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Kn
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cted
in
c
o
llab
o
r
atio
n
b
etwe
en
I
n
d
o
n
esian
u
n
iv
e
r
s
ities
an
d
in
ter
n
atio
n
al
in
s
titu
tio
n
s
,
s
u
ch
a
s
th
e
Un
iv
er
s
ity
o
f
Qu
ee
n
s
lan
d
in
Au
s
tr
alia
an
d
th
e
J
o
h
n
s
Ho
p
k
in
s
B
lo
o
m
b
er
g
Sch
o
o
l
o
f
Pu
b
lic
Hea
lth
i
n
th
e
Un
ited
States
,
h
as
s
h
o
w
n
th
at
ap
p
r
o
x
im
ately
2
.
4
5
m
illi
o
n
I
n
d
o
n
esian
ad
o
le
s
ce
n
ts
,
o
r
5
.
5
%
o
f
th
e
p
o
p
u
la
tio
n
,
m
ee
t
th
e
d
iag
n
o
s
tic
cr
iter
ia
f
o
r
d
ep
r
ess
iv
e
d
is
o
r
d
er
o
u
tlin
ed
in
t
h
e
f
if
th
e
d
itio
n
o
f
t
h
e
d
iag
n
o
s
tic
an
d
s
t
atis
tical
m
an
u
al
o
f
m
en
tal
d
is
o
r
d
er
s
(
DSM
-
V)
[
1
]
.
W
est
Su
m
atr
a,
o
n
e
o
f
th
e
I
n
d
o
n
esian
p
r
o
v
in
ce
s
,
ex
h
ib
its
a
n
o
tab
ly
elev
ated
r
ate
o
f
d
e
p
r
ess
io
n
at
8
.
2
%,
s
u
r
p
ass
in
g
th
e
n
atio
n
al
p
r
ev
alen
ce
[
3
]
.
W
ith
in
th
e
W
e
s
t
Su
m
atr
a
Pro
v
i
n
ce
,
a
p
p
r
o
x
i
m
ately
7
.
9
7
% o
f
t
h
e
p
o
p
u
latio
n
in
th
e
city
o
f
Pad
an
g
,
W
est
Su
m
atr
a
Pro
v
in
ce
,
I
n
d
o
n
esia
,
p
r
ec
is
ely
th
o
s
e
a
g
ed
1
5
to
2
4
y
ea
r
s
,
g
r
ap
p
le
with
d
ep
r
ess
io
n
[
4
]
.
No
tab
ly
,
th
e
p
r
ev
ale
n
ce
o
f
d
e
p
r
ess
io
n
is
h
ig
h
er
in
th
e
ad
o
le
s
ce
n
t
ag
e
g
r
o
u
p
th
a
n
in
o
th
er
a
g
e
b
r
ac
k
ets,
an
d
it
is
also
m
o
r
e
p
r
e
v
alen
t
in
w
o
m
en
co
m
p
ar
e
d
to
m
e
n
,
wit
h
r
ates
o
f
7
.
4
%
f
o
r
wo
m
en
an
d
4
.
7
% f
o
r
m
e
n
[
3
]
.
Ad
o
lescen
ts
g
r
ap
p
lin
g
with
d
e
p
r
ess
io
n
ar
e
h
ig
h
l
y
s
u
s
ce
p
tib
le
to
f
ac
in
g
ex
cl
u
s
io
n
an
d
d
is
cr
im
in
atio
n
,
wh
ich
,
in
tu
r
n
,
h
i
n
d
er
s
th
eir
w
illi
n
g
n
ess
to
s
ee
k
p
r
o
f
ess
io
n
al
ass
is
tan
ce
[
5
]
.
T
h
is
s
itu
atio
n
l
ea
d
s
to
ed
u
ca
tio
n
al
ch
allen
g
es,
r
is
k
y
b
eh
a
v
io
u
r
s
,
d
im
in
is
h
ed
p
h
y
s
ical
well
-
b
ein
g
,
an
d
v
io
latio
n
s
o
f
th
eir
h
u
m
an
r
ig
h
ts
[
6
]
.
C
o
n
s
eq
u
en
tly
,
teen
ag
er
s
with
d
ep
r
ess
io
n
m
u
s
t
r
ec
eiv
e
ap
p
r
o
p
r
iate
tr
ea
tm
en
t.
R
eg
r
ettab
ly
,
m
an
y
ca
s
es
r
em
ain
u
n
n
o
ticed
an
d
u
n
tr
ea
ted
,
as
h
ig
h
lig
h
ted
b
y
th
e
W
HO
[
1
]
.
Ad
o
lescen
ts
f
r
eq
u
e
n
tly
r
e
f
r
ai
n
f
r
o
m
s
ee
k
in
g
h
elp
f
o
r
th
eir
m
en
tal
h
ea
lth
is
s
u
es,
as
d
em
o
n
s
tr
ated
b
y
th
e
m
er
e
2
.
6
%
o
f
ad
o
lescen
ts
r
ec
e
iv
in
g
tr
ea
tm
en
t
f
o
r
d
ep
r
ess
io
n
[
2
]
.
T
h
is
p
er
ce
n
ta
g
e
f
alls
wel
l
s
h
o
r
t
o
f
b
o
th
th
e
n
atio
n
al
tar
g
et
s
et
b
y
th
e
g
o
v
er
n
m
en
t
(
9
%),
W
est
Su
m
atr
a'
s
p
r
o
v
in
cial
tar
g
et
(
8
.
5
7
%),
a
n
d
Pad
a
n
g
'
s
m
u
n
ici
p
al
tar
g
et
(
1
1
.
2
5
%)
[
4
]
.
Ma
n
y
ad
o
lescen
ts
cite
s
tig
m
a
as a
s
ig
n
if
ican
t im
p
ed
i
m
en
t to
s
ee
k
in
g
p
r
o
f
ess
io
n
al
ass
is
tan
ce
[
7
]
.
Sti
g
m
atis
atio
n
am
o
n
g
ad
o
lescen
ts
ca
n
s
ig
n
if
ican
tly
im
p
ac
t
th
eir
willin
g
n
ess
to
s
ee
k
p
r
o
f
ess
io
n
al
h
elp
[
8
]
.
Ad
d
itio
n
ally
,
a
s
u
b
s
tan
tial
m
ajo
r
ity
o
f
teen
ag
er
s
ten
d
to
co
p
e
with
th
eir
is
s
u
es
b
y
co
n
f
id
in
g
in
f
r
ien
d
s
(
9
8
.
7
%),
av
o
id
in
g
th
e
p
r
o
b
lem
s
alto
g
eth
er
(
9
4
.
1
%),
o
r
tu
r
n
in
g
to
th
e
in
ter
n
et
f
o
r
in
f
o
r
m
atio
n
(
8
9
.
9
%)
[
9
]
.
T
h
e
r
elu
ctan
ce
o
f
ad
o
lescen
ts
to
o
p
en
ly
ac
k
n
o
wled
g
e
an
d
ac
ce
p
t
m
en
tal
h
ea
lth
is
s
u
es
o
f
te
n
k
ee
p
s
th
em
co
n
f
i
n
ed
with
in
t
h
eir
lim
ited
p
er
s
p
ec
tiv
es.
Ad
o
lescen
ts
wh
o
ar
e
n
o
t
well
-
v
e
r
s
ed
in
r
ec
o
g
n
is
in
g
th
e
s
ig
n
s
o
f
d
ep
r
ess
io
n
m
ay
ten
d
to
s
tig
m
atis
e
it,
lab
ellin
g
it
as
a
s
o
u
r
ce
o
f
s
h
am
e
o
r
ev
en
co
n
s
id
er
in
g
th
em
s
elv
es
as
"c
r
az
y
.
"
T
h
is
s
tig
m
a
p
lace
s
im
m
en
s
e
p
r
ess
u
r
e
o
n
ad
o
lescen
ts
with
m
e
n
ta
l
h
ea
lth
ch
allen
g
es
an
d
m
ak
es
it
d
if
f
ic
u
lt
f
o
r
t
h
em
to
b
e
r
ec
e
p
tiv
e
to
tr
ea
tm
en
t
[
1
0
]
.
As
a
r
esu
lt,
p
r
o
m
o
tin
g
liter
ac
y
ab
o
u
t
d
ep
r
ess
io
n
is
ess
en
tial
to
co
m
b
at
s
tig
m
a,
an
d
p
r
o
v
id
i
n
g
a
cc
ess
to
m
en
tal
h
ea
lth
s
er
v
ices
is
cr
u
cial
to
o
f
f
er
s
u
p
p
o
r
t a
n
d
co
u
n
s
ellin
g
f
o
r
th
e
em
o
tio
n
al
an
d
b
e
h
av
io
u
r
al
p
r
o
b
lem
s
ex
p
e
r
ien
ce
d
b
y
ad
o
le
s
ce
n
ts
[
1
1
]
.
Ad
o
lescen
ts
wh
o
ex
p
er
ien
ce
d
ep
r
ess
io
n
ar
e
o
f
ten
b
u
r
d
e
n
ed
b
y
th
eir
em
o
tio
n
al
s
tate
d
u
e
t
o
a
lack
o
f
u
n
d
er
s
tan
d
i
n
g
,
wh
ich
te
n
d
s
to
r
esu
lt
in
th
e
s
tig
m
atis
atio
n
o
f
d
ep
r
ess
io
n
.
T
h
is
s
tig
m
a
s
ig
n
if
ican
tly
h
a
m
p
er
s
th
eir
willin
g
n
ess
to
s
ee
k
p
r
o
f
ess
io
n
al
ass
i
s
tan
ce
.
Sti
g
m
a
c
o
n
tin
u
es
to
b
e
th
e
p
r
im
ar
y
b
ar
r
ier
th
at
p
r
e
v
en
ts
ad
o
lescen
ts
f
r
o
m
s
ee
k
i
n
g
h
elp
,
u
n
d
er
s
co
r
in
g
th
e
n
ee
d
f
o
r
ed
u
ca
tio
n
al
ef
f
o
r
ts
to
r
ed
u
ce
s
tig
m
a
an
d
en
h
an
ce
ad
o
lescen
ts
'
u
n
d
er
s
tan
d
in
g
o
f
d
ep
r
ess
io
n
[
1
2
]
.
T
h
e
lim
it
ed
k
n
o
wled
g
e
th
at
ad
o
lescen
ts
p
o
s
s
ess
ab
o
u
t
d
ep
r
ess
io
n
o
f
ten
lead
s
th
em
to
co
n
ce
al
an
d
attem
p
t
to
m
an
ag
e
th
eir
m
en
tal
h
ea
lth
is
s
u
es
.
A
p
r
ev
io
u
s
s
tu
d
y
h
as
in
d
icate
d
th
at
teen
ag
er
s
f
r
eq
u
en
tly
f
ail
to
r
ec
o
g
n
is
e
d
ep
r
ess
io
n
,
in
s
tead
o
p
tin
g
to
s
ee
k
s
u
p
p
o
r
t
f
r
o
m
clo
s
e
in
d
iv
id
u
als
lik
e
f
a
m
ily
an
d
f
r
ien
d
s
,
all
th
e
wh
ile
attac
h
in
g
a
s
tig
m
a
to
d
ep
r
ess
io
n
[
1
3
]
.
Ma
n
y
tee
n
ag
er
s
ex
p
r
ess
th
eir
r
elu
ctan
ce
to
d
is
clo
s
e
th
eir
d
ep
r
ess
io
n
to
an
y
o
n
e.
T
h
is
tr
en
d
u
n
d
er
s
co
r
es
th
a
t
ad
o
lescen
ts
o
f
ten
lack
s
u
f
f
icien
t
k
n
o
wled
g
e
an
d
h
ar
b
o
u
r
s
ig
n
i
f
ican
t
co
n
ce
r
n
s
ab
o
u
t
d
e
p
r
ess
io
n
,
p
e
r
ce
iv
in
g
i
t
as
a
m
en
tal
h
ea
lth
is
s
u
e
th
at
n
ec
ess
itate
s
tr
ea
tm
en
t a
n
d
p
r
o
f
ess
io
n
al
ass
is
tan
ce
[
1
4
]
.
Dep
r
ess
io
n
s
tan
d
s
as
th
e
m
o
s
t
s
ig
n
if
ican
t
co
n
tr
ib
u
tin
g
f
ac
t
o
r
to
th
e
elev
ated
r
ates
o
f
s
u
icid
e
am
o
n
g
ad
o
lescen
ts
,
as
r
ep
o
r
ted
b
y
t
h
e
W
HO
[
1
]
.
W
h
en
lef
t
u
n
t
r
ea
ted
,
d
ep
r
ess
io
n
ca
n
ex
ac
er
b
ate
an
in
d
iv
i
d
u
al'
s
m
en
tal
s
tate,
p
o
te
n
tially
lead
in
g
to
s
u
icid
al
ten
d
en
cies.
F
em
ales
ex
h
ib
ited
an
ele
v
ated
s
u
s
ce
p
tib
ilit
y
to
en
g
ag
in
g
in
s
u
icid
e
attem
p
ts
(
OR
1
.
9
6
,
9
5
%
C
I
1
.
5
4
–
2
.
5
0
)
,
wh
ile
m
ales
d
em
o
n
s
tr
ated
a
g
r
ea
ter
lik
elih
o
o
d
o
f
s
u
cc
u
m
b
in
g
t
o
s
u
icid
e
-
r
elate
d
f
atalities
(
HR
2
.
5
0
,
9
5
%
C
I
1
.
8
–
3
.
6
)
[
1
5
]
.
Giv
en
its
d
em
o
g
r
ap
h
ic
b
o
n
u
s
,
th
is
p
r
esen
ts
a
co
n
s
id
er
ab
le
ch
allen
g
e
f
o
r
I
n
d
o
n
esia,
as
ap
p
r
o
x
i
m
ately
2
0
%
o
f
th
e
n
atio
n
'
s
p
o
p
u
latio
n
f
alls
with
in
th
e
ag
e
r
an
g
e
o
f
1
0
-
1
9
y
ea
r
s
[
2
]
.
W
h
ile
th
er
e
h
av
e
b
ee
n
n
u
m
er
o
u
s
s
tu
d
ies
ex
p
lo
r
in
g
k
n
o
wled
g
e
an
d
s
tig
m
a
r
elate
d
to
m
en
tal
d
is
o
r
d
er
s
,
th
ese
s
tu
d
ies
h
av
e
o
f
ten
h
ad
a
b
r
o
ad
er
f
o
c
u
s
o
n
m
en
tal
h
e
alth
in
g
en
er
al
an
d
ty
p
ically
tar
g
ete
d
th
e
g
en
e
r
al
p
o
p
u
latio
n
.
I
n
co
n
tr
ast,
th
e
c
u
r
r
en
t
r
esear
ch
ze
r
o
es
in
o
n
ad
o
lescen
ts
,
with
a
s
p
ec
if
ic
em
p
h
asis
o
n
th
eir
u
n
d
er
s
tan
d
in
g
o
f
an
d
attitu
d
es
to
war
d
s
d
ep
r
ess
io
n
.
T
h
er
ef
o
r
e,
t
h
e
o
b
jectiv
e
o
f
th
is
s
tu
d
y
was to
ex
am
in
e
t
h
e
r
elat
io
n
s
h
ip
b
etwe
en
a
d
o
lescen
ts
'
k
n
o
wled
g
e
an
d
t
h
e
s
tig
m
a
o
f
d
ep
r
ess
io
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
57
8
-
1
58
8
1580
2.
M
E
T
H
O
D
2
.
1
.
Study
Desig
n
I
n
th
is
s
tu
d
y
,
a
q
u
an
titativ
e
ap
p
r
o
ac
h
was
em
p
lo
y
e
d
,
u
tili
s
in
g
a
d
escr
ip
tiv
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
to
ass
es
s
th
e
k
n
o
wled
g
e
an
d
s
tig
m
a
ass
o
ciate
d
with
d
ep
r
ess
i
o
n
am
o
n
g
ad
o
lescen
ts
.
T
h
is
r
esear
ch
d
esig
n
is
p
ar
ticu
lar
ly
well
-
s
u
ited
f
o
r
s
i
m
u
ltan
eo
u
s
ly
e
x
am
in
in
g
m
u
lt
ip
le
v
ar
iab
les
an
d
is
in
s
tr
u
m
e
n
tal
in
p
r
o
v
id
in
g
a
d
etailed
d
escr
ip
tio
n
o
f
th
e
p
o
t
en
tial r
elatio
n
s
h
ip
s
am
o
n
g
th
e
s
e
v
ar
iab
les
[
1
6
]
.
2
.
2
.
Set
t
ing
s
a
nd
s
a
m
ples
T
h
e
s
tu
d
y
was
ca
r
r
ied
o
u
t
b
etwe
en
Ma
r
ch
an
d
J
u
n
e
2
0
2
1
,
an
d
it
in
v
o
lv
ed
t
h
e
o
b
s
er
v
atio
n
o
f
ad
o
lescen
ts
atten
d
in
g
p
u
b
lic
v
o
ca
tio
n
al
h
i
g
h
s
ch
o
o
l
(
PVHS)
4
in
Pad
a
n
g
.
R
eg
ar
d
in
g
in
cl
u
s
io
n
cr
iter
ia,
d
u
r
i
n
g
th
e
d
ata
co
llectio
n
,
th
e
s
tu
d
y
in
v
ited
ad
o
lescen
ts
ag
ed
1
8
y
e
ar
s
an
d
ab
o
v
e
to
en
r
o
l
as
s
tu
d
en
ts
at
PV
HS
4
in
Pad
an
g
.
I
n
d
iv
id
u
als
with
s
ev
er
e
co
m
m
u
n
icatio
n
p
r
o
b
lem
s
,
s
u
ch
as
a
co
m
p
lete
in
ab
ili
ty
to
co
m
p
r
eh
en
d
I
n
d
o
n
esian
an
d
Min
an
g
la
n
g
u
ag
es,
wer
e
ex
clu
d
ed
f
r
o
m
th
e
s
tu
d
y
.
To
ascer
tain
th
e
s
u
itab
le
m
ag
n
itu
d
e
o
f
th
e
s
am
p
le,
we
u
tili
ze
d
th
e
G*
P
o
wer
s
o
f
twar
e
(
latest
v
er
s
io
n
3
.
1
.
9
.
7
;
Hein
r
ich
-
Hein
e
-
Un
i
v
er
s
ität
Dü
s
s
eld
o
r
f
,
Dü
s
s
eld
o
r
f
,
Ger
m
an
y
)
[
1
7
]
.
T
h
e
ca
lcu
lated
s
am
p
le
s
ize
r
ec
o
m
m
en
d
atio
n
was
d
er
iv
ed
f
r
o
m
an
ef
f
ec
t
s
ize
(
p
)
o
f
0
.
2
5
,
a
s
ig
n
if
ican
ce
lev
el
(
α
)
o
f
0
.
0
5
,
a
n
d
a
p
o
wer
o
f
0
.
9
9
.
T
h
is
ca
lcu
latio
n
in
d
icate
d
a
m
in
im
u
m
to
tal
s
am
p
le
s
ize
o
f
2
3
8
.
E
v
en
tu
ally
,
2
4
0
a
d
o
lescen
ts
willin
g
ly
v
o
lu
n
teer
ed
to
p
ar
ticip
at
e
in
th
is
s
tu
d
y
as
r
esp
o
n
d
en
ts
.
Par
ticip
a
n
ts
wer
e
s
elec
ted
f
o
r
t
h
is
r
esear
ch
th
r
o
u
g
h
a
s
im
p
le
r
a
n
d
o
m
s
am
p
li
n
g
f
r
o
m
s
tu
d
e
n
ts
in
th
e
1
0
t
h
,
1
1
th
,
an
d
1
2
th
g
r
ad
e
s
.
T
h
ey
wer
e
p
r
o
v
i
d
ed
with
a
s
elf
-
ass
es
s
m
en
t
to
o
l
to
ev
alu
a
te
th
eir
k
n
o
wled
g
e
o
f
d
ep
r
ess
io
n
an
d
th
e
ass
o
ciate
d
s
tig
m
a.
E
ac
h
ad
o
lescen
t
co
m
p
leted
th
e
in
s
tr
u
m
e
n
t
b
ased
o
n
th
eir
cir
cu
m
s
tan
ce
s
an
d
r
etu
r
n
e
d
it
to
th
e
r
esear
ch
er
.
I
t'
s
im
p
o
r
tan
t
to
n
o
te
th
at
p
ar
ticip
atio
n
in
th
e
s
tu
d
y
was
en
tire
ly
v
o
lu
n
tar
y
.
2
.
3
.
Resea
rc
h
ins
t
rum
ent
s
a
nd
da
t
a
co
llect
io
n
All
p
ar
ticip
an
ts
in
th
is
s
tu
d
y
co
m
p
leted
a
s
o
ci
o
-
d
em
o
g
r
ap
h
ic
f
o
r
m
,
a
d
o
lescen
t
d
ep
r
ess
io
n
k
n
o
wled
g
e
q
u
esti
o
n
n
air
e
(
A
DKQ)
,
an
d
d
ep
r
ess
io
n
s
tig
m
a
s
ca
le
(
DSS).
T
h
e
s
o
cio
-
d
em
o
g
r
ap
h
ic
f
o
r
m
,
in
clu
d
in
g
ag
e,
g
en
d
e
r
,
a
h
is
to
r
y
o
f
d
ep
r
ess
io
n
,
an
d
s
o
u
r
ce
s
o
f
in
f
o
r
m
atio
n
r
eg
ar
d
i
n
g
d
ep
r
ess
io
n
.
Ad
d
itio
n
ally
,
th
e
o
r
ig
in
al
a
u
th
o
r
au
th
o
r
is
ed
th
e
au
th
o
r
s
to
tr
an
s
late
th
e
q
u
e
s
tio
n
n
air
e.
2
.
3
.
1
.
Ado
lescent
depres
s
io
n
k
no
wledg
e
qu
estio
nn
a
ire
(
A
DK
Q
)
T
h
e
s
tu
d
y
u
tili
s
ed
th
e
ADKQ
d
ev
elo
p
ed
b
y
Hess
et
a
l.
[
1
8
]
to
ass
ess
p
ar
ticip
an
ts
'
k
n
o
wled
g
e
.
T
h
is
q
u
esti
o
n
n
air
e
is
d
iv
id
ed
in
to
th
r
ee
m
ain
co
m
p
o
n
en
ts
:
k
n
o
wled
g
e,
ca
u
s
es,
an
d
s
y
m
p
to
m
s
o
f
d
ep
r
ess
io
n
.
I
t
en
co
m
p
ass
es
1
5
item
s
p
r
esen
ted
in
a
tr
u
e
-
or
-
f
alse
f
o
r
m
at,
f
o
llo
win
g
th
e
s
tr
u
ctu
r
e
o
f
th
e
Gu
ttm
an
s
ca
le.
A
co
r
r
ec
t
r
esp
o
n
s
e
was
awa
r
d
e
d
a
s
co
r
e
o
f
1
,
wh
ile
a
n
in
c
o
r
r
ec
t
r
esp
o
n
s
e
r
ec
eiv
ed
a
0
.
A
h
ig
h
er
to
tal
s
co
r
e
s
ig
n
if
ied
a
m
o
r
e
co
m
p
r
eh
en
s
i
v
e
g
r
asp
o
f
d
e
p
r
ess
io
n
.
B
ef
o
r
e
co
m
m
en
ci
n
g
th
e
s
t
u
d
y
,
th
e
a
u
th
o
r
s
co
n
d
u
cted
tr
an
s
latio
n
,
v
alid
ity
,
an
d
r
eliab
ilit
y
ass
es
s
m
en
ts
,
as
th
e
p
u
b
lis
h
ed
I
n
d
o
n
esian
v
er
s
io
n
o
f
th
is
in
s
tr
u
m
en
t
was
u
n
a
v
ailab
le.
T
h
e
i
n
itial
tr
an
s
latio
n
o
f
th
e
ADKQ
f
r
o
m
E
n
g
lis
h
to
B
ah
asa
I
n
d
o
n
esia
was
ca
r
r
ied
o
u
t
b
y
two
p
r
o
f
icien
t
tr
an
s
la
to
r
s
f
lu
en
t
in
b
o
th
lan
g
u
ag
es.
T
h
e
tr
an
s
lated
v
er
s
io
n
s
wer
e
th
en
r
ev
iewe
d
b
y
r
esear
ch
er
s
an
d
co
n
s
o
lid
ated
to
f
o
r
m
th
e
in
itial
I
n
d
o
n
esian
v
er
s
io
n
o
f
th
e
AD
KQ.
Su
b
s
eq
u
en
tly
,
two
i
n
d
ep
en
d
en
t
tr
an
s
lato
r
s
,
p
r
o
f
icien
t
i
n
b
o
th
E
n
g
lis
h
an
d
B
ah
asa
I
n
d
o
n
esia,
co
n
d
u
cte
d
a
r
ev
er
s
e
tr
an
s
latio
n
o
f
th
e
in
itial
I
n
d
o
n
esian
ADKQ
v
er
s
io
n
b
ac
k
in
to
E
n
g
lis
h
.
Fo
llo
win
g
th
e
tr
an
s
latio
n
s
,
a
p
an
el
o
f
ex
p
er
ts
in
r
elev
an
t
f
i
eld
s
,
in
clu
d
in
g
two
p
s
y
ch
o
lo
g
is
ts
,
s
cr
u
tin
is
ed
th
e
tr
an
s
lated
q
u
esti
o
n
n
air
e
an
d
t
h
e
r
ev
er
s
e
tr
an
s
latio
n
.
Af
ter
th
e
tr
an
s
latio
n
p
r
o
ce
s
s
was
co
m
p
leted
,
v
alid
ity
an
d
r
eliab
ilit
y
ass
e
s
s
m
en
ts
wer
e
c
o
n
d
u
cte
d
.
Du
r
in
g
th
e
co
n
s
tr
u
ct
v
alid
ity
test
u
s
in
g
Pear
s
o
n
co
r
r
elatio
n
,
it
was
o
b
s
er
v
ed
th
at
all
item
s
h
ad
a
n
r
c
o
u
n
t
v
alu
e
m
o
r
e
s
ig
n
if
ica
n
t
th
an
th
e
r
tab
le
v
alu
e,
af
f
ir
m
in
g
th
eir
v
alid
ity
.
Fu
r
th
er
m
o
r
e
,
C
r
o
n
b
ac
h
'
s
alp
h
a
test
in
g
was
p
er
f
o
r
m
e
d
,
d
e
m
o
n
s
tr
atin
g
t
h
e
q
u
esti
o
n
n
air
e
'
s
r
eliab
ilit
y
with
a
C
r
o
n
b
ac
h
'
s
α
v
alu
e
o
f
0
.
7
1
.
C
o
n
s
eq
u
en
tly
,
th
e
q
u
esti
o
n
n
a
ir
e
was
d
ee
m
ed
s
u
itab
le
f
o
r
u
s
e
in
th
is
s
tu
d
y
.
A
d
escr
ip
tio
n
o
f
a
d
o
lescen
t
d
e
p
r
ess
io
n
k
n
o
wled
g
e
q
u
esti
o
n
n
ai
r
e
i
tem
s
ca
n
b
e
s
ee
n
in
T
ab
le
1
.
T
ab
le
1
.
Ad
o
lescen
t
d
ep
r
ess
io
n
k
n
o
wled
g
e
q
u
esti
o
n
n
air
e
ite
m
d
escr
ip
tio
n
I
t
e
ms n
u
mb
e
r
C
o
n
t
e
n
t
1
,
2
,
7
,
1
1
,
a
n
d
1
2
F
u
n
d
a
m
e
n
t
a
l
k
n
o
w
l
e
d
g
e
a
b
o
u
t
d
e
p
r
e
s
si
o
n
3
,
4
,
5
,
8
,
a
n
d
1
3
C
a
u
ses
o
f
d
e
p
r
e
ss
i
o
n
6
,
9
,
a
n
d
1
0
,
1
4
a
n
d
1
5
S
i
g
n
s
a
n
d
s
y
m
p
t
o
ms
o
f
d
e
p
r
e
ss
i
o
n
2
.
3
.
2
.
Depre
s
s
io
n
s
t
ig
m
a
s
ca
le
(
DSS)
T
h
e
ass
es
s
m
en
t
o
f
d
ep
r
ess
io
n
-
r
elate
d
s
tig
m
a
in
th
is
s
tu
d
y
was
co
n
d
u
cted
u
s
in
g
th
e
d
ep
r
ess
io
n
s
tig
m
a
s
ca
le
(
D
SS
)
,
wh
ich
w
as
in
itially
d
ev
elo
p
ed
b
y
Gr
if
f
ith
s
et
a
l.
[
1
9
]
.
T
h
is
in
s
tr
u
m
en
t
in
co
r
p
o
r
ated
1
8
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
K
n
o
w
led
g
e
a
n
d
s
tig
ma
o
f d
ep
r
ess
io
n
a
mo
n
g
a
d
o
lescen
ts
in
I
n
d
o
n
esia
:
a
cro
s
s
-
s
ec
tio
n
a
l
…
(
R
ika
S
a
r
fika
)
1581
item
s
r
elate
d
to
p
er
s
o
n
al
s
tig
m
a
an
d
n
in
e
item
s
ass
o
ciate
d
with
p
er
ce
iv
ed
s
tig
m
a,
all
o
f
wh
ich
wer
e
em
p
lo
y
e
d
in
th
e
r
esear
ch
.
T
h
e
o
v
er
all
s
c
ale
s
co
r
es
r
an
g
ed
f
r
o
m
0
to
3
6
,
wh
ile
th
e
two
n
in
e
-
item
s
u
b
s
ca
les
r
an
g
ed
f
r
o
m
0
to
1
8
.
I
n
th
is
q
u
esti
o
n
n
air
e
,
a
L
ik
er
t
s
ca
le
was
u
s
ed
as
th
e
m
ea
s
u
r
em
en
t
s
ca
le,
f
ea
tu
r
in
g
f
iv
e
r
esp
o
n
s
e
ca
teg
o
r
ies:
"Str
o
n
g
ly
A
g
r
ee
"
(
s
co
r
ed
as
5
)
,
"Ag
r
ee
"
(
s
co
r
e
d
as
4
)
,
"D
o
n
o
t
Kn
o
w"
(
s
co
r
ed
as
3
)
,
"Disag
r
ee
"
(
s
co
r
ed
as 2
)
,
an
d
"Str
o
n
g
ly
D
is
ag
r
ee
"
(
s
co
r
ed
as 1
)
.
Similar
to
th
e
ADKQ
,
th
er
e
was
n
o
p
u
b
lis
h
ed
I
n
d
o
n
esia
n
v
er
s
io
n
o
f
th
e
DSS
in
s
tr
u
m
en
t.
T
h
e
au
th
o
r
s
f
o
llo
wed
a
p
r
o
ce
d
u
r
e
s
im
ilar
to
th
e
ADKQ
,
wh
i
ch
in
v
o
l
v
ed
tr
a
n
s
latio
n
,
v
ali
d
ity
,
an
d
r
eliab
ilit
y
test
in
g
.
Du
r
in
g
th
e
ex
a
m
in
atio
n
o
f
co
n
s
tr
u
ct
v
alid
ity
th
r
o
u
g
h
Pear
s
o
n
co
r
r
elatio
n
,
it
was
e
v
id
en
t
th
at
all
item
s
ex
h
ib
ited
an
r
v
alu
e
ex
ce
e
d
i
n
g
th
e
r
eq
u
ir
e
d
th
r
esh
o
ld
,
c
o
n
f
ir
m
in
g
th
eir
v
alid
ity
.
Ad
d
it
io
n
ally
,
C
r
o
n
b
ac
h
'
s
alp
h
a
test
in
g
was
co
n
d
u
cted
,
r
ev
ea
lin
g
a
C
r
o
n
b
ac
h
'
s
α
co
ef
f
icien
t
o
f
0
.
7
0
f
o
r
p
er
s
o
n
al
s
tig
m
a
an
d
a
C
r
o
n
b
ac
h
'
s
α
co
e
f
f
icien
t
o
f
0
.
7
3
f
o
r
p
er
ce
iv
e
d
s
tig
m
a
with
in
th
e
DSS.
T
h
is
u
n
d
er
lin
ed
th
e
q
u
esti
o
n
n
air
e'
s
r
eliab
ilit
y
an
d
s
u
itab
ilit
y
f
o
r
th
e
s
tu
d
y
.
2
.
4
.
St
a
t
is
t
ica
l
a
na
ly
s
is
T
h
e
d
ata
was
an
aly
ze
d
u
s
in
g
th
e
I
B
M
SP
SS
Sta
tis
tic
s
s
o
f
twar
e
v
er
s
io
n
2
5
.
0
,
d
ev
elo
p
e
d
b
y
I
B
M
C
o
r
p
o
r
atio
n
lo
ca
te
d
in
Ar
m
o
n
k
,
NY,
USA.
I
n
th
is
p
ar
ticu
lar
in
v
esti
g
atio
n
,
u
n
i
v
ar
iate
d
ata
an
aly
s
is
tech
n
iq
u
es
wer
e
em
p
l
o
y
ed
.
T
h
e
d
ata
was
p
r
esen
ted
u
s
in
g
d
escr
ip
tiv
e
s
tatis
tics
,
in
clu
d
in
g
f
r
eq
u
en
cy
,
p
er
ce
n
tag
e,
m
ea
n
,
a
n
d
s
tan
d
ar
d
d
ev
iatio
n
.
T
o
ass
ess
th
e
n
o
r
m
ality
o
f
th
e
d
ata,
th
e
Ko
lm
o
g
o
r
o
v
-
Sm
ir
n
o
v
test
was
co
n
d
u
cted
,
r
e
v
ea
lin
g
th
at
th
e
d
ata
was
n
o
t
d
is
tr
ib
u
ted
n
o
r
m
ally
(
p
<0
.
0
5
)
.
C
o
n
s
eq
u
e
n
tly
,
n
o
n
-
p
ar
am
et
r
ic
test
s
,
s
p
ec
if
ically
th
e
Sp
ea
r
m
an
co
r
r
elatio
n
,
wer
e
u
tili
ze
d
t
o
in
v
esti
g
ate
th
e
co
n
n
ec
tio
n
b
etwe
en
k
n
o
wled
g
e
an
d
s
tig
m
a
ass
o
ciate
d
with
d
e
p
r
ess
io
n
.
T
h
e
s
ig
n
if
ica
n
ce
lev
el
was set a
t p
<0
.
0
5
.
2
.
5
.
E
t
hica
l
clea
ra
nce
T
h
is
s
tu
d
y
r
ec
eiv
ed
eth
ical
ap
p
r
o
v
al
f
r
o
m
t
h
e
Hea
lth
R
esear
ch
E
th
ics
C
o
m
m
ittee
af
f
iliate
d
with
t
h
e
Facu
lty
o
f
Nu
r
s
in
g
at
Un
iv
er
s
itas
An
d
alas
(
No
:
0
1
5
.
laik
eti
k
/KE
PKFKEPU
NAND
)
.
Data
wer
e
co
llected
b
y
d
is
tr
ib
u
tin
g
q
u
esti
o
n
n
air
es
to
r
esp
o
n
d
en
ts
.
T
h
e
r
esear
ch
er
g
av
e
in
f
o
r
m
ed
co
n
s
en
t
to
th
e
r
esear
ch
p
ar
ticip
an
t
b
ef
o
r
e
c
o
m
p
letin
g
th
e
q
u
esti
o
n
n
air
e.
C
o
n
f
id
e
n
tiality
o
f
all
i
n
f
o
r
m
atio
n
r
etr
iev
e
d
was
en
s
u
r
ed
at
ev
er
y
s
tag
e
o
f
th
e
s
tu
d
y
.
All
r
esp
o
n
d
e
n
ts
wer
e
in
f
o
r
m
ed
a
b
o
u
t
th
e
r
esear
ch
o
b
jectiv
es,
n
atu
r
e,
an
d
p
r
o
ce
d
u
r
es.
R
esp
o
n
d
en
ts
wer
e
ad
d
itio
n
all
y
ap
p
r
is
ed
o
f
th
eir
en
titl
em
en
t
to
d
is
co
n
ti
n
u
e
p
ar
ticip
atio
n
in
th
e
r
esear
c
h
at
a
n
y
ju
n
ctu
r
e
with
o
u
t
in
cu
r
r
in
g
a
n
y
r
ep
er
c
u
s
s
io
n
s
.
No
n
e
o
f
th
e
s
tu
d
y
p
ar
ticip
an
ts
en
d
u
r
e
d
an
y
h
ar
m
th
r
o
u
g
h
o
u
t
th
e
in
v
esti
g
atio
n
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
t
he
r
esp
o
nd
ent
s
T
ab
le
2
s
h
o
ws
th
at
m
o
s
t
p
ar
t
icip
an
ts
f
all
with
in
th
e
1
7
-
2
0
ag
e
g
r
o
u
p
(
5
9
.
2
%).
Ad
d
itio
n
ally
,
m
o
r
e
th
an
h
alf
o
f
th
e
r
esp
o
n
d
en
ts
ar
e
f
em
ale
(
5
2
.
9
%).
Nea
r
ly
o
n
e
-
f
if
th
o
f
th
e
p
ar
ticip
an
ts
h
av
e
a
p
r
io
r
h
is
to
r
y
o
f
d
ep
r
ess
io
n
(
1
8
.
8
%).
Fu
r
th
e
r
m
o
r
e,
m
o
s
t
p
ar
ticip
an
ts
in
d
icat
ed
a
p
r
ef
er
e
n
ce
f
o
r
o
b
tain
in
g
in
f
o
r
m
atio
n
ab
o
u
t
d
ep
r
ess
io
n
f
r
o
m
th
e
in
te
r
n
et
(
5
1
.
3
%).
Tabl
e
2. C
ha
r
ac
t
er
i
s
t
i
cs
o
f
r
es
pond
ent
s (
n
=240
)
C
h
a
r
a
c
t
e
r
i
s
t
i
c
F
r
e
q
u
e
n
c
y
(
f
)
P
e
r
c
e
n
t
a
g
e
(
%)
A
g
e
,
i
n
y
e
a
r
s
Ea
r
l
y
a
d
o
l
e
sce
n
t
s
(
1
0
-
13)
M
i
d
d
l
e
a
d
o
l
e
s
c
e
n
t
s
(
1
4
-
1
6
)
La
t
e
a
d
o
l
e
sce
n
t
s
(
1
7
-
20)
0
98
1
4
2
0
4
0
.
8
5
9
.
2
G
e
n
d
e
r
M
a
l
e
F
e
mal
e
1
1
3
1
2
7
4
7
.
1
5
2
.
9
H
i
st
o
r
y
o
f
d
e
p
r
e
ss
i
o
n
N
e
v
e
r
Ev
e
r
1
9
5
45
8
1
.
3
1
8
.
8
S
o
u
r
c
e
s
o
f
i
n
f
o
r
mat
i
o
n
r
e
g
a
r
d
i
n
g
d
e
p
r
e
ssi
o
n
H
e
a
l
t
h
p
r
o
f
e
ss
i
o
n
a
l
F
a
mi
l
y
F
r
i
e
n
d
S
c
h
o
o
l
S
o
c
i
a
l
me
d
i
a
I
n
t
e
r
n
e
t
Te
l
e
v
i
si
o
n
O
t
h
e
r
s
10
15
21
13
49
1
2
3
6
3
4
.
2
3
.
6
8
.
8
5
.
4
2
0
.
4
5
1
.
3
2
.
5
1
.
3
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
57
8
-
1
58
8
1582
3
.
2
.
Descript
io
n o
f
a
do
lescent
s
'
k
no
wledg
e
o
f
depress
io
n
T
ab
le
3
p
r
o
v
id
es a
s
u
m
m
ar
y
o
f
th
e
r
esp
o
n
d
en
t'
s
k
n
o
wled
g
e
r
eg
ar
d
in
g
d
ep
r
ess
io
n
.
T
h
e
m
ea
n
s
co
r
e
o
f
th
e
r
esp
o
n
d
en
t'
s
k
n
o
wled
g
e
was
7
.
6
4
,
with
SD
2
.
7
2
.
T
h
e
m
ajo
r
ity
o
f
p
a
r
ticip
an
ts
co
r
r
ec
tly
an
s
wer
ed
q
u
esti
o
n
s
r
eg
a
r
d
in
g
d
e
p
r
ess
io
n
in
teen
ag
e
r
s
.
Sp
ec
if
ically
,
8
9
.
6
%
k
n
ew
th
at
5
%
o
f
teen
ag
er
s
wo
u
ld
s
u
f
f
er
f
r
o
m
m
ajo
r
d
e
p
r
ess
io
n
,
9
0
%
k
n
ew
th
at
d
ep
r
ess
io
n
co
u
ld
r
u
n
in
f
am
ilies
,
7
8
.
3
%
r
ec
o
g
n
iz
ed
th
at
a
ch
an
g
e
in
b
eh
av
io
u
r
co
u
ld
b
e
a
s
y
m
p
t
o
m
o
f
d
ep
r
ess
io
n
,
an
d
8
2
.
5
%
k
n
ew
th
at
m
ajo
r
d
ep
r
ess
io
n
is
a
tr
ea
tab
le
m
ed
ical
illn
ess
.
Ad
d
itio
n
ally
,
8
4
.
2
%
id
en
tifie
d
th
at
s
u
b
s
tan
ce
ab
u
s
e
ca
n
b
e
a
s
ig
n
o
f
d
ep
r
ess
io
n
,
an
d
5
0
.
8
%
k
n
ew
th
a
t
b
ip
o
lar
d
is
o
r
d
er
is
m
o
r
e
co
m
m
o
n
th
a
n
m
ajo
r
d
ep
r
ess
io
n
.
W
h
ile
o
n
e
q
u
esti
o
n
was
an
s
wer
ed
in
co
r
r
ec
tly
b
y
p
r
im
ar
y
r
esp
o
n
d
en
ts
,
it
is
ess
en
tial
t
o
n
o
te
th
at
in
clu
d
in
g
m
ajo
r
d
ep
r
ess
io
n
as
a
r
eg
u
lar
p
ar
t
o
f
ad
o
lescen
ce
is
a
co
m
m
o
n
m
is
co
n
ce
p
tio
n
(
6
1
.
7
%).
I
t
is
also
im
p
o
r
tan
t
t
o
n
o
te
th
at
d
ep
r
ess
io
n
ca
n
n
o
t
b
e
c
o
n
tr
o
lled
th
r
o
u
g
h
willp
o
wer
alo
n
e
(
9
1
.
7
%)
a
n
d
th
at
th
e
ca
u
s
e
o
f
Ma
jo
r
Dep
r
ess
io
n
is
n
o
t
y
et
f
u
lly
u
n
d
er
s
to
o
d
(
6
1
.
7
%).
A
d
d
itio
n
ally
,
th
er
e
is
n
o
ev
id
e
n
ce
to
s
u
g
g
est
th
a
t
ce
r
tain
g
r
o
u
p
s
o
f
p
e
o
p
le
ar
e
im
m
u
n
e
to
d
ep
r
ess
io
n
(
5
8
%).
Acc
o
r
d
in
g
to
th
e
s
u
r
v
ey
,
8
2
.
5
%
o
f
p
e
o
p
le
with
d
ep
r
ess
io
n
r
ep
o
r
t
f
ee
lin
g
s
ad
.
Ad
d
itio
n
ally
,
7
7
.
5
%
o
f
th
o
s
e
with
m
ajo
r
d
ep
r
ess
io
n
f
in
d
th
at
it
is
a
cu
r
ab
le
illn
ess
.
C
o
n
tr
ar
y
to
p
o
p
u
lar
b
elief
,
s
ig
n
if
ican
t
s
tr
ess
,
s
u
ch
as
th
at
ca
u
s
ed
b
y
p
a
r
en
ts
g
ett
in
g
a
d
iv
o
r
ce
,
d
o
es
n
o
t
alwa
y
s
lead
to
a
d
ep
r
ess
iv
e
illn
ess
(
8
2
.
9
%).
T
h
e
s
u
r
v
ey
also
id
en
tifie
d
f
iv
e
s
y
m
p
t
o
m
s
o
f
d
ep
r
ess
iv
e
illn
ess
(
7
1
.
3
%)
an
d
two
s
y
m
p
t
o
m
s
o
f
m
an
ia
(
9
0
.
8
%).
T
ab
le
3
.
Kn
o
wled
g
e
o
f
d
e
p
r
ess
io
n
am
o
n
g
r
esp
o
n
d
en
ts
N
u
mb
e
r
Q
u
e
st
i
o
n
s
C
o
r
r
e
c
t
n
(
%)
I
n
c
o
r
r
e
c
t
n
(
%)
1
F
i
v
e
p
e
r
c
e
n
t
o
f
a
l
l
t
e
e
n
a
g
e
r
s w
i
l
l
s
u
f
f
e
r
a
M
a
j
o
r
D
e
p
r
e
ssi
o
n
2
1
5
(
8
9
.
6
)
2
5
(
1
0
.
4
)
2
M
a
j
o
r
d
e
p
r
e
ss
i
o
n
i
s
a
n
o
r
mal
p
a
r
t
o
f
a
d
o
l
e
s
c
e
n
c
e
9
2
(
3
8
.
3
)
1
4
8
(
6
1
.
7
)
3
D
e
p
r
e
ss
i
o
n
r
u
n
s i
n
s
o
m
e
f
a
m
i
l
i
e
s
2
1
6
(
9
0
.
0
)
2
4
(
1
0
.
0
)
4
D
e
p
r
e
ss
i
o
n
c
a
n
b
e
c
o
n
t
r
o
l
l
e
d
t
h
r
o
u
g
h
w
i
l
l
p
o
w
e
r
2
0
(
8
.
3
)
2
2
0
(
9
1
.
7
)
5
Th
e
c
a
u
s
e
o
f
M
a
j
o
r
D
e
p
r
e
ss
i
o
n
i
s w
e
l
l
-
k
n
o
w
n
9
2
(
3
8
.
3
)
1
4
8
(
6
1
.
7
)
6
A
c
h
a
n
g
e
i
n
b
e
h
a
v
i
o
u
r
i
s
a
sy
m
p
t
o
m
o
f
d
e
p
r
e
ssi
o
n
1
8
8
(
7
8
.
3
)
5
2
(
2
1
.
7
)
7
C
e
r
t
a
i
n
g
r
o
u
p
s
o
f
p
e
o
p
l
e
a
r
e
i
mm
u
n
e
t
o
d
e
p
r
e
s
si
o
n
9
9
(
4
1
.
2
)
1
4
1
(
5
8
.
8
)
8
M
a
j
o
r
d
e
p
r
e
ss
i
o
n
i
s
a
t
r
e
a
t
a
b
l
e
m
e
d
i
c
a
l
i
l
l
n
e
ss
1
9
8
(
8
2
.
5
)
4
2
(
1
7
.
5
)
9
A
p
e
r
s
o
n
w
i
t
h
d
e
p
r
e
ssi
o
n
a
l
w
a
y
s fe
e
l
s sa
d
4
2
(
1
7
.
5
)
1
9
8
(
8
2
.
5
)
10
Th
e
a
b
u
s
e
o
f
a
l
c
o
h
o
l
a
n
d
d
r
u
g
s
c
a
n
b
e
a
si
g
n
o
f
d
e
p
r
e
s
si
o
n
2
0
2
(
8
4
.
2
)
3
8
(
1
5
.
8
)
11
B
i
p
o
l
a
r
D
i
so
r
d
e
r
i
s m
o
r
e
c
o
mm
o
n
t
h
a
n
M
a
j
o
r
D
e
p
r
e
ssi
o
n
1
2
2
(
5
0
.
8
)
1
1
8
(
4
9
.
2
)
12
M
a
j
o
r
d
e
p
r
e
ss
i
o
n
i
s
a
c
u
r
a
b
l
e
i
l
l
n
e
ss
5
4
(
2
2
.
5
)
1
8
6
(
7
7
.
5
)
13
S
o
me
o
n
e
w
h
o
h
a
s
ma
j
o
r
s
t
r
e
ss
(
l
i
k
e
h
a
v
i
n
g
p
a
r
e
n
t
s
g
e
t
a
d
i
v
o
r
c
e
)
a
l
w
a
y
s
d
e
v
e
l
o
p
s
a
d
e
p
r
e
ss
i
v
e
i
l
l
n
e
ss
4
1
(
1
7
.
1
)
1
9
9
(
8
2
.
9
)
14
Li
st
f
i
v
e
s
y
m
p
t
o
ms
o
f
d
e
p
r
e
ss
i
v
e
i
l
l
n
e
ss
6
9
(
2
8
.
7
)
1
7
1
(
7
1
.
3
)
15
Li
st
t
w
o
s
y
mp
t
o
ms
o
f
ma
n
i
a
2
2
(
9
.
2
)
2
1
8
(
9
0
.
8
)
K
n
o
w
l
e
d
g
e
t
o
t
a
l
M
e
a
n
±
S
D
7
.
6
4
±
2
.
7
2
A
b
b
r
e
v
i
a
t
i
o
n
:
S
D
=
s
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
3
.
3
.
Descript
io
n
o
f
a
do
lescent
s
' s
t
ig
m
a
o
f
depress
io
n
T
ab
le
4
p
r
o
v
id
es
a
s
u
m
m
ar
y
o
f
th
e
r
esp
o
n
d
en
t'
s
s
tig
m
a
r
eg
a
r
d
in
g
d
ep
r
ess
io
n
.
T
h
e
m
ea
n
s
c
o
r
e
o
f
t
h
e
r
esp
o
n
d
en
t'
s
s
tig
m
a
was
2
1
.
0
0
with
SD
4
.
5
1
,
th
e
r
esp
o
n
d
en
t'
s
p
er
ce
iv
ed
s
tig
m
a
was
2
1
.
0
0
with
SD
4
.
6
5
,
an
d
th
e
m
ea
n
s
co
r
e
o
f
th
e
r
esp
o
n
d
en
t'
s
to
tal
s
t
ig
m
a
s
co
r
e
was
4
2
.
0
0
with
SD
8
.
4
3
.
4
7
.
1
%
o
f
th
e
p
a
r
ticip
an
ts
b
eliev
e
th
at
p
eo
p
le
with
d
ep
r
e
s
s
io
n
ca
n
s
n
ap
o
u
t
o
f
it
if
th
ey
wan
t
to
.
Ad
d
itio
n
ally
,
5
3
.
8
%
o
f
th
e
p
ar
ticip
an
ts
th
in
k
th
at
d
ep
r
ess
io
n
is
a
s
ig
n
o
f
p
er
s
o
n
al
wea
k
n
ess
,
an
d
3
3
.
3
%
b
eliev
e
th
at
d
ep
r
ess
io
n
is
n
o
t
an
ac
t
u
al
m
ed
ical
illn
ess
.
Fu
r
th
er
m
o
r
e,
3
0
.
8
%
o
f
th
e
p
a
r
ticip
an
ts
b
eli
ev
e
th
at
p
eo
p
le
with
d
e
p
r
ess
io
n
ar
e
d
a
n
g
er
o
u
s
.
I
t
is
co
n
ce
r
n
in
g
t
h
at
3
7
.
2
%
o
f
th
e
p
a
r
ticip
an
ts
wo
u
ld
n
o
t
tell
an
y
o
n
e
if
th
ey
h
ad
d
e
p
r
ess
io
n
,
an
d
3
8
.
8
%
o
f
th
e
p
ar
ticip
an
ts
b
eliev
e
th
at
m
o
s
t
p
eo
p
le
wo
u
ld
n
o
t
em
p
lo
y
s
o
m
eo
n
e
wh
o
h
as
b
ee
n
d
ep
r
ess
ed
.
Similar
ly
,
3
8
.
8
%
o
f
th
e
p
ar
ticip
an
ts
b
eliev
e
th
at
m
o
s
t
p
eo
p
le
wo
u
ld
n
o
t
v
o
te
f
o
r
a
p
o
liti
cian
if
th
ey
k
n
ew
th
ey
h
ad
b
ee
n
d
ep
r
ess
ed
.
Mo
r
eo
v
e
r
,
3
7
.
5
%
o
f
th
e
p
ar
ticip
an
ts
wer
e
u
n
awa
r
e
th
at
in
d
iv
id
u
als
with
d
ep
r
ess
io
n
ca
n
b
e
u
n
p
r
e
d
ictab
le.
Ad
d
itio
n
ally
,
3
5
.
4
%
o
f
th
e
r
esp
o
n
d
en
ts
d
is
ag
r
ee
d
with
th
e
n
o
tio
n
th
at
av
o
id
in
g
p
e
o
p
le
with
d
ep
r
ess
io
n
is
th
e
b
est wa
y
to
p
r
ev
en
t b
ec
o
m
in
g
d
ep
r
ess
ed
th
em
s
elv
es.
3
.
4
.
Rela
t
io
ns
hip
s
bet
wee
n
Ado
lescent
s
' k
no
wledg
e
a
nd
t
he
s
t
ig
m
a
o
f
depress
io
n
T
ab
le
5
illu
s
tr
ates
th
at
th
e
to
tal
s
tig
m
a
s
co
r
e
h
as
a
p
-
v
a
lu
e
o
f
<0
.
0
0
1
,
s
ig
n
if
y
in
g
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
b
etwe
en
ad
o
lescen
ts
'
k
n
o
wled
g
e
an
d
s
tig
m
a
.
C
o
n
cu
r
r
en
tly
,
th
e
co
r
r
elatio
n
co
ef
f
icien
t
(
r
)
is
-
0
.
4
5
,
in
d
icatin
g
a
m
o
d
er
a
te
an
d
n
eg
ativ
e
r
elatio
n
s
h
ip
.
T
h
is
d
is
co
v
er
y
lead
s
to
th
e
co
n
clu
s
io
n
th
at
as
k
n
o
wled
g
e
d
ec
r
ea
s
es,
s
tig
m
a
r
eg
ar
d
in
g
d
ep
r
ess
io
n
i
n
cr
ea
s
es.
Fu
r
th
er
m
o
r
e,
t
h
e
c
o
ef
f
icien
t
o
f
d
eter
m
in
atio
n
(r
2
)
is
0
.
2
7
,
s
ig
n
if
y
i
n
g
th
at
k
n
o
wled
g
e
co
n
tr
ib
u
tes to
ad
o
lescen
t sti
g
m
a
r
elate
d
to
d
e
p
r
ess
io
n
b
y
2
7
%.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
K
n
o
w
led
g
e
a
n
d
s
tig
ma
o
f d
ep
r
ess
io
n
a
mo
n
g
a
d
o
lescen
ts
in
I
n
d
o
n
esia
:
a
cro
s
s
-
s
ec
tio
n
a
l
…
(
R
ika
S
a
r
fika
)
1583
T
ab
le
4
.
Sti
g
m
a
o
f
d
e
p
r
ess
io
n
am
o
n
g
r
esp
o
n
d
e
n
ts
S
t
i
g
ma
o
f
d
e
p
r
e
ss
i
o
n
S
t
r
o
n
g
l
y
a
g
r
e
e
A
g
r
e
e
D
o
n
o
t
k
n
o
w
D
i
sag
r
e
e
S
t
r
o
n
g
l
y
d
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s
a
g
r
e
e
n
(
%)
n
(
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n
(
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n
(
%)
n
(
%)
P
e
r
so
n
a
l
st
i
g
ma
(
M
e
a
n
±
S
D
:
2
1
.
0
0
±
4
.
5
1
)
P
e
o
p
l
e
w
i
t
h
d
e
p
r
e
ssi
o
n
c
o
u
l
d
s
n
a
p
o
u
t
o
f
i
t
i
f
t
h
e
y
w
a
n
t
e
d
1
1
3
(
4
7
.
1
)
1
0
5
(
4
3
.
8
)
1
5
(
6
.
3
)
2
(
0
.
8
)
5
(
2
.
1
)
D
e
p
r
e
ss
i
o
n
i
s
a
s
i
g
n
o
f
p
e
r
s
o
n
a
l
w
e
a
k
n
e
ss
1
7
(
7
.
1
)
1
2
9
(
5
3
.
8
)
4
9
(
2
0
.
4
)
4
2
(
1
7
.
5
)
3
(
1
.
3
)
D
e
p
r
e
ss
i
o
n
i
s
n
o
t
a
r
e
a
l
me
d
i
c
a
l
i
l
l
n
e
s
s
1
7
(
7
.
1
)
8
0
(
3
3
.
3
)
7
6
(
3
1
.
7
)
5
2
(
2
1
.
7
)
1
5
(
6
.
3
)
P
e
o
p
l
e
w
i
t
h
d
e
p
r
e
ssi
o
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Evaluation Warning : The document was created with Spire.PDF for Python.
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d
ep
r
ess
ed
teen
ag
er
s
[
2
3
]
,
[
2
4
]
.
T
h
is
m
a
y
b
e
b
ased
o
n
th
e
co
n
ce
p
t
th
at
a
p
er
s
o
n
'
s
attitu
d
e
t
en
d
s
to
alig
n
with
th
eir
k
n
o
wled
g
e
ab
o
u
t
a
s
u
b
ject
[
2
5
]
.
Neg
ativ
e
k
n
o
wled
g
e
ca
n
co
n
tr
ib
u
te
to
s
tig
m
a
an
d
o
th
e
r
n
eg
ativ
e
p
er
ce
p
tio
n
s
[
2
6
]
.
T
h
e
ADKQ
,
co
n
s
is
tin
g
o
f
tr
u
e
o
r
f
alse
q
u
esti
o
n
s
,
was
u
s
ed
in
th
e
s
tu
d
y
.
T
h
e
an
aly
s
is
s
h
o
wed
th
at
th
e
m
ajo
r
ity
o
f
ad
o
lescen
ts
an
s
wer
ed
ac
cu
r
ately
r
eg
ar
d
i
n
g
th
e
p
r
ev
ale
n
ce
o
f
m
ajo
r
d
ep
r
ess
io
n
an
d
f
am
ily
h
is
to
r
y
(
8
9
.
6
% a
n
d
9
0
% a
cc
u
r
ac
y
,
r
esp
ec
tiv
ely
)
.
H
o
wev
er
,
a
s
ig
n
if
ican
t p
r
o
p
o
r
tio
n
o
f
r
esp
o
n
d
en
ts
in
co
r
r
ec
tl
y
b
eliev
ed
th
at
d
ep
r
ess
io
n
ca
n
b
e
co
n
tr
o
lled
th
r
o
u
g
h
willp
o
wer
(
8
.
3
%
ac
cu
r
ac
y
)
.
T
h
ese
r
esu
lts
alig
n
with
a
p
r
ev
io
u
s
s
tu
d
y
[
2
7
]
,
wh
ich
f
o
u
n
d
th
at
m
an
y
Ma
r
y
lan
d
ad
o
l
escen
ts
m
is
co
n
ce
iv
e
th
at
willp
o
wer
alo
n
e
ca
n
tr
ea
t
d
ep
r
ess
io
n
.
T
h
is
s
u
g
g
ests
a
n
e
ed
f
o
r
ed
u
ca
tio
n
an
d
m
ed
ical
s
u
p
p
o
r
t to
ad
d
r
ess
th
is
m
is
co
n
ce
p
tio
n
.
T
h
e
an
aly
s
is
o
f
th
e
ADKQ
u
s
ed
an
ess
ay
-
f
illi
n
g
m
eth
o
d
f
o
r
d
ep
r
ess
iv
e
an
d
b
ip
o
lar
s
y
m
p
t
o
m
s
.
L
ess
th
an
h
alf
o
f
th
e
s
tu
d
en
ts
co
r
r
ec
tly
lis
ted
f
o
u
r
o
r
f
iv
e
d
e
p
r
ess
iv
e
s
y
m
p
to
m
s
,
an
d
m
o
s
t
co
u
ld
n
'
t
ac
cu
r
ately
r
ec
o
r
d
two
b
ip
o
lar
s
y
m
p
to
m
s
.
T
h
is
r
esear
ch
s
u
p
p
o
r
ts
a
p
r
ev
io
u
s
s
tu
d
y
[
1
8
]
f
i
n
d
in
g
s
,
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
a
d
o
lescen
ts
k
n
o
win
g
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
to
id
en
tify
th
e
co
n
d
itio
n
.
Diag
n
o
s
is
o
f
d
ep
r
ess
io
n
r
eq
u
ir
es e
x
p
er
ien
ci
n
g
s
y
m
p
to
m
s
an
d
m
ee
tin
g
s
p
ec
if
ic
cr
iter
ia
f
o
r
two
wee
k
s
,
wh
ile
b
ip
o
lar
d
is
o
r
d
er
d
iag
n
o
s
is
in
v
o
lv
es
th
r
ee
s
y
m
p
to
m
s
o
v
e
r
o
n
e
wee
k
,
ac
co
r
d
in
g
to
DSM
-
V
[
2
8
]
.
Hen
ce
,
ad
o
lescen
t
s
n
ee
d
to
r
ec
o
g
n
is
e
d
ep
r
ess
io
n
s
y
m
p
to
m
s
f
o
r
ea
r
l
y
d
etec
tio
n
.
T
h
e
s
tu
d
y
f
o
u
n
d
th
at
th
e
av
e
r
ag
e
s
tig
m
a
o
f
d
e
p
r
ess
io
n
am
o
n
g
ad
o
lescen
ts
is
4
2
.
0
2
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
8
.
4
3
2
)
,
in
d
icatin
g
a
h
ig
h
lev
el
o
f
s
tig
m
a,
am
o
u
n
tin
g
to
5
8
.
3
%.
T
h
e
s
tu
d
y
ass
ess
ed
s
tig
m
a
in
two
s
u
b
ca
teg
o
r
ies:
p
er
s
o
n
al
s
tig
m
a,
wh
ich
m
ea
s
u
r
es
r
esp
o
n
d
e
n
ts
'
attitu
d
es
to
war
d
s
d
ep
r
ess
io
n
,
an
d
p
er
ce
iv
ed
s
tig
m
a,
wh
ich
g
au
g
es
r
esp
o
n
d
en
ts
'
p
er
ce
p
tio
n
s
o
f
h
o
w
o
th
er
s
v
iew
d
ep
r
ess
io
n
.
T
h
e
av
er
a
g
e
p
er
ce
iv
ed
s
tig
m
a
was
2
1
.
3
0
(
SD=4
.
6
4
7
)
,
wh
ile
p
er
s
o
n
al
s
tig
m
a
was
2
0
.
7
2
(
SD=4
.
5
1
0
)
,
d
em
o
n
s
tr
atin
g
t
h
at
p
er
ce
iv
ed
s
tig
m
a
was
h
ig
h
er
th
an
p
er
s
o
n
al
s
tig
m
a.
T
h
is
f
in
d
in
g
alig
n
s
with
Dar
d
as
et
a
l.
[
2
9
]
s
tu
d
y
o
n
J
o
r
d
an
ian
ad
o
lescen
ts
,
wh
ich
also
f
o
u
n
d
h
ig
h
er
p
e
r
c
eiv
ed
s
tig
m
a
(
1
8
.
5
)
co
m
p
a
r
e
d
to
p
er
s
o
n
al
s
tig
m
a
(
1
7
.
5
)
.
Similar
ly
,
p
r
ev
io
u
s
r
esear
ch
s
u
p
p
o
r
ted
th
is
r
esu
lt,
in
d
icatin
g
th
at
p
er
ce
i
v
ed
s
tig
m
a
s
co
r
es
ex
ce
ed
ed
p
e
r
s
o
n
al
s
tig
m
a
s
co
r
es.
T
h
is
s
u
g
g
ests
th
at
ad
o
lescen
ts
m
ay
b
e
ju
d
g
ed
b
ased
o
n
th
eir
b
eh
av
io
u
r
s
ass
o
ciate
d
with
d
e
p
r
ess
io
n
r
ath
er
t
h
an
th
eir
b
elief
s
[
8
]
T
h
e
r
esear
ch
f
in
d
in
g
s
r
ev
ea
l
th
at
m
o
s
t
ad
o
lescen
ts
(
5
9
.
2
%)
f
all
with
in
th
e
1
7
-
2
0
a
g
e
g
r
o
u
p
,
ca
teg
o
r
is
in
g
th
em
as
late
ad
o
l
escen
ts
.
T
h
e
an
aly
s
is
f
u
r
th
er
i
n
d
icate
s
th
at
th
e
av
er
ag
e
s
tig
m
a
o
f
d
e
p
r
ess
io
n
in
late
ad
o
lescen
ts
is
4
2
.
2
5
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
8
.
7
1
0
)
,
wh
ic
h
is
h
ig
h
e
r
th
an
th
a
t
o
b
s
er
v
ed
i
n
m
id
-
teen
ag
er
s
,
wh
er
e
it
av
er
ag
ed
4
1
.
6
8
(
with
a
s
tan
d
ar
d
d
ev
iat
io
n
o
f
8
.
0
4
4
)
.
L
ate
ad
o
lescen
ts
ty
p
ically
ex
h
ib
it
em
o
tio
n
al
m
atu
r
ity
an
d
p
o
s
s
ess
th
e
ab
ilit
y
to
th
in
k
o
b
jectiv
ely
[
30
]
.
T
h
eir
in
ter
ac
tio
n
s
in
h
eter
o
s
ex
u
al
s
o
cial
r
elatio
n
s
h
ip
s
ca
n
in
f
lu
en
ce
t
h
eir
p
er
ce
p
tio
n
o
f
th
e
s
u
r
r
o
u
n
d
in
g
en
v
ir
o
n
m
en
t.
T
h
is
alig
n
s
with
th
e
f
in
d
in
g
s
o
f
th
e
p
r
ev
io
u
s
s
tu
d
y
,
wh
ich
h
ig
h
lig
h
t
ag
e
as
a
s
ig
n
if
ican
t
f
ac
to
r
r
elate
d
to
s
tig
m
a,
p
er
s
o
n
al
s
tig
m
a,
an
d
p
er
ce
iv
ed
s
tig
m
a
in
ad
o
lescen
ts
[
29
]
.
Sp
ec
if
ically
,
s
tig
m
a
t
en
d
s
to
b
e
m
o
r
e
p
r
o
n
o
u
n
ce
d
i
n
ad
o
lescen
ts
ag
ed
1
6
an
d
ab
o
v
e.
B
ased
o
n
th
is
,
i
t
is
s
u
g
g
ested
th
at
as
teen
ag
er
s
g
r
o
w
o
ld
er
,
th
ey
b
ec
o
m
e
m
o
r
e
attu
n
ed
to
p
u
b
lic
s
tig
m
a,
u
n
d
er
s
tan
d
is
s
u
es c
o
m
p
r
eh
en
s
iv
ely
,
an
d
b
ec
o
m
e
awa
r
e
o
f
n
eg
ativ
e
attitu
d
es.
Per
ce
iv
ed
s
tig
m
a
i
n
th
is
s
tu
d
y
r
ef
lects
h
o
w
ad
o
lescen
ts
p
er
c
eiv
e
o
th
e
r
s
'
attitu
d
es
to
war
d
d
ep
r
ess
io
n
,
m
ea
s
u
r
ed
th
r
o
u
g
h
t
h
eir
o
p
in
i
o
n
s
o
n
n
in
e
s
tatem
en
ts
ab
o
u
t
d
ep
r
ess
io
n
.
T
h
e
r
esear
ch
r
e
v
ea
l
s
th
at
m
ales
ex
h
ib
it
th
e
h
ig
h
est
p
er
ce
iv
ed
s
tig
m
a,
with
an
av
er
ag
e
s
co
r
e
o
f
2
1
.
9
2
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
4
.
6
7
0
)
.
T
h
is
is
attr
ib
u
ted
to
m
ascu
lin
e
n
o
r
m
s
th
at
v
iew
d
ep
r
ess
io
n
as
a
s
ig
n
o
f
wea
k
n
ess
an
d
a
lack
o
f
in
d
ep
en
d
en
ce
o
r
s
elf
-
co
n
tr
o
l.
C
o
n
s
eq
u
e
n
tly
,
m
ales
o
f
ten
d
o
n
o
t
p
e
r
ce
iv
e
d
ep
r
ess
io
n
as
a
m
en
tal
illn
ess
b
u
t
r
ath
er
as
a
p
er
s
o
n
al
wea
k
n
ess
,
lead
in
g
to
m
is
co
n
ce
p
tio
n
s
an
d
b
iases
ag
ain
s
t
d
ep
r
ess
io
n
[
3
1
]
.
A
d
o
lescen
ts
with
o
u
t
a
h
is
to
r
y
o
f
d
ep
r
ess
io
n
also
s
h
o
w
h
ig
h
er
p
er
ce
iv
ed
s
tig
m
a,
av
e
r
ag
in
g
2
1
.
4
6
(
with
a
s
tan
d
ar
d
d
e
v
iatio
n
o
f
4
.
8
2
6
)
,
lik
el
y
d
u
e
to
th
eir
lim
ited
k
n
o
wle
d
g
e
ab
o
u
t
d
ep
r
ess
io
n
,
ca
u
s
i
n
g
th
em
to
alig
n
with
s
o
cieta
l
s
tig
m
a
ag
ain
s
t
in
d
iv
id
u
als with
d
ep
r
ess
io
n
.
Per
s
o
n
al
s
tig
m
a,
wh
ich
m
ea
s
u
r
es
ad
o
lescen
ts
'
attitu
d
es
to
wa
r
d
s
d
ep
r
ess
io
n
b
ased
o
n
th
eir
ag
r
ee
m
en
t
with
n
in
e
s
tatem
en
ts
ab
o
u
t
d
e
p
r
ess
io
n
,
is
o
b
s
er
v
ed
to
b
e
h
i
g
h
est
in
late
ad
o
lescen
ce
.
T
h
i
s
f
in
d
in
g
is
in
lin
e
with
s
tu
d
ies
b
y
Sar
f
ik
a
th
at
s
h
o
w
th
at
late
ad
o
lescen
ts
h
av
e
a
h
i
g
h
er
s
tig
m
a
th
a
n
m
i
d
d
l
e
ad
o
lescen
ts
an
d
ea
r
ly
ad
o
lescen
ts
[
8
]
.
T
h
is
tr
en
d
ar
is
es
b
ec
au
s
e
o
ld
e
r
teen
ag
er
s
b
ec
o
m
e
m
o
r
e
s
en
s
itiv
e
an
d
awa
r
e
o
f
th
e
co
n
s
eq
u
en
ce
s
o
f
th
eir
ac
tio
n
s
[
3
2
]
.
On
th
e
o
t
h
er
h
an
d
,
f
em
ales
ex
h
ib
it
th
e
lo
west
p
er
s
o
n
al
s
tig
m
a,
with
an
av
er
ag
e
s
co
r
e
o
f
2
0
.
3
4
(
with
a
s
tan
d
a
r
d
d
ev
iatio
n
o
f
4
.
4
6
0
)
.
T
h
is
ca
n
b
e
attr
ib
u
ted
to
wo
m
en
'
s
s
tr
o
n
g
er
co
n
n
ec
tio
n
s
with
in
th
e
s
o
cial
s
y
s
tem
,
m
ak
in
g
th
em
m
o
r
e
co
n
s
cio
u
s
o
f
th
e
s
tig
m
a
th
ey
m
a
y
p
er
p
etu
ate
.
T
h
is
o
b
s
er
v
atio
n
is
s
u
p
p
o
r
ted
b
y
a
p
r
ev
io
u
s
s
tu
d
y
[
3
3
]
,
wh
o
ass
er
t
th
at
wo
m
en
p
o
s
s
ess
h
ig
h
er
em
p
ath
y
an
d
th
e
ab
ilit
y
to
u
n
d
e
r
s
tan
d
an
d
c
o
n
s
id
er
o
th
e
r
s
'
p
er
s
p
ec
tiv
es
m
o
r
e
th
a
n
m
e
n
,
m
ak
in
g
th
em
m
o
r
e
atten
tiv
e
t
o
d
if
f
er
en
t
v
iewp
o
in
ts
.
A
d
d
itio
n
ally
,
th
e
p
r
e
v
alen
ce
o
f
d
ep
r
ess
io
n
am
o
n
g
wo
m
en
co
n
tr
ib
u
tes
to
th
eir
g
r
ea
ter
ex
p
o
s
u
r
e,
k
n
o
wled
g
e,
an
d
aw
ar
en
ess
o
f
th
e
co
n
d
itio
n
c
o
m
p
ar
ed
to
m
e
n
[
3
4
]
.
Ad
o
lescen
ts
with
a
h
is
to
r
y
o
f
d
ep
r
ess
io
n
d
is
p
lay
l
o
wer
p
er
s
o
n
al
s
tig
m
a,
av
er
ag
i
n
g
1
9
.
9
3
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
4
.
5
5
0
)
,
lik
ely
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u
e
to
th
eir
i
n
cr
ea
s
ed
k
n
o
wled
g
e
ab
o
u
t
d
e
p
r
ess
io
n
s
tem
m
in
g
f
r
o
m
th
eir
Evaluation Warning : The document was created with Spire.PDF for Python.
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n
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led
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a
n
d
s
tig
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o
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ep
r
ess
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ts
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ika
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1585
o
wn
ex
p
er
ie
n
ce
s
.
T
h
ese
ad
o
l
escen
ts
ca
n
b
etter
em
p
ath
is
e
with
in
d
iv
id
u
als
s
u
f
f
er
in
g
f
r
o
m
d
ep
r
ess
io
n
.
T
h
is
o
b
s
er
v
atio
n
is
co
n
s
is
ten
t
with
th
e
f
in
d
in
g
s
o
f
a
p
r
ev
io
u
s
s
tu
d
y
,
wh
ich
s
u
g
g
ests
th
at
ex
p
e
r
ien
cin
g
d
ep
r
ess
io
n
ca
n
en
h
an
ce
d
e
p
r
ess
io
n
liter
ac
y
an
d
r
ed
u
ce
n
eg
ativ
e
b
el
ief
s
ab
o
u
t
it
[
3
1
]
.
T
h
e
av
er
ag
e
s
tig
m
a
am
o
n
g
ad
o
lescen
ts
wh
o
h
av
e
ex
p
er
i
en
ce
with
d
ep
r
ess
io
n
s
u
f
f
er
er
s
is
4
1
.
9
5
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
7
.
6
9
0
)
,
wh
ile
th
e
av
er
a
g
e
s
tig
m
a
am
o
n
g
th
o
s
e
wh
o
h
a
v
en
'
t
h
ad
s
u
c
h
ex
p
e
r
ien
ce
s
is
4
2
.
1
6
(
with
a
s
tan
d
ar
d
d
ev
iatio
n
o
f
9
.
9
2
7
)
.
T
h
is
in
d
icate
s
th
at
ad
o
lescen
ts
wh
o
lack
ex
p
er
ien
ce
with
d
ep
r
ess
io
n
s
u
f
f
er
er
s
ten
d
to
h
av
e
s
lig
h
tly
h
ig
h
er
s
tig
m
a
lev
els,
alth
o
u
g
h
th
e
d
if
f
er
e
n
ce
is
n
o
t statis
tical
ly
s
ig
n
if
ican
t.
Sp
ea
r
m
an
'
s
co
r
r
elatio
n
test
r
e
v
ea
led
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
(
p
-
v
alu
e=
0
.
0
0
0
)
b
etwe
en
k
n
o
wled
g
e
an
d
th
e
s
tig
m
a
o
f
d
ep
r
ess
io
n
i
n
ad
o
lescen
ts
.
T
h
is
f
in
d
in
g
ali
g
n
s
with
p
r
ev
io
u
s
r
esear
ch
in
C
h
in
a,
wh
ich
also
id
en
tifie
d
a
s
ig
n
if
ican
t
lin
k
b
etwe
en
k
n
o
wled
g
e
a
n
d
d
ep
r
ess
io
n
s
tig
m
a
[
1
2
]
.
Fu
r
th
er
m
o
r
e
,
a
s
tu
d
y
in
T
o
k
y
o
also
r
ep
o
r
te
d
a
s
ig
n
if
ican
t r
elatio
n
s
h
ip
b
etwe
en
k
n
o
wled
g
e
a
n
d
d
ep
r
ess
io
n
s
tig
m
a.
T
h
e
co
r
r
elatio
n
co
e
f
f
icien
t
(
r
)
was
f
o
u
n
d
to
b
e
-
0
.
4
4
6
,
in
d
icatin
g
a
m
o
d
er
ate
s
tr
en
g
th
o
f
th
e
r
elatio
n
s
h
ip
with
a
n
eg
ativ
e
d
ir
ec
tio
n
.
T
h
is
r
esu
lt
s
u
g
g
ests
th
at
as
k
n
o
wled
g
e
d
ec
r
ea
s
es,
s
tig
m
a
ab
o
u
t
d
ep
r
ess
io
n
ten
d
s
to
in
cr
ea
s
e
[
3
5
]
.
T
h
is
o
b
s
er
v
atio
n
is
in
lin
e
w
ith
a
p
r
ev
io
u
s
s
t
u
d
y
,
wh
ich
em
p
h
asis
ed
th
at
s
tig
m
a
ac
ts
a
s
a
p
r
im
ar
y
b
ar
r
ier
f
o
r
ad
o
lescen
ts
s
ee
k
in
g
h
elp
,
u
n
d
e
r
s
co
r
in
g
th
e
im
p
o
r
tan
ce
o
f
r
e
d
u
cin
g
p
er
ce
i
v
ed
s
tig
m
a
[
1
2
]
.
Fin
ally
,
ad
o
lescen
ts
with
lim
ited
k
n
o
wled
g
e
ab
o
u
t
d
e
p
r
ess
io
n
ten
d
to
p
er
ce
iv
e
m
o
r
e
s
tig
m
a,
an
d
th
is
r
elatio
n
s
h
ip
is
n
eg
ativ
ely
co
r
r
elate
d
.
Per
s
o
n
al
s
tig
m
a,
in
tu
r
n
,
af
f
e
cts
th
eir
willin
g
n
ess
to
s
ee
k
h
elp
[
3
4
]
.
Pre
v
io
u
s
r
esear
ch
in
d
icate
s
t
h
e
r
elatio
n
s
h
ip
b
etwe
en
k
n
o
wled
g
e,
p
e
r
ce
iv
ed
s
tig
m
a,
an
d
p
er
s
o
n
al
s
tig
m
a
is
q
u
ite
s
im
ilar
.
Hen
ce
,
ad
o
lesce
n
ts
with
b
etter
k
n
o
wled
g
e
o
f
d
ep
r
ess
io
n
ten
d
to
h
av
e
lo
wer
s
tig
m
a
ab
o
u
t
it.
I
t'
s
wo
r
th
n
o
tin
g
th
at
s
tig
m
a
r
e
m
ain
s
a
s
ig
n
if
ican
t
b
ar
r
ier
to
s
ee
k
in
g
h
el
p
,
an
d
b
ec
au
s
e
k
n
o
wled
g
e
ab
o
u
t
d
ep
r
ess
io
n
is
n
eg
ativ
ely
co
r
r
elate
d
with
s
tig
m
a,
ef
f
o
r
ts
s
h
o
u
ld
f
o
c
u
s
o
n
r
ed
u
ci
n
g
p
er
ce
iv
ed
s
tig
m
a.
T
o
ad
d
r
ess
th
is
,
it'
s
cr
u
cial
to
en
h
an
ce
ad
o
lescen
ts
'
u
n
d
er
s
tan
d
i
n
g
o
f
d
e
p
r
ess
io
n
b
y
p
r
o
v
id
in
g
th
em
with
ac
cu
r
at
e
an
d
tr
u
s
two
r
th
y
i
n
f
o
r
m
atio
n
[
1
1
]
.
No
tab
ly
,
th
e
i
n
ter
n
et
is
a
m
ajo
r
s
o
u
r
ce
o
f
in
f
o
r
m
atio
n
f
o
r
ad
o
lescen
ts
,
b
u
t
n
o
t
all
o
n
lin
e
s
o
u
r
ce
s
ar
e
r
eliab
le.
T
h
er
ef
o
r
e,
it'
s
es
s
en
ti
al
to
ed
u
ca
te
th
em
ab
o
u
t
cr
ed
ib
le
in
f
o
r
m
atio
n
s
o
u
r
ce
s
.
Sch
o
o
ls
ca
n
p
lay
a
v
ital
r
o
le
in
d
is
s
em
in
atin
g
k
n
o
wled
g
e
ab
o
u
t
d
ep
r
ess
io
n
an
d
s
er
v
in
g
as
a
tr
u
s
ted
s
o
u
r
ce
o
f
in
f
o
r
m
atio
n
f
o
r
ad
o
lescen
ts
.
Fu
r
th
er
m
o
r
e,
s
ch
o
o
ls
ca
n
co
n
tr
ib
u
te
to
m
en
tal
h
ea
lth
p
r
o
g
r
am
s
f
o
r
ch
ild
r
en
an
d
ad
o
lescen
ts
,
o
f
f
er
in
g
s
u
p
p
o
r
t a
n
d
p
r
o
m
o
tin
g
m
e
n
tal
well
-
b
ein
g
am
o
n
g
a
d
o
lescen
ts
[
3
6
]
.
3
.
5
.
1
.
Study
lim
it
a
t
io
n
T
h
e
s
tu
d
y
'
s
lim
itatio
n
lies
in
i
ts
f
ailu
r
e
to
d
if
f
er
e
n
tiate
b
etwe
en
ad
o
lescen
ts
wh
o
h
a
d
f
r
ie
n
d
s
with
a
h
is
to
r
y
o
f
d
ep
r
ess
io
n
an
d
th
o
s
e
wh
o
d
id
n
o
t.
I
t'
s
ess
en
tial
to
r
ec
o
g
n
is
e
th
at
ad
o
lescen
ts
wit
h
f
r
ien
d
s
wh
o
h
av
e
ex
p
er
ien
ce
d
d
ep
r
ess
io
n
m
ay
h
av
e
a
m
o
r
e
em
p
ath
etic
an
d
in
f
o
r
m
e
d
p
er
s
p
ec
tiv
e.
I
n
co
n
t
r
ast,
th
o
s
e
with
o
u
t
s
u
ch
f
r
ien
d
s
m
ay
lac
k
p
er
s
o
n
a
l
ex
p
o
s
u
r
e
to
th
e
co
n
d
itio
n
,
p
o
ten
tially
lead
in
g
to
d
if
f
er
en
t
attitu
d
es
an
d
lev
els
o
f
s
tig
m
a.
Fu
r
th
er
m
o
r
e,
ad
o
l
escen
ts
h
av
e
d
iv
er
s
e
life
ex
p
er
ien
ce
s
an
d
p
er
s
o
n
al
h
is
to
r
ies.
So
m
e
m
ay
h
av
e
en
co
u
n
ter
e
d
d
ep
r
ess
io
n
in
th
eir
o
wn
f
am
ilies
o
r
with
in
th
eir
clo
s
e
cir
cle
o
f
f
r
ien
d
s
,
wh
ile
o
th
er
s
m
ay
h
av
e
h
ad
n
o
d
ir
ec
t
e
x
p
o
s
u
r
e
to
it.
Mo
r
eo
v
er
,
ad
o
lescen
ts
m
ay
p
o
s
s
ess
d
is
tin
ct
v
iewp
o
in
ts
o
n
d
ep
r
ess
io
n
,
wh
ic
h
a
r
an
g
e
o
f
f
ac
to
r
s
,
in
cl
u
d
in
g
c
u
ltu
r
e,
ed
u
ca
tio
n
,
m
e
d
ia
ex
p
o
s
u
r
e,
an
d
p
er
s
o
n
al
b
elief
s
,
ca
n
in
f
lu
en
ce
.
So
m
e
ad
o
lescen
ts
m
ay
r
eg
ar
d
d
ep
r
e
s
s
io
n
as
a
tr
ea
tab
le
m
ed
ical
co
n
d
itio
n
,
wh
ile
o
th
er
s
m
ig
h
t
h
o
ld
s
tig
m
atis
in
g
o
r
m
is
in
f
o
r
m
ed
v
iews,
p
er
ce
iv
in
g
it a
s
a
s
ig
n
o
f
wea
k
n
ess
o
r
m
o
r
al
f
ailin
g
.
3
.
5
.
2
.
I
m
pli
ca
t
io
n f
o
r
nu
rsin
g
pra
ct
ices
T
h
is
s
tu
d
y
p
r
o
v
es
th
at
g
o
o
d
-
k
n
o
wled
g
e
ad
o
lescen
ts
h
a
v
e
a
lo
w
s
tig
m
a
ab
o
u
t
d
ep
r
ess
io
n
.
T
h
u
s
,
th
is
r
esear
ch
h
as im
p
licatio
n
s
th
at
th
er
e
is
a
n
ee
d
f
o
r
in
n
o
v
ativ
e
i
n
ter
v
en
tio
n
s
to
in
c
r
ea
s
e
ad
o
le
s
ce
n
t k
n
o
wled
g
e
to
r
ed
u
ce
t
h
e
s
tig
m
a
a
b
o
u
t
d
e
p
r
ess
io
n
am
o
n
g
a
d
o
lescen
ts
.
Als
o
,
co
n
d
u
ctin
g
m
o
r
e
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s
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ed
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s
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m
a
o
f
d
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ess
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o
s
s
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y
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d
th
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4.
CO
NCLU
SI
O
N
T
h
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s
tu
d
y
f
i
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d
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g
s
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d
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a
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h
a
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tr
ate
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if
ican
t
lev
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s
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s
d
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ess
io
n
.
I
t'
s
ev
id
en
t
th
at
th
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e
ex
is
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a
s
ig
n
if
ican
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r
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ically
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k
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m
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atis
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it.
E
f
f
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ts
s
h
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ld
f
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cu
s
o
n
in
cr
ea
s
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en
ess
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tial
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ar
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ier
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th
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t
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t
s
f
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o
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s
ee
k
in
g
ass
is
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ce
an
d
eq
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ip
p
in
g
s
ch
o
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l
co
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ello
r
s
with
ap
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lf
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m
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t
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v
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ca
tes
f
o
r
m
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tal
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s
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Fu
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th
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eg
ativ
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attitu
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es su
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r
o
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m
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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