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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel


CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

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2191-0278
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Volume 30, Issue 1

Issues

Depressive symptoms, hostility, and hopelessness in inner-city adolescent health clinic patients: factor structure and demographic correlates

Kathleen A. Pajer
  • Corresponding author
  • Department of Psychiatry, Children’s Hospital of Eastern Ontario and Professor of Psychiatry, University of Ottawa Faculty of Medicine, 401 Smyth Rd., Ottawa, ON K1H 8L1 Canada, Phone: +1-613-737-7600 Ext. 2723, Fax: +1-613-737-2257
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/ Michael C. Edwards / Andrea E. Lourie / Sherecce Fields / Savannah Kalman
Published Online: 2016-08-10 | DOI: https://doi.org/10.1515/ijamh-2016-0009

Abstract

Background:

Depression, hostility, and hopelessness are risk factors for adult cardiovascular disease (CVD). People living in inner-city environments are particularly vulnerable. These associations may begin in adolescence, but research in this area is hampered by inadequate knowledge about how these negative psychological factors are related in teens and how they are affected by demographic characteristics. We hypothesized that depression, hostility, and hopelessness are one construct, and that this construct would be associated with race and gender in attendees at an inner-city adolescent health clinic.

Methods:

Two hundred and forty-six 15–18-year-old patients filled out instruments measuring depressive symptoms, hostility, and hopelessness. Confirmatory factor analysis was used to determine whether the negative psychological factors comprised a single construct or three separate ones. General linear modeling (GLM) was used to test the associations between demographic characteristics and the results of the factor analysis.

Results:

Depressive symptoms, hostility, and hopelessness were best characterized as three separate constructs, not one (root mean square error of approximation (RMSEA)=0.041, 90% confidence interval (CI)=(0.035, 0.047), comparative fit index (CFI)=0.98). There were no significant relationships between demographic variables and depressive symptoms or hostility. Six percent of the variance in hopelessness scores was accounted for by gender, race, and the interaction between the two (F=3.76; p=0.006), with White males, reporting the highest levels of hopelessness.

Conclusion:

In an urban adolescent health clinic population, depressive symptoms, hostility, and hopelessness were best understood as three separate constructs. Hopelessness was significantly higher in White males. Implications for future clinical research on negative psychological factors in teens are discussed.

Keywords: adolescent health clinics; adolescents; depressive symptoms; hopelessness; hostility

References

  • 1.

    Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull 2005;131:260–300.PubMedCrossrefGoogle Scholar

  • 2.

    Kubzansky LD, Davidson KW, Rozanski A. The clinical impact of negative psychological states: expanding the spectrum of risk for coronary artery disease. Psychosom Med 2005;67(Suppl 1):S10–4.PubMedCrossrefGoogle Scholar

  • 3.

    Everson SA, Kaplan GA, Goldberg DE, Salonen R, Salonen JT, et al. Hopelessness and 4-year progression of carotid atherosclerosis. The Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscl Throm Vas 1997;17:1490–5.CrossrefGoogle Scholar

  • 4.

    Possel P, Mitchell AM, Ronkainen K, Kaplan GA, Kauhanen J, et al. Do depressive symptoms predict the incidence of myocardial infarction independent of hopelessness? J Health Psychol 2015;20:60–8.PubMedCrossrefGoogle Scholar

  • 5.

    Appleton KM, Woodside JV, Arveiler D, Haas B, Amouyel P, et al. A role for behavior in the relationships between depression and hostility and cardiovascular disease incidence, mortality, and all-cause mortality: the prime study. Ann Behav Med 2016;50:582–91.CrossrefPubMedGoogle Scholar

  • 6.

    Lundgren O, Garvin P, Jonasson L, Andersson G, Kristenson M. Psychological resources are associated with reduced incidence of coronary heart disease. An 8-year follow-up of a community-based Swedish sample. Int J Behav Med 2015;22:77–84.CrossrefPubMedGoogle Scholar

  • 7.

    Nayyar D, Hwang SW. Cardiovascular health issues in inner city populations. Can J Cardiol 2015;31:1130–8.PubMedCrossrefGoogle Scholar

  • 8.

    Bolland JM. Hopelessness and risk behaviour among adolescents living in high-poverty inner-city neighbourhoods. J Adolesc 2003;26:145–58.CrossrefPubMedGoogle Scholar

  • 9.

    Stiffman AR, Earls F, Robins LN, Jung KG. Problems and help seeking in high-risk adolescent patients of health clinics. J Adolesc Health Care 1988;9:305–9.CrossrefPubMedGoogle Scholar

  • 10.

    Lieberman A, Adalist-Estrin A, Erinle O, Sloan N. On-site mental health care: a route to improving access to mental health services in an inner-city, adolescent medicine clinic. Child Care Health Dev 2006;32:407–13.CrossrefGoogle Scholar

  • 11.

    Bartlett JA, Schleifer SJ, Johnson RL, Keller SE. Depression in inner city adolescents attending an adolescent medicine clinic. J Adolesc Health 1991;12:316–8.CrossrefPubMedGoogle Scholar

  • 12.

    Raikkonen K, Matthews KA, Salomon K. Hostility predicts metabolic syndrome risk factors in children and adolescents. Health Psychol 2003;22:279–86.CrossrefPubMedGoogle Scholar

  • 13.

    Pajer K, Hoffman R, Gardner W, Chang CN, Boley D, et al. Endothelial dysfunction and negative emotions in adolescent girls. Int J Adolesc Med Health 2016;28:141–8.PubMedGoogle Scholar

  • 14.

    Goldstein BI, Carnethon MR, Matthews KA, McIntyre RS, Miller GE, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2015;132:965–86.CrossrefPubMedGoogle Scholar

  • 15.

    Sirois BC, Sears SF, Jr., Bertolet B. Biomedical and psychosocial predictors of anginal frequency in patients following angioplasty with and without coronary stenting. J Behav Med 2003;26:535–51.PubMedCrossrefGoogle Scholar

  • 16.

    Cunningham S, Gunn T, Alladin A, Cawthorpe D. Anxiety, depression and hopelessness in adolescents: a structural equation model. J Can Acad Child Adolesc Psychiatry 2008;17:137–44.PubMedGoogle Scholar

  • 17.

    Knox S, Barnes A, Kiefe C, Lewis CE, Iribarren C, et al. History of depression, race, and cardiovascular risk in CARDIA. Int J Behav Med 2006;13:44–50.CrossrefPubMedGoogle Scholar

  • 18.

    Everson-Rose SA, Lewis TT, Karavolos K, Matthews KA, Sutton-Tyrrell K, et al. Cynical hostility and carotid atherosclerosis in African American and white women: the Study of Women’s Health Across the Nation (SWAN) Heart Study. Am Heart J 2006;152:982.e7–13.CrossrefGoogle Scholar

  • 19.

    Krantz DS, Olson MB, Francis JL, Phankao C, Bairey Merz CN, et al. Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women’s Ischemia Syndrome Evaluation (WISE) Study. J Womens Health (Larchmt) 2006;15:1214–23.CrossrefPubMedGoogle Scholar

  • 20.

    Murray ET, Diez Roux AV, Carnethon M, Lutsey PL, Ni H, et al. Trajectories of neighborhood poverty and associations with subclinical atherosclerosis and associated risk factors: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2010;171:1099–108.CrossrefPubMedGoogle Scholar

  • 21.

    Klabbers G, Bosma H, Van Lenthe FJ, Kempen GI, Van Eijk JT, et al. The relative contributions of hostility and depressive symptoms to the income gradient in hospital-based incidence of ischaemic heart disease: 12-Year follow-up findings from the GLOBE study. Soc Sci Med 2009;69:1272–80.CrossrefPubMedGoogle Scholar

  • 22.

    Beck AT, Steer RA, Brown GK. Manual for the beck depression inventory-II, 2nd ed. San Antonio, TX: Psychological Corporation, 1996.Google Scholar

  • 23.

    Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.PubMedCrossrefGoogle Scholar

  • 24.

    Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A. Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents. J Am Acad Child Adolesc Psychiatry 1991;30:51–7.CrossrefPubMedGoogle Scholar

  • 25.

    Osman A, Kopper BA, Barrios F, Gutierrez PM, Bagge CL. Reliability and validity of the Beck depression inventory–II with adolescent psychiatric inpatients. Psychol Assess 2004;16:120–32.CrossrefPubMedGoogle Scholar

  • 26.

    Beck A, Steer R, Ball R, Ranieri W. Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996;67:588–97.PubMedCrossrefGoogle Scholar

  • 27.

    Strik JJ, Honig A, Lousberg R, Denollet J. Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics 2001;42:423–8.CrossrefPubMedGoogle Scholar

  • 28.

    Woodall KL, Matthews KA. Changes in and stability of hostile characteristics: results from a 4-year longitudinal study of children. J Pers Soc Psychol 1993;64:491–9.CrossrefPubMedGoogle Scholar

  • 29.

    Liehr P, Meininger JC, Mueller WH, Chan W, Frazier L, et al. Psychometric testing of the adolescent version of the Cook-Medley hostility scale. Issues Compr Pediatr Nurs 2000;23:103–16.CrossrefPubMedGoogle Scholar

  • 30.

    Bunde J, Suls J. A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors. Health Psychol 2006;25:493–500.PubMedCrossrefGoogle Scholar

  • 31.

    Barefoot JC, Dahlstrom WG, Williams RB, Jr. Hostility, CHD incidence, and total mortality: a 25-year follow-up study of 255 physicians. Psychosom Med 1983;45:59–63.CrossrefPubMedGoogle Scholar

  • 32.

    Barefoot JC, Dodge KA, Peterson BL, Dahlstrom WG, Williams RB, Jr. The Cook-Medley hostility scale: item content and ability to predict survival. Psychosom Med 1989;51:46–57.CrossrefPubMedGoogle Scholar

  • 33.

    Miller TQ, Smith TW, Turner CW, Guijarro ML, Hallet AJ. A meta-analytic review of research on hostility and physical health. Psychol Bull 1996;119:322–48.CrossrefPubMedGoogle Scholar

  • 34.

    Siegler IC, Peterson BL, Barefoot JC, Williams RB. Hostility during late adolescence predicts coronary risk factors at mid-life. Am J Epidemiol 1992;136:146–54.CrossrefPubMedGoogle Scholar

  • 35.

    Beck A, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974;42:861–5.PubMedCrossrefGoogle Scholar

  • 36.

    Beck A, Steer R. Manual for the beck hopelessness scale. San Antonio, Tex: Psychological Corporation, 1988.Google Scholar

  • 37.

    Steer R, Kumar G, Beck A. Hopelessness in adolescent psychiatric inpatients. Psychol Rep 1993;72:559–64.CrossrefPubMedGoogle Scholar

  • 38.

    Lester D. Hopelessness in adolescents. J Affect Disord 2015;173:221–5.PubMedCrossrefGoogle Scholar

  • 39.

    Wirth RJ, Edwards MC. Item factor analysis: current approaches and future directions. Psychol Methods 2007;12:58–79.PubMedCrossrefGoogle Scholar

  • 40.

    Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. New York, NY: Sage, 1993:136–62.Google Scholar

  • 41.

    Bentler PM. Comparative fit indexes in structural models. Psychol Bull 1990;107:238–46.CrossrefPubMedGoogle Scholar

  • 42.

    Olejnik S, Algina J. Generalized eta and omega squared statistics: measures of effect size for some common research designs. Psychol Methods 2003;8:434–47.PubMedCrossrefGoogle Scholar

  • 43.

    Bleil ME, Gianaros PJ, Jennings JR, Flory JD, Manuck SB, et al. Trait negative affect: toward an integrated model of understanding psychological risk for impairment in cardiac autonomic function. Psychosom Med 2008;70:328–37.CrossrefPubMedGoogle Scholar

  • 44.

    Landis D, Gaylord-Harden NK, Malinowski SL, Grant KE, Carleton RA, et al. Urban adolescent stress and hopelessness. J Adolesc 2007;30:1051–70.PubMedCrossrefGoogle Scholar

  • 45.

    Grunbaum JA, Vernon SW, Clasen CM. The association between anger and hostility and risk factors for coronary heart disease in children and adolescents: a review. Ann Behav Med 1997;19:179–89.PubMedCrossrefGoogle Scholar

  • 46.

    Rottenberg J, Yaroslavsky I, Carney RM, Freedland KE, George CJ, et al. The association between major depressive disorder in childhood and risk factors for cardiovascular disease in adolescence. Psychosom Med 2014;76:122–7.PubMedCrossrefGoogle Scholar

  • 47.

    Waloszek JM, Byrne ML, Woods MJ, Nicholas CL, Bei B, et al. Early physiological markers of cardiovascular risk in community based adolescents with a depressive disorder. J Affect Disord 2015;175:403–10.PubMedCrossrefGoogle Scholar

  • 48.

    Alt RL. Where the boys are not: a brief overview of male preventive health. WMJ: official publication of the State Medical Society of Wisconsin 2002;101:22–7.Google Scholar

  • 49.

    Juszczak L, Cooper K. Improving the health and well-being of adolescent boys. Nurs Clin North Am 2002;37:433–42.PubMedCrossrefGoogle Scholar

  • 50.

    Gibbons RD, Weiss DJ, Kupfer DJ, Frank E, Fagiolini A, et al. Using computerized adaptive testing to reduce the burden of mental health assessment. Psychiatr Serv 2008;59:361–8.PubMedCrossrefGoogle Scholar

  • 51.

    Gibbons RD, Weiss DJ, Pilkonis PA, Frank E, Moore T, et al. Development of a computerized adaptive test for depression. Arch Gen Psychiatry 2012;69:1104–12.PubMedCrossrefGoogle Scholar

  • 52.

    Gardner W, Kelleher KJ, Pajer K. Multidimensional adaptive testing for mental health problems in primary care. Med Care 2002;40:812–23.CrossrefPubMedGoogle Scholar

About the article

Received: 2016-01-24

Accepted: 2016-06-29

Published Online: 2016-08-10


Funding Source: National Institutes of Health

Award identifier / Grant number: 1R01MH066003-01A1

The authors thank Cynthia Holland-Hall, M.D. the staff of the Nationwide Children’s Hospital’s (NCH) Adolescent Medicine Clinic, and Elaine Damo from the NCH Research Data Center. We also thank the study participants for their time and effort. The study was supported by the National Institutes of Health: 1R01MH066003-01A1 (Pajer-PI) and the Research Institute for Nationwide Children’s Hospital, Internal Funds (Pajer-PI).


Citation Information: International Journal of Adolescent Medicine and Health, Volume 30, Issue 1, 20160009, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2016-0009.

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