# Exercise as it relates to Disease/Physical activity and it's relation to depression in adolescent females

The following Wikibooks page is an analysis of the journal article "Prospective Reciprocal Relations between Physical Activity and Depression in Adolescent Females" by Jerstard,Boutelle, Ness and Stice.
This has been created by U3162214

## What is the background of this research?

In recent years, there has been an increase in female adolescents affected by depression. Research has shown that depression between the ages of 14-16 leads to an increased risk of relapse in later years. Furthermore, it has been said that adolescents with depression tended to have higher rates of conduct disorders, substance abuse, and can cause comorbidity. Comorbidity is when one disorder leads to another or when two disorders overlap. It has been found on cross-sectional studies that there is a correlation between low physical activity (PA) and depression.
In general, people with depression lead fairly sedentary lives, which decreases physiological wellbeing and can cause a decrease in self-esteem. The objective of the study was to find the prospective relation between PA and depression. This study also looks at how PA activity affects possible relapses into depression in later years, and how depression may affect the level of PA.

## Where is the research from?

The research was conducted in four private schools and four public schools in the United States. The girls that the test was conducted on where all between the ages of 11-15 years of age. The study was approved by the local International Review Board and by the parents whose children were involved. The distribution of the participants was representative of the population of the metropolitan city in which the sample was taken.

## What kind of research was this?

The study is a non-randomised, six-year study. This study is a longitudinal study, which can have issues in the future especially with reliability. The assessment was conducted yearly with a 56% participation rate from the eligible girls. This participation rate is quite good for a longitudinal study because of the number of participants that would normally drop out of a study during the period of six years. This type of study allows for some continuity to be assessed and therefore is very good for research looking at relapses of depression.

## What did the research involve?

The research involved four hundred and ninety-six adolescent school girls. All the girls were from 11-15 years of age. During the yearly meet-ups with the candidates, they participated in a questionnaire referring to six measures: depression, PA, body dissatisfaction, bulimic symptoms, social support and Body mass. The structured interview of “The Schedule for Affective Disorders and Schizophrenia for School-Age Children”was conducted to classify whether the participant had major or minor depression that year. If the participant met 5 criteria they were classified as having major depression.
For PA, a variation of the “Past year activity scale” questionnaire was used to assess the amount of physical activity done by the participant.
Body dissatisfaction was assessed with the “Satisfaction and Dissatisfaction with Body Parts Scale” questionnaire with the scale ranging from 1-6.
Bulimic symptoms were assessed by performing a semi-structured investigator based interview from the Eating Disorder Examination, which assesses the DSM-IV bulimia nervosa symptoms.
Social support was assessed with a perceived amount of companionship, guidance, intimacy, admiration, affection, and reliance from parents and peers. This was assessed using the Network of Relationships Inventory.
At each interview, the participant's weight and height were measured to calculate BMI. The results of these tests are reported at 95% confidence, therefore appear to be reliable and valid assessments.

## What were the basic results?

Table 1: Percentage of incidence rates of major and minor depression amid the participants from first year of assessment to sixth year of the assessment.
| | 1st year | 2nd year | 3rd year | 4th year | 5th year | 6th year |
| Incidence rates of major & minor depression amid the participants | 8% | 10% | 7% | 11% | 11% | 6% |
Table 2: Results from generalized linear models showing the impact of number of physical activities in the previous year on depression in the participants.
| variable | Risk Ratio | p-value |
| Depression symptoms | | |
| Number of activities previous year | 0.99 | 0.002 |
| baseline depression symptoms | 1.17 | <0.001 |
| Major depression | | |
| Number of activities previous year | 0.86 | 0.005 |
| Baseline depression | 14.92 | <0.001 |
Analysis showed that there was a reciprocal relationship between major and minor depression and physical activity. PA seems to have a protective effect against major and minor depression, however, depression also leads to a decline in PA. Analysis showed that there was a reciprocal relationship between major and minor depression and physical activity. PA seems to have a protective effect against major and minor depression, however, depression also leads to a decline in PA. It is shown in table one that the rate of depression increases during adolescence. Females tend to decrease the amount of physical activity they participate in during adolescence due to lack of interest and or time, the decline in PA can be seen in table 2.

## How did the researchers interpret the results?

PA offers protection against major and minor depression in adolescent females and also reduces the probability of recurring depression in later years of the participant's life. Self-esteem plays a role on the amount of PA an adolescent female will participate in. Low self-esteem does not help girls believe they have the ability to play sport properly.Socially, PA increases the amount of human interaction and provides social connectedness and enjoyment. PA declining during girls adolescent years is a concern as that is the period of time depression generally increases.

## What conclusions can be taken away from this research?

The results of the study imply that PA is beneficial in preventing depression in school-aged girls and in also preventing the later onset of depression as adults. However, self-esteem plays a role in both depression and the amount of physical activity the participant does, therefore, promoting a healthy body image is also beneficial. Group physical activity is beneficial with feeling included and involved in an activity.

## What are the implications of this research?

The results of this assessment show that when treating an adolescent girl who has depression, especially those whose parents have a history of depression, should be encouraged to partake in PA. Group activities should be highly recommended, however, simply reducing the amount of sedentary behavior still has an impact. PA activity should be encouraged at an early age. This research can also have implications for future research as a component of prevention and or treatment studies.

## Further reading

The following article may be of interest regarding the topic discussed in this review:
1. Diagnostic and Statistical Manual of Mental Disorders
2. Intergrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness
3. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Jerstad S, Boutelle K, Ness K, Stice E. Prospective reciprocal relations between physical activity and depression in female adolescents. Journal of Consulting and Clinical Psychology [Internet]. 2010 [cited 13 September 2017];78(2):268-272.
* 1 2 3 4 Nabkasorn C. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. The European Journal of Public Health [Internet]. 2005 [cited 14 September 2017];16(2):179-184. Available from: https://academic.oup.com/eurpub/article/16/2/179/505757/Effects-of-physical-exercise-on-depression.
* 1 2 Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry. 2002; 59:225–31. Available from:http://jamanetwork.com/journals/jamapsychiatry/fullarticle/206141
* ↑ Kleine D. Different reasons for comorbidity require different solutions. World Psychiatry [Internet]. 2004;3(1):28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414660/
* ↑ Seeley J, Stice E, Rohde P. Screening for depression prevention: Identifying adolescent girls at high risk for future depression. Journal of Abnormal Psychology [Internet]. 2009 [cited 15 September 2017];118(1):161-170. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849672/
* 1 2 FARRINGTON D. Longitudinal Research Strategies: Advantages, Problems, and Prospects. Journal of the American Academy of Child & Adolescent Psychiatry. 1991;30(3):369-374.
* ↑ AMBROSINI P. Historical Development and Present Status of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). Journal of the American Academy of Child & Adolescent Psychiatry. 2000;39(1):49-58.
* ↑ Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Publishing; 2014.
* ↑ Jerstad S, Boutelle K, Ness K, Stice E. Prospective reciprocal relations between physical activity and depression in female adolescents. Journal of Consulting and Clinical Psychology [Internet]. 2010 [cited 13 September 2017];78(2):268-272. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847789/table/T2/
* ↑ Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Publishing; 2014.
* ↑ Richardson C, Faulkner G, McDevitt J, Skrinar G, Hutchinson D, Piette J. Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness. Psychiatric Services. 2005;56(3):324-331.