Psychometric Properties and Factorial Invariance of the Educational- Clinical Questionnaire: Anxiety and Depression (CECAD) in Basque Population
PDF

Keywords

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

How to Cite

Gorostiaga, A., Balluerka , N., Aliri , J., Echeveste, U., & Lameirinhas, J. (2024). Psychometric Properties and Factorial Invariance of the Educational- Clinical Questionnaire: Anxiety and Depression (CECAD) in Basque Population. Psicothema, 36(1), 80–90. Retrieved from https://reunido.uniovi.es/index.php/PST/article/view/20900

Abstract

Background: Anxiety and depression are the most common current mental health problems. Due to their comorbidity, there is a need for instruments that measure them simultaneously. Moreover, given that their prevalence varies by gender and age, it is important to examine the factorial invariance of such instruments. The present study aimed to analyze the dimensionality and factorial invariance of the Basque version of the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) as a function of gender and age, and to gather additional evidence of its validity.

Method: The sample comprised 2131 participants (54.2% female) between 7 and 24 years old (M = 13.2; SD = 3.52).

Results: The CECAD was found to have a two-dimensional structure invariant to gender and age, with higher latent means for girls in both dimensions, and for those aged 14 and over in depression, but with small effect sizes. Both reliability and convergent validity values were good.

Conclusions: The Basque version of the CECAD has good evidence of validity and reliability for assessing anxiety and depression in Basque-speaking children and adolescents.

PDF

References

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