This study aims to investigate an integrative model that explores how two types of self-focused attention—rumination on negative aspects of the self and reflection involving deeper exploration of the self—affect depression among adolescents, mediated by two dimensions of self-esteem. Specifically, the study examines how contingent self-worth, which depends on external standards, and a sense of authenticity, which reflects a feeling of being true to oneself, mediate these relationships. A total of 183 Japanese university students participated in the survey. Self-focused attention was assessed using measures of rumination and reflection; self-esteem was evaluated through scales of authenticity and contingency of self-worth; and depression was measured with the Zung Self-Rating Depression Scale. Structural equation modeling demonstrated a direct positive association between rumination and depressive symptoms, as well as an indirect negative association between reflection and depressive symptoms, with authenticity functioning as a mediating variable. These findings suggest that higher levels of reflection characterized by authenticity and lower levels of rumination may tend to be associated with reduced depressive symptoms in adolescents.

The purpose of this study is to evaluate the development quality and content validity of patient-reported outcome measures (PROMs) of help-seeking skills for children and adolescents. A systematic review was performed in accordance with the COSMIN methodologies. Of the 1362 studies, seven measurement studies met inclusion criteria. Most of the extracted PROMs were characterized by asking about general tendencies without specifying the nature or partner of the help-seeking. Results suggested that none of the PROMs could be recommended for use. Inadequate development quality depended on the unclear measurement concept, the lack of confirmation of correspondence between its measurement concept and items in designing the PROM, and the absence of appropriate cognitive interviews. Poor content validity was evident across all PROMs against a background of non-party involvement.