washington DC, United States. Electronic address: hudhudr@gwmail.gwu.edu. 4. Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal. Electronic address: drkamal.gautam@gmail.com. 5. Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, and ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom. Electronic address: helen.2.fisher@kcl.ac.uk. 6. Department of Psychiatry, Universidade Federal do Rio Grande do Sul; and Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. Electronic address: ckieling@ufrgs.br. 7. Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom. Electronic address: valeria.mondelli@kcl.ac.uk. 8. Division of Global Mental Health, George Washington University, Washington DC, United States. Electronic address: bkohrt@gwu.edu.
Abstract
BACKGROUND: Adolescence represents a vulnerable period for the onset of depression. Globally, there is a need to better understand risk factors for adolescent depression to inform policies for effective prevention initiatives. METHODS: A Delphi consensus study was conducted on risk factors, early signs, and detection strategies for adolescent depression in global settings. Over 3 survey rounds, global experts formulated and ranked these variables for (1) specificity for adolescent depression and (2) feasibility of measurement (round 1, n=21 participants; rounds 2 and 3, n=17). We calculated Smith's salience index as a measure of consensus. Interviews were conducted with 10 participants to elicit qualitative reflections on the ranking results, and on the influence of cultural and contextual factors on depression risks. RESULTS: Thirty-one risk factors for adolescent depression were generated. Panelists ranked three as highly specific and highly feasible to measure: family history of depression, exposure to bullying, and a negative family environment. Six were ranked as modestly specific and highly feasible: physical illness or disability, female sex, bereavement, trauma exposure, substance abuse, and low self-esteem. An additional 5 items were modestly specific and modestly feasible: social difficulties, academic stress, poverty, loss of family, and cognitive distortions. Five symptoms were at least modestly specific and feasible to measure: mood changes, loss of interest, social isolation, suicidality, and sleep changes. Schools were considered the most feasible place for screening. LIMITATIONS: The participants were not representative of all countries and cultural regions. CONCLUSIONS: This study offers a profile of risk factors developed and prioritized by experts to inform a research agenda for risk, identification and prevention of adolescent depression across global settings.
BACKGROUND: Adolescence represents a vulnerable period for the onset of depression. Globally, there is a need to better understand risk factors for adolescent depression to inform policies for effective prevention initiatives. METHODS: A Delphi consensus study was conducted on risk factors, early signs, and detection strategies for adolescent depression in global settings. Over 3 survey rounds, global experts formulated and ranked these variables for (1) specificity for adolescent depression and (2) feasibility of measurement (round 1, n=21 participants; rounds 2 and 3, n=17). We calculated Smith's salience index as a measure of consensus. Interviews were conducted with 10 participants to elicit qualitative reflections on the ranking results, and on the influence of cultural and contextual factors on depression risks. RESULTS: Thirty-one risk factors for adolescent depression were generated. Panelists ranked three as highly specific and highly feasible to measure: family history of depression, exposure to bullying, and a negative family environment. Six were ranked as modestly specific and highly feasible: physical illness or disability, female sex, bereavement, trauma exposure, substance abuse, and low self-esteem. An additional 5 items were modestly specific and modestly feasible: social difficulties, academic stress, poverty, loss of family, and cognitive distortions. Five symptoms were at least modestly specific and feasible to measure: mood changes, loss of interest, social isolation, suicidality, and sleep changes. Schools were considered the most feasible place for screening. LIMITATIONS: The participants were not representative of all countries and cultural regions. CONCLUSIONS: This study offers a profile of risk factors developed and prioritized by experts to inform a research agenda for risk, identification and prevention of adolescent depression across global settings.
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