Propiedades Psicométricas e Invarianza Factorial del Cuestionario Educativo- Clínico: Ansiedad y Depresión (CECAD) en Población Vasca
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Palabras clave

Ansiedad
Depresión
Propiedades psicométricas
TRI
Invarianza factorial Anxiety
Depression
Psychometric properties
IRT
Factorial invariance

Cómo citar

Gorostiaga, A., Balluerka , N., Aliri , J., Echeveste, U., & Lameirinhas, J. (2024). Propiedades Psicométricas e Invarianza Factorial del Cuestionario Educativo- Clínico: Ansiedad y Depresión (CECAD) en Población Vasca. Psicothema, 36(1), 80–90. Recuperado a partir de https://reunido.uniovi.es/index.php/PST/article/view/20900

Resumen

Antecedentes: En la actualidad, la ansiedad y la depresión son los problemas de salud mental más comunes. Debido a su comorbilidad, resulta necesario disponer de instrumentos que los midan simultáneamente. Además, dado que su prevalencia varía en función del género y la edad, es importante examinar la invarianza factorial de tales instrumentos. El objetivo del presente estudio fue analizar la dimensionalidad y la invarianza factorial de la versión en euskera del Cuestionario Educativo-Clínico: Ansiedad y Depresión (CECAD) en función del género y la edad, y recabar evidencias adicionales de validez.

Método: La muestra estuvo compuesta por 2131 participantes (54.2% mujeres) con edades comprendidas entre los 7 y 24 años (M = 13.2; DT = 3.52).

Resultados: El CECAD mostró una estructura de dos dimensiones invariantes al género y la edad, con medias latentes más altas para las chicas en ambas dimensiones, y para mayores de 14 años en depresión, pero con tamaños del efecto pequeños. Tanto las estimaciones de los índices de fiabilidad como las evidencias de validez convergente fueron buenas.

Conclusiones: La versión en euskera del CECAD posee adecuadas evidencias de validez y fiabilidad para evaluar la ansiedad y la depresión en niños y adolescentes vascoparlantes.

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Citas

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Amorós-Reche, V., Belzunegui-Pastor, Á., Hurtado, G., & Espada, J. P. (2022). Emotional problems in Spanish children and adolescents during the COVID-19 pandemic: A systematic review. Clínica y Salud, 33(1), 19–28. https://doi.org/10.5093/clysa2022a2

Baker, F. B. (2001). The basics of item response theory (2nd ed.). ERIC Clearinghouse on Assessment and Evaluation.

Balluerka, N., Gorostiaga, A., & Haranburu, M. (2012). Validation of CDS (Children’s Depression Scale) in the Basque-speaking population. The Spanish Journal of Psychology, 15(3), 1400–1410. https://doi.org/10.5209/rev_SJOP.2012.v15.n3.39424

Basta, M., Micheli, K., Koutra, K., Fountoulaki, M., Dafermos, V., Drakaki, M., Faloutsos, K., Soumaki, E., Anagnostopoulos, D., Papadakis, N., & Vgontzas, A. N. (2022). Depression and anxiety symptoms in adolescents and young adults in Greece: Prevalence and associated factors. Journal of Affective Disorders Reports, 8, Article 100334. https://doi.org/10.1016/j.jadr.2022.100334

Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology, 10, Article 543. https://doi.org/10.3389/fpsyg.2019.00543

Blain-Arcaro, C., & Vaillancourt, T. (2019). Longitudinal associations between externalizing problems and symptoms of depression in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 48(1), 108–119. https://doi.org/10.1080/15374416.2016.1270830

Canals, J., Voltas, N., Hernández-Martínez, C., Cosi, S., & Arija, V. (2019). Prevalence of DSM-5 anxiety disorders, comorbidity, and persistence of symptoms in Spanish early adolescents. European Child & Adolescent Psychiatry, 28(1), 131–143. https://doi.org/10.1007/s00787-018-1207-z

Castelpietra, G., Knudsen, A. K. S., Agardh, E. E., Armocida, B., Beghi, M., Iburg, K. M., Logroscino, G., Ma, R., Starace, F., Steel, N., Addolorato, G.,Andrei, C. L., Andrei, T., Ayuso-Mateos, J. L., Banach, M., Bärnighausen, T. W., Barone-Adesi, F., Bhagavathula, A. S., Carvalho, F., … Monasta, L. (2022). The burden of mental disorders, substance use disorders and selfharm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019. The Lancet Regional Health – Europe, 16, Article 100341. https://doi.org/10.1016/j.lanepe.2022.100341

Chai, J., Xu, H., An, N., Zhang, P., Liu, F., He, S., Hu, N., Xiao, X., Cui, Y., & Li, Y. (2021). The prevalence of mental problems for Chinese children and adolescents during COVID-19 in China: A systematic review and metaanalysis. Frontiers in Pediatrics, 9, Article 661796. https://doi.org/10.3389/fped.2021.661796

Chen, R., Huang, Y., & Yu, M. (2021). The latent profile analysis of Chinese adolescents’ depression: Examination and validation. Children and Youth Services Review, 125, Article 106006. https://doi.org/10.1016/j.childyouth.2021.106006

Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5

Chung, J. E., Song, G., Kim, K., Yee, J., Kim, J. H., Lee, K. E., & Gwak, H. S. (2019). Association between anxiety and aggression in adolescents: A crosssectional study. BMC Pediatrics, 19, Article 115. https://doi.org/10.1186/s12887-019-1479-6

Cioffredi, L.-A., Kamon, J., & Turner, W. (2021). Effects of depression, anxiety and screen use on adolescent substance use. Preventive Medicine Reports, 22, Article 101362. https://doi.org/10.1016/j.pmedr.2021.101362

Costa, D., Cunha, M., Ferreira, C., Gama, A., Machado-Rodrigues, A. M., Rosado-Marques, V., Nogueira, H., Silva, M. R. G., & Padez, C. (2020). Self-reported symptoms of depression, anxiety and stress in Portuguese primary school-aged children. BMC Psychiatry, 20, Article 87. https://doi.org/10.1186/s12888-020-02498-z

Costello, E. J., Erkanli, A., & Angold, A. (2006). Is there an epidemic of child or adolescent depression? Journal of Child Psychology and Psychiatry, 47(12), 1263–1271. https://doi.org/10.1111/j.1469-7610.2006.01682.x

Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816–845. https://doi.org/10.1037/a0034733

de la Fuente-Solana, E. I., Gómez-Urquiza, J. L., Cañadas, G. R., Albendín-García, L., Ortega-Campos, E., & Cañadas-De la Fuente, G. A. (2017). Burnout and its relationship with personality factors in oncology nurses. European Journal of Oncology Nursing, 30, 91–96. https://doi.org/10.1016/j.ejon.2017.08.004

de Lijster, J. M., Dieleman, G. C., Utens, E. M. W. J., Dierckx, B., Wierenga, M., Verhulst, F. C., & Legerstee, J. S. (2018). Social and academic functioning in adolescents with anxiety disorders: A systematic review. Journal of Affective Disorders, 230, 108–117. https://doi.org/10.1016/j.jad.2018.01.008

de Oliveira, H. C. S. A., Marques, R. R., Curado, M. A. D. S., Gaspar, M. F. M., & Sousa, P. J. D. S. (2022). Instruments for measuring incidents related to patient safety in the context of paediatric intensive care: Protocol for a scoping review. Systematic Reviews, 11(1), Article 17. https://doi.org/10.1186/s13643-022-01888-6

Delvecchio, E., Mabilia, D., Di Riso, D., Miconi, D., & Li, J.-B. (2015). A comparison of anxiety symptoms in community-based Chinese and Italian adolescents. Journal of Child and Family Studies, 24(8), 2418–2431. https://doi.org/10.1007/s10826-014-0045-y

Detullio, D., Millen, D. H., & Kennedy, T. D. (2022). A meta-analysis of the association between the Children’s Depression Inventory (CDI) and suicidality. Aggression and Violent Behavior, 64, Article 101539. https://doi.org/10.1016/j.avb.2020.101539

Domènech-Llaberia, E., Viñas, F., Pla, E., Jané, M. C., Mitjavila, M., Corbella, T., & Canals, J. (2009). Prevalence of major depression in preschool children. European Child & Adolescent Psychiatry, 18(10), 597–604. https://doi.org/10.1007/s00787-009-0019-6

Doval, E., Vilandrich, C., & Angulo-Brunet, A. (2023). Coefficient alpha: The resistance of a classic. Psicothema, 35(1), 5–20. https://doi.org/10.7334/psicothema2022.321

Drugé, J. R., & Potvin, S. (2022). Developmental multi-trajectory of irritability, anxiety, and hyperactivity as psychological markers of heterogeneity in childhood aggression. Psychological Medicine, 52(2), 241–250. https://doi.org/10.1017/S0033291720001877

Essau, C. A., Lewinsohn, P. M., Olaya, B., & Seeley, J. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163, 125–132. https://doi.org/10.1016/j.jad.2013.12.033

Fernández-Pinto, I., Santamaría, P., Sánchez-Sánchez, F., Carrasco, M. A., & del Barrio, V. (2015). SENA: Sistema de Evaluación de Niños y Adolescentes [SENA: Child and Adolescent Assessment System]. TEA Ediciones.

Ferrando, P. J., Lorenzo-Seva, U., Hernández-Dorado, A., & Muñiz, J. (2022). Decálogo para el análisis factorial de los ítems de un test [Decalogue for the factor analysis of test items]. Psicothema, 34(1), 7-17. https://doi.org/10.7334/psicothema2021.456

Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., López-Navarro, E. R., Muñiz, J., Lucas-Molina, B., Pérez-Albéniz, A., Baños Rivera, R., Cano-Vindel, A., Gimeno-Peón, A., Prado-Abril, J., González-Menéndez, A., Valero, A. V., Priede, A., González-Blanch, C., Ruiz-Rodríguez-P., Moriana, J. A., Gómez, L. E., … Montoya-Castilla,

I. (2021). Tratamientos psicológicos empíricamente apoyados para la infancia y adolescencia: Estado de la cuestión [Empirically supported psychological treatments for children and adolescents: State of the art]. Psicothema, 33(3), 386–398. https://doi.org/10.7334/psicothema2021.56

Fusar-Poli, P., on behalf of the Healthy London Partnership. (2019). Integrated mental health services for the developmental period (0 to 25 years): A critical review of the evidence. Frontiers in Psychiatry, 10, Article 355. https://doi.org/10.3389/fpsyt.2019.00355

Gaeta, L., & Martínez-Otero, V. (2014). La ansiedad en alumnos mexicanos de primaria: Variables personales, escolares y familiares [Anxiety in primary Mexican students: Personal, school and familiar variables]. Revista Iberoamericana de Educación / Educaçao, 66, 45–58. https://doi.org/10.35362/rie660377

Gaspar de Matos, M., Barrett, P., Dadds, M., & Shortt, A. (2003). Anxiety, depression, and peer relationships during adolescence: Results from the Portuguese national health behaviour in school-aged children survey. European Journal of Psychology of Education, 18(1), 3–14. https://doi.org/10.1007/BF03173600

Gorostiaga, A., Aliri, J., Echeveste, U., Balluerka, N., Soroa, G., Muela, A., & Aritzeta, A. (2018). Manual técnico de la adaptación al euskera del CECAD. Cuestionario Educativo Clínico: Ansiedad y Depresión [Technical manual for the adaptation to Basque of the CECAD. Educational-Clinical Questionnaire: Anxiety and Depression]. TEA Ediciones.

Hancock, G. R. (2001). Effect size, power, and sample size determination for structured means modeling and mimic approaches to between-groups hypothesis testing of means on a single latent construct. Psychometrika, 66(3), 373–388. https://doi.org/10.1007/BF02294440

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

Jacobson, N. C., & Newman, M. G. (2017). Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychological Bulletin, 143(11), 1155–1200. https://doi.org/10.1037/bul0000111

Jiang, Q., She, X., Dill, S.-E., Sylvia, S., Singh, M. K., Wang, H., Boswell, M., & Rozelle, S. (2022). Depressive and anxiety symptoms among children and adolescents in rural China: A large-scale epidemiological study. International Journal of Environmental Research and Public Health, 19(9), Article 5026. https://doi.org/10.3390/ijerph19095026

Kanwar, A., Malik, S., Prokop, L. J., Sim, L. A., Feldstein, D., Wang, Z., & Murad, M. H. (2013). The association between anxiety disorders and suicidal behaviors: A systematic review and meta-analysis. Depression & Anxiety, 30(10), 917–929. https://doi.org/10.1002/da.22074

Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & .Üstün, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593

Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359

Klein, R. J., Gyorda, J. A., & Jacobson, N. C. (2022). Anxiety, depression, and substance experimentation in childhood. PLOS ONE, 17(5), Article e0265239. https://doi.org/10.1371/journal.pone.0265239

Konac, D., Young, K. S., Lau, J., & Barker, E. D. (2021). Comorbidity between depression and anxiety in adolescents: Bridge symptoms and relevance of risk and protective factors. Journal of Psychopathology and Behavioral Assessment, 43(3), 583–596. https://doi.org/10.1007/s10862-021-09880-5

Lang, M., & Tisher, M. (1978). Children’s Depression Scale. Australian Council for Educational Research.

Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation.

Lozano, L., García-Cueto, E., & Lozano, L. M. (2007). CECAD. Cuestionario Educativo-Clínico: Ansiedad y Depresión [CECAD. Educational-Clinical Questionnaire: Anxiety and Depression]. TEA Ediciones.

Lozano, L., García-Cueto, E., & Lozano, L. M. (2013). CECAD. Cuestionario Educativo-Clínico: Ansiedad y Depresión [CECAD. Educational-Clinical Questionnaire: Anxiety and Depression] (3rd ed.). TEA Ediciones.

Membrive-Jiménez, M. J., Velando-Soriano, A., Pradas-Hernandez, L., Gómez-Urquiza, J. L., Romero-Béjar, J. L., Cañadas-de la Fuente, G. A., & de la Fuente-Solana, E. I. (2022). Prevalence, levels and related factors of burnout in nurse managers: A multi-centre cross-sectional study. Journal of Nursing Management, 30(4), 954–961. https://doi.org/10.1111/jonm.13575

Menéndez-Aller, Á., Postigo, Á., Montes-Álvarez, P., González-Primo, F. J., & García-Cueto, E. (2020). Humor as a protective factor against anxiety and depression. International Journal of Clinical and Health Psychology, 20(1), 38–45. https://doi.org/10.1016/j.ijchp.2019.12.002

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity study-adolescent supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017

Nearchou, F., Flinn, C., Niland, R., Subramaniam, S. S., & Hennessy, E. (2020). Exploring the impact of COVID-19 on mental health outcomes in children and adolescents: A systematic review. International Journal of Environmental Research and Public Health, 17(22), Article 8479. https://doi.org/10.3390/ijerph17228479

O’Neil, K. A., Conner, B. T., & Kendall, P. C. (2011). Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention. Clinical Psychology Review, 31(1), 104–112.

https://doi.org/10.1016/j.cpr.2010.08.002

Orgilés, M., Espada, J. P., Delvecchio, E., Francisco, R., Mazzeschi, C., Pedro, M., & Morales, A. (2021). Anxiety and depressive symptoms in children and adolescents during COVID-19 pandemic: A transcultural approach. Psicothema, 33(1), 125–130. https://doi.org/10.7334/psicothema2020.287

Orgilés, M., Méndez, X., Espada, J. P., Carballo, J. L., & Piqueras, J. A. (2012). Síntomas de trastornos de ansiedad en niños y adolescentes: Diferencias en función de la edad y el sexo en una muestra comunitaria [Anxiety disorder symptoms in children and adolescents: differences by age and gender in a community sample]. Revista de Psiquiatría y Salud Mental, 5(2), 115–120. https://doi.org/10.1016/J.RPSM.2012.01.005

Orlando, M., & Thissen, D. (2000). Likelihood-based itemfit indices for dichotomous item response theory models. Applied Psychological Measurement, 24(1), 50–64. https://doi.org/10.1177/01466216000241003

Orlando, M., & Thissen, D. (2003). Further investigation of the performance of S − X2: An item fit index for use with dichotomous item response theory models. Applied Psychological Measurement, 27(4), 289–298. https://doi.org/10.1177/0146621603027004004

Pampamallco, M. M., & Matalinares, M. L. (2022). Ansiedad según género, edad y grado de estudios en adolescentes de San Martín de Porres, Lima [Anxiety according to gender, age and education degree in adolescents from San Martin de Porres, Lima]. Socialium, 6(1), 48–64. https://doi.org/10.26490/uncp.sl.2022.6.1.1106

Pan American Health Organization. (2018). Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation. https://www.who.int/publications/i/item/9789241512343

Park, J. H., Bang, Y. R., & Kim, C. K. (2014). Sex and age differences in psychiatric disorders among children and adolescents: High-risk students study. Psychiatry Investigation, 11(3), 251–257. https://doi.org/10.4306/pi.2014.11.3.251

Patel, V., & Jain, A. (2017). Assessment of anxiety levels in male and female adolescents. International Journal of Indian Psychology, 4(4), 67–71.https://doi.org/10.25215/0404.066

Pereira da Silva, B. F. P., Santos Vitti, L. S., Fiorim Enumo, S. R. F., & Faro, A. (2022). Do self-steem and gender help explain depressive and/or anxiety symptoms in adolescents? Revista de Psicología, 40(1), 579–601. https://doi.org/10.18800/psico.202201.019

Pizarro-Ruiz, J. P., & Ordóñez-Camblor, N. (2021). Effects of Covid-19 confinement on the mental health of children and adolescents in Spain. Scientific Reports, 11, Article 11713. https://doi.org/10.1038/s41598-021-91299-9

Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381

Pozuelo, J. R., Desborough, L., Stein, A., & Cipriani, A. (2022). Systematic review and meta-analysis: Depressive symptoms and risky behaviors among adolescents in low- and middle-income countries. Journal of the American Academy of Child & Adolescent Psychiatry, 61(2), 255–276. https://doi.org/10.1016/j.jaac.2021.05.005

Quero, L., Moreno, M. Á., de León, P., Espino, R., & Coronel, C. (2021). Estudio del impacto emocional de la pandemia por COVID-19 en niños de 7 a 15 años de Sevilla [Study of the emotional impact of the COVID-19 pandemic in children from 7 to 15 years old of Sevilla]. Revista de Psiquiatría Infanto- Juvenil, 38(1), 20–30. https://doi.org/10.31766/revpsij.v38n1a4

Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatrics, 175(11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482

Radwan, E., Radwan, A., Radwan, W., & Pandey, D. (2021). Prevalence of depression, anxiety and stress during the COVID-19 pandemic: A crosssectional study among Palestinian students (10–18 years). BMC Psychology,9, Article 187. https://doi.org/10.1186/s40359-021-00688-2

Romero, K., Canals, J., Hernández-Martínez, C., Jané, M. C., Viñas, F., & Domènech-Llaberia, E. (2010). Comorbilidad entre los factores de ansiedad del SCARED y la sintomatología depresiva en niños de 8-12 años [Comorbidity between the SCARED anxiety factors and depressive symptoms in 8-12-year-old children]. Psicothema, 22(4), 613–618. Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02

Ruiz, K. M. (2014). Propiedades psicométricas del Cuestionario Educativo-Clínico: Ansiedad y depresión en estudiantes de secundaria de Trujillo [Psychometric properties of the Questionnaire Clinical Education: Anxiety and Depression in high school students from Trujillo]. Revista de Investigaciones Altoandinas, 16(1), 149–162.

Southam-Gerow, M. A., & Chorpita, B. F. (2007). Anxiety in children and adolescents. In E. J. Mash & R. A. Barkley (Eds.), Assessment of childhood disorders (pp. 347–397). Guilford Press.

Spence, S. H. (2018). Assessing anxiety disorders in children and adolescents. Child and Adolescent Mental Health, 23(3), 266–282.https://doi.org/10.1111/camh.12251

Tan, T. X., Teng, Y., & Velasco, J. C. (2020). Youth’s school experience: Testing the role of symptoms of anxiety and co-occurring symptoms of depression. Journal of Clinical Psychology, 76(3), 526–538. https://doi.org/10.1002/jclp.22888

Tang, X., Tang, S., Ren, Z., & Wong, D. F. K. (2019). Prevalence of depressive symptoms among adolescents in secondary school in mainland China: A systematic review and meta-analysis. Journal of Affective Disorders, 245, 498–507. https://doi.org/10.1016/j.jad.2018.11.043

van Beek, Y., Hessen, D. J., Hutteman, R., Verhulp E. E., & van Leuven, M. (2012). Age and gender differences in depression across adolescence: Real or ‘bias’? Journal of Child Psychology and Psychiatry, 53(9), 973–985. https://doi.org/10.1111/j.1469-7610.2012.02553.x

van Droogenbroeck, F., Spruyt, B., & Keppens, G. (2018). Gender differences in mental health problems among adolescents and the role of social support: Results from the Belgian health interview surveys 2008 and 2013. BMC Psychiatry, 18, Article 6. https://doi.org/10.1186/s12888-018-1591-4

Verboom, C. E., Sijtsema, J. J., Verhulst, F. C., Penninx, B. W. J. H., & Ormel, J. (2014). Longitudinal associations between depressive problems, academic performance, and social functioning in adolescent boys and girls. Developmental Psychology, 50(1), 247–257. https://doi.org/10.1037/a0032547

Windarwati, H. D., Lestari, R., Wicaksono, S. A., Kusumawati, M. W., Ati, N. A. L., Ilmy, S. K., Sulaksono, A. D., & Susanti, D. (2022).Relationship between stress, anxiety, and depression with suicidal ideation in adolescents. Jurnal Ners, 17(1), 36–41. http://doi.org/10.20473/jn.v17i1.31216

World Health Organization. (2006). Orientation programme on adolescent health for health-care providers. https://apps.who.int/iris/handle/10665/42868

World Health Organization. (2022). World mental health report: Transforming mental health for all - executive summary. https://www.who.int/publications/i/item/9789240050860