Evaluación de la depresión y ansiedad en adolescentes en contextos educativos

Mental health is understood as a positive state of well-being that extends beyond just the absence of mental disorders. It is a complex process that each individual experiences from their unique perspective, with varying levels of difficulty and diverse social and clinical outcomes. Someone’s mental health can be threatened by so-called "life problems", such as adversities, burdens, threats, conflicts, crises, disappointments, frustrations, uncertainties, traumas, etc. If the individual cannot handle these issues effectively and they start impacting their daily functioning these difficulties can result in emotional disturbances. Internalizing problems constitute a dimension of mental health and refer to emotional alterations that manifest themselves at a cognitive, behavioral, and somatic level. They are common during adolescence and can lead to symptoms commonly associated with affective disorders, such as depression and anxiety. Depression is an emotional disorder characterized by sadness or a lack of pleasure or interest in daily activities. For its part, anxiety is defined as an emotional response triggered by the expectation of a potential threat, whether real or imagined, and is future oriented. Generalized anxiety disorder (GAD) is a specific form of anxiety marked by a pattern of excessive worry focused on multiple daily events, often related to family, health, finances, and school or work. . Anxiety disorders are often comorbid with each other and with other mental disorders, especially depression. Such comorbidity generally results in more severe symptoms, a greater clinical burden, and greater difficulty in treatment. Detecting and preventing these issues during adolescence is crucial because without intervention, their symptoms can worsen and persist into adulthood, leading to their perpetuation or even the development of other disorders. Adolescence is a stage of life where socio-emotional issues are often seen most frequently in school. This context provides an ideal setting to implement programs that promote emotional well-being and prevent mental health problems among students. This is because schools, beyond the family setting, offer extensive interactions with peers, facilitating significant learning experiences that can enhance individuals' socio-emotional skills, such as emotional regulation and self-control. In addition to the points mentioned earlier, it's important to remember that issues with emotional and behavioral adjustment start in around 50% of cases before the age of 15, during the time when adolescents are in school. The general objective of this doctoral thesis was to evaluate depressive and anxious symptomatology in educational contexts and examine its relationship with psycho-social adjustment in a sample of Spanish adolescents. This general objective was specified in the following specific objectives: a) analyze self-reported symptoms of anxiety and depression in educational contexts, their prevalence, and their association with socio-emotional and behavioral adjustment, in a representative sample of Spanish adolescents; b) develop and validate a short combined version of the Patient Health Questionnaire -9 (PHQ-9) and the Generalized Anxiety Disorder Assessment-7 (GAD-7) for use as a screening system for depressive symptoms and generalized anxiety in educational settings; c) validate the Generalized Anxiety Disorder Assessment-7 (GAD-7) in a representative sample of Spanish adolescents; and d) provide Spanish regulatory data for the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Assessment-7 (GAD-7) in a representative sample of Spanish adolescents. The doctoral thesis comprises three scientific articles aimed at addressing the various research objectives. The research utilized the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Assessment-7 (GAD-7) to assess depressive and anxious symptoms. Additionally, various psychometric indicators were employed to evaluate the socio-emotional and behavioral adjustment, and mental health of adolescents. The study sample included 2,235 students from Rioja (52.9% female, M = 14.49 years; SD = 1.76), selected through a method of stratified cluster sampling at the classroom level. In the first article were analysed self-reported symptoms of anxiety and depression in educational settings, a brief versión of the PHQ-9 and GAD-7 called PHQ-GAD8 was validated, the prevalence of self-reported symptoms of anxiety and depression has been examined and the relationship between anxiety and depression and psychometric indicators of psychological adjustment has been studied. The model with the best goodness-of-fit indices was the ESEM with two related factors (depression and anxiety). From this model, the four items of each latent factor with the highest factor loadings have been selected. The internal consistency of the PHQ-GAD-8 scores was 0,89 (IC 95% 0,88-0,90); discrimination indices have been found to be above 0,30. With regard to the prevalence of depressive and anxious symptomatology, 11.94% of the sample indicate that they have little interest or find little pleasure in doing things,19.61% that they have felt nervous, anxious, or very upset or have been unable to stop worrying and 21.36% that they have worried excessively about different things more than half of the days in the last two weeks. Symptoms of anxiety and depression have been positively associated with negative affect and psychopathology, and negatively associated with positive affect and quality of life. Furthermore, the structural equation model suggests that the depression dimension can be predicted from the scores on emotional and behavioural problems, positive and negative affect, and quality of life, while the anxiety dimension can be predicted from the values on emotional and behavioural problems and positive and negative affect. In conclusion, the PHQ-GAD-8 questionnaire appears to be a brief, simple instrument with adequate psychometric properties for the assessment of emotional difficulties in educational settings. It is necessary to have standardised screening procedures for the evaluation of emotional regulation problems in educational contexts that allow for their prevention, mitigate the possible impact at different levels (family, school, etc.), optimise teaching-learning processes and enhance their well-being and quality of life. In the second investigation the psychometric properties of the GAD-7 scores in a representative sample of Spanish adolescents were analysed. The unidimensional factor model showed satisfactory goodness of fit indices. Scalar measurement invariance across sex or age was found. The internal consistency of the GAD-7 total frequency score, estimated with McDonald’s Omega, was 0.90 (95 % CI: 0.89–0.91). and the test information function provides an optimal estimation at the medium-high latent trait. Los índices de discriminación de los ítems fueron superiores a 0,30. The prevalence of severe anxiety symptomatology found in the analyzed sample reached 11.1 %, being higher in girls (17.2 %) than in boys (4.3 %) and in the older group (12.5 %) than in the younger (9.6%). On the other hand, the GAD-7 scores were positively associated with self-reported depressive symptoms, negative affect, and emotional and behavioral problems, and negatively associated with positive affect and quality of life. In conclusion, the GAD-7, is presented as a instrument with adequate psychometric properties for the assessment of anxious symptomatology in educational contexts. In the third study, normative data were obtained from the PHQ-9 y GAD-7 in a representative sample of Spanish adolescents in educational settings. First of all, it was verified by means of univariate and multivariate analysis of the variance the existence of statistically significant differences in PHQ-9 and GAD-7 scores based on participants’ sex and age. Univariate contrasts revealed that girls attained higher mean scores than boys, and that older adolescents (late adolescence) had higher mean scores tan younger adolescents (early adolescence), both in depression and anxiety. the interaction between sex and age was not statistically significant nor in the analysis of the PHQ-9 or GAD-7 scores. In this way, the scores scales in both instruments were calculated for both the total sample and the subgroups created according to the sex and age of the participants. These normative data, derived from the scores observed in a representative sample of the adolescent population in Spain, are highly beneficial for evaluating, diagnosing, and addressing depression and anxiety symptoms in boys and girls aged between 12 and 18 years of age, and implement programs to prevent their appearance. The present study completes the validation of the PHQ-9 and GAD-7 questionnaires in Spanish adolescents, and provides normative data and cut-off points for adolescents according to gender and age, in order to ensure an adequate interpretation of the questionnaire scores. Their small number of items and the joint assessment they offer of both depressive and anxious symptomatology make them relevant screening tests for internalizing disorders in the adolescent population.

Grantor dc:publisher

Universidad de La Rioja (España)

Year dc:date

2024

Author dc:creator

• Casares García, María de los Angeles

Contributors dc:contributor

• Fonseca Pedrero, Eduardo (Universidad de La Rioja)
• Pérez de Albéniz Iturriaga, Alicia (Universidad de La Rioja)

Statement dc:rights

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Language dc:language

spa

Repository record dc:identifier

https://dialnet.unirioja.es/servlet/oaites?codigo=342205

OAI identifier oai:identifier

oai:dialnet.unirioja.es:TES0000023149