Stressors and child and adolescent psychopathology: measurement issues and prospective effects

Non-suicidal self-injury and life stress: A systematic meta-analysis and theoretical elaboration

Recent years have seen a considerable growth of interest in the study of life stress and non-suicidal self-injury (NSSI). The current article presents a systematic review of the empirical literature on this association. In addition to providing a comprehensive meta-analysis, the current article includes a qualitative review of the findings for which there were too few cases (i.e., <3) for reliable approximations of effect sizes. Across the studies included in the meta-analysis, a significant but modest relation between life stress and NSSI was found (pooled OR=1.81 [95% CI=1.49-2.21]). After an adjustment was made for publication bias, the estimated effect size was smaller but still significant (pooled OR=1.33 [95% CI=1.08-1.63]). This relation was moderated by sample type, NSSI measure type, and length of period covered by the NSSI measure. The empirical literature is characterized by several methodological limitations, particularly the frequent use of cross-sectional analyses involving temporal overlap between assessments of life stress and NSSI, leaving unclear the precise nature of the relation between these two phenomena (e.g., whether life stress may be a cause, concomitant, or consequence of NSSI). Theoretically informed research utilizing multi-wave designs, assessing life stress and NSSI over relatively brief intervals, and featuring interview-based assessments of these constructs holds promise for advancing our understanding of their relation. The current review concludes with a theoretical elaboration of the association between NSSI and life stress, with the aim of providing a conceptual framework to guide future study in this area.

Exposure to Community Violence and the Trajectory of Internalizing and Externalizing Symptoms in a Sample of Low-Income Urban Youth

This study examined trajectories of psychopathology in a sample of low-income urban youth and tested exposure to community violence as a predictor of these trajectories. Self-report and parent-report survey measures of psychological problems and exposure to community violence were collected annually over 3 years from a sample of 364 fifth- to ninth-grade low-income urban youth (64% female; 95% youth of color). Linear growth models showed that youth experienced declines in both internalizing and externalizing symptoms across adolescence. Exposure to community violence was more strongly associated with externalizing symptoms than with internalizing symptoms but predicted declines in both types of symptoms. Results also indicated that youth reported more internalizing and externalizing symptoms than their parents reported for them. Exposure to community violence may explain unique trajectories of mental health problems among low-income urban youth. In addition, youth efforts to adopt a tough façade in the face of community violence could lead to higher rates of externalizing problems relative to internalizing problems, whereas desensitization processes may better explain reductions in both types of symptoms over time. Finally, youth report may be more valid than parent report in the context of urban poverty.

Adolescence and the ontogeny of the hormonal stress response in male and female rats and mice

Adolescent development is marked by many changes in neuroendocrine function, resulting in both immediate and long-term influences on an individual's physiology and behavior. Stress-induced hormonal responses are one such change, with adolescent animals often showing different patterns of hormonal reactivity following a stressor compared with adults. This review will describe the unique ways in which adolescent animals respond to a variety of stressors and how these adolescent-related changes in hormonal responsiveness can be further modified by the sex and previous experience of the individual. Potential central and peripheral mechanisms that contribute to these developmental shifts in stress reactivity are also discussed. Finally, the short- and long-term programming effects of chronic stress exposure during adolescence on later adult hormonal responsiveness are also examined. Though far from a clear understanding of the neurobehavioral consequences of these adolescent-related shifts in stress reactivity, continued study of developmental changes in stress-induced hormonal responses may shed light on the increased vulnerability to physical and psychological dysfunctions that often accompany a stressful adolescence.

Intrinsic and extrinsic goals as moderators of stress and depressive symptoms in Chinese undergraduate students: A multi-wave longitudinal study

BACKGROUND

Studies in western countries have examined the specific vulnerability hypothesis of Dykman's theory of goal-orientation predispositions to depression through two-time point designs. The purpose of this prospective longitudinal study was to investigate the moderating effects of intrinsic and extrinsic goals on stress and depressive symptoms in Chinese undergraduate students.

METHODS

A total of 462 undergraduate students [46% female; mean age, 19.06 (range, 17-22) years] completed self-reported measures assessing intrinsic and extrinsic goals, depressive symptoms, and the occurrence of social and academic hassles. Every 3 months over the subsequent 12 months, the undergraduate students completed measures assessing depressive symptoms and the occurrence of daily hassles.

RESULTS

Results of hierarchical linear modeling analyses indicated that undergraduate students with low levels of intrinsic goals reported greater depressive symptoms following the occurrence of social and academic hassles than did those with high levels of such goals. However, undergraduate students with high levels of extrinsic goals did not report greater depressive symptoms following the occurrence of social and academic hassles than did those possessing low levels.

CONCLUSIONS

These findings suggest that intrinsic goals can protect undergraduate students experiencing high levels of social and academic hassles from depressive symptoms. The study findings provide new insight into the course of depressive symptoms among undergraduate students, and offer psychologist and psychiatrists ways to protect individuals from depressive symptoms by building up intrinsic goals.

Chronic Stress and Adolescents' Mental Health: Modifying Effects of Basal Cortisol and Parental Psychiatric History. The TRAILS Study

Large individual differences in adolescent mental health following chronic psychosocial stress suggest moderating factors. We examined two established moderators, basal cortisol and parental psychiatric history, simultaneously. We hypothesized that individuals with high basal cortisol, assumed to indicate high context sensitivity, would show relatively high problem levels following chronic stress, especially in the presence of parental psychiatric history. With Linear Mixed Models, we investigated the hypotheses in 1917 Dutch adolescents (53.2 % boys), assessed at ages 11, 13.5, and 16. Low basal cortisol combined with the absence of a parental psychiatric history increased the risk of externalizing but not internalizing problems following chronic stress. Conversely, low basal cortisol combined with a substantial parental psychiatric history increased the risk of internalizing but not externalizing problems following chronic stress. Thus, parental psychiatric history moderated stress- cortisol interactions in predicting psychopathology, but in a different direction than hypothesized. We conclude that the premise that basal cortisol indicates context sensitivity may be too crude. Context sensitivity may not be a general trait but may depend on the nature of the context (e.g., type or duration of stress exposure) and on the outcome of interest (e.g., internalizing vs. externalizing problems). Although consistent across informants, our findings need replication.

Development of an Empirically Based Preventive Intervention for Depression in Preadolescent African American Girls

We describe the development, feasibility, and acceptability of a novel preventive intervention for depression in African American girls living in urban poverty. Our approach targeted individual and interpersonal vulnerabilities that have been shown to confer risk for depression in samples of African American girls living in low-income, urban settings, including suppression of negative emotion and lack of assertiveness with peers, memory for positive emotion, active coping, and family connection. Focus groups and an open trial were conducted to refine the goals and mechanisms for skill building. A randomized controlled trial (RCT) of the new program (Cities Mother-Daughter Project) was conducted with 3rd-5th grade students from Chicago Public Schools (CPS). Three cycles of screening, randomization, and deployment were conducted to assess feasibility, satisfaction, and usability. Results indicate that feasibility was weak; whereas, satisfaction and usability were high. Future directions for testing efficacy are discussed.

Self-compassion in recovery following potentially traumatic stress: longitudinal study of at-risk youth

Despite promising theory, empirical study of the putative protective properties of self-compassion (SC) with respect to resilience to and recovery from traumatic stress is limited. The present study tested the theorized protective role(s) of SC with respect to trauma-related psychopathology over time among an at-risk sample of adolescents (N = 64, 26 % females, M(SD) age  = 17.5(1.07) years-old, range age  = 15-19; grades 9-12) directly exposed to a potentially traumatic stressful event - the Mount Carmel Forest Fire Disaster. The longitudinal design involved three assessment time-points - within 30-days of the potentially traumatic event (T1) and then at 3- (T2) and 6-months (T3) follow-up intervals. Consistent with prediction, multi-level modeling of mediation documented the prospective protective function(s) of SC, above and beyond dispositional mindfulness, with respect to posttraumatic stress and panic symptoms, depressive symptoms, and suicidality symptoms, but not well-being. The findings are discussed, theoretically, with respect to SC as a malleable protective factor for trauma-related psychopathology outcomes; and, clinically, with respect to SC as a target for future trauma-related selective-prevention and -early intervention research.

Diffusion Modelling Reveals the Decision Making Processes Underlying Negative Judgement Bias in Rats

Human decision making is modified by emotional state. Rodents exhibit similar biases during interpretation of ambiguous cues that can be altered by affective state manipulations. In this study, the impact of negative affective state on judgement bias in rats was measured using an ambiguous-cue interpretation task. Acute treatment with an anxiogenic drug (FG7142), and chronic restraint stress and social isolation both induced a bias towards more negative interpretation of the ambiguous cue. The diffusion model was fit to behavioural data to allow further analysis of the underlying decision making processes. To uncover the way in which parameters vary together in relation to affective state manipulations, independent component analysis was conducted on rate of information accumulation and distances to decision threshold parameters for control data. Results from this analysis were applied to parameters from negative affective state manipulations. These projected components were compared to control components to reveal the changes in decision making processes that are due to affective state manipulations. Negative affective bias in rodents induced by either FG7142 or chronic stress is due to a combination of more negative interpretation of the ambiguous cue, reduced anticipation of the high reward and increased anticipation of the low reward.

An evaluation of the healthy immigrant effect with adolescents in Canada: Examinations of gender and length of residence

BACKGROUND

The healthy immigrant effect, HIE, is the finding that immigrants initially arrive in the settlement society in the same or better health than their native-born counterparts, yet this advantage is lost as their length of residence increases. This phenomenon has been found among adult populations.

OBJECTIVE

The present study sought to extend the premise of HIE to adolescents in Canada.

METHODS

Utilizing national data sets of three years (Canadian Community Health Survey 2007, 2009, 2011; Statistics Canada), adolescents (aged 12-19), foreign-born immigrants (N = 2919) and native-born non-immigrants (N = 39,083), were compared for their perceived general health and mental health as well as diagnosed chronic illnesses and psychological illnesses. Multiple imputations were first carried out for the degrees of missing values, and multivariate analyses were conducted to find differences between non-immigrants and immigrants, and between recent and long-term immigrants to verify (1) whether immigrant adolescents show better health than their non-immigrant peers, (2) whether the health of immigrant adolescents vary with length of residence and gender, and (3) whether persistent trends would be shown across the three survey years.

RESULTS

After adjusting for age, visible minority status, household income and household size as covariates, immigrant adolescents indeed reported better health in all four measures in each survey year. Girls experienced more health problems regardless of immigrant status, especially for chronic and psychological illnesses. However, only in 2009 the long-term immigrant adolescents reported less favorite health than recent immigrants, and length of residence influenced boys' and girls' mental health in different directions.

CONCLUSIONS

The HIE was confirmed with national community population samples of adolescents in Canada: foreign-born immigrant adolescents experience better health than their native-born peers. However, understanding of the HIE needs to be further extended to encompass the influence of societal contexts and their impact on various segments of populations.

Support for the Multidimensional Adolescent Stress Questionnaire in a Sample of Adolescents in the United Kingdom

Adolescence is a time of physical, social and emotional development, and this development can be accompanied by feelings of stress. The Adolescent Stress Questionnaire is a 56-item scale measuring stress in 10 domains. Developed in Australia, the scale has been translated, and its reliability and validity have been tested in a number of countries across Europe, where the 10-factor, 56-item version of the scale has received little support. The present study tested the factor structure, construct validity and reliability in a sample (n = 610) of adolescents in the United Kingdom. Support was found for the 10-factor, 56-item version of the scale, and correlations with self-concept measures, sex scores on stress factors and Cronbach's α-values, suggesting that the scale may be a viable assessment tool for adolescent stress. Results for alcohol-specific analyses support the domain-specific nature of the scale. Future work may seek to investigate the stability of age-specific stress domains (e.g. the stress of Emerging Adult Responsibility) in samples that include younger adolescents.

A Qualitative Evaluation of Student Learning and Skills Use in a School-Based Mindfulness and Yoga Program

Previous studies on school-based mindfulness and yoga programs have focused primarily on quantitative measurement of program outcomes. This study used qualitative data to investigate program content and skills that students remembered and applied in their daily lives. Data were gathered following a 16-week mindfulness and yoga intervention delivered at three urban schools by a community non-profit organization. We conducted focus groups and interviews with nine classroom teachers who did not participate in the program and held six focus groups with 22 fifth and sixth grade program participants. This study addresses two primary research questions: (1) What skills did students learn, retain, and utilize outside the program? and (2) What changes did classroom teachers expect and observe among program recipients? Four major themes related to skill learning and application emerged as follows: (1) youths retained and utilized program skills involving breath work and poses; (2) knowledge about health benefits of these techniques promoted self-utilization and sharing of skills; (3) youths developed keener emotional appraisal that, coupled with new and improved emotional regulation skills, helped de-escalate negative emotions, promote calm, and reduce stress; and (4) youths and teachers reported realistic and optimistic expectations for future impact of acquired program skills. We discuss implications of these findings for guiding future research and practice.

Predictors of change in depressive symptoms from preschool to first grade

Children's depressive symptoms in the transition from preschool to school are rarely investigated. We therefore tested whether children's temperament (effortful control and negative affect), social skills, child psychopathology, environmental stressors (life events), parental accuracy of predicting their child's emotion understanding (parental accuracy), parental emotional availability, and parental depression predict changes in depressive symptoms from preschool to first grade. Parents of a community sample of 995 4-year-olds were interviewed using the Preschool Age Psychiatric Assessment. The children and parents were reassessed when the children started first grade (n = 795). The results showed that DSM-5 defined depressive symptoms increased. Child temperamental negative affect and parental depression predicted increased, whereas social skills predicted decreased, depressive symptoms. However, such social skills were only protective among children with low and medium effortful control. Further, high parental accuracy proved protective among children with low effortful control and high negative affect. Thus, interventions that treat parental depression may be important for young children. Children with low effortful control and high negative affect may especially benefit from having parents who accurately perceive their emotional understanding. Efforts to enhance social skills may prove particularly important for children with low or medium effortful control.

Measuring adolescents' exposure to victimization: The Environmental Risk (E-Risk) Longitudinal Twin Study

This paper presents multilevel findings on adolescents' victimization exposure from a large longitudinal cohort of twins. Data were obtained from the Environmental Risk (E-Risk) Longitudinal Twin Study, an epidemiological study of 2,232 children (1,116 twin pairs) followed to 18 years of age (with 93% retention). To assess adolescent victimization, we combined best practices in survey research on victimization with optimal approaches to measuring life stress and traumatic experiences, and introduce a reliable system for coding severity of victimization. One in three children experienced at least one type of severe victimization during adolescence (crime victimization, peer/sibling victimization, Internet/mobile phone victimization, sexual victimization, family violence, maltreatment, or neglect), and most types of victimization were more prevalent among children from low socioeconomic backgrounds. Exposure to multiple victimization types was common, as was revictimization; over half of those physically maltreated in childhood were also exposed to severe physical violence in adolescence. Biometric twin analyses revealed that environmental factors had the greatest influence on most types of victimization, while severe physical maltreatment from caregivers during adolescence was predominantly influenced by heritable factors. The findings from this study showcase how distinct levels of victimization measurement can be harmonized in large-scale studies of health and development.

The impact of early life stress on risk of tobacco smoking initiation by adolescents

AIMS

Our study aimed to examine the association between early life stress and early initiation of alcohol and tobacco use.

DESIGN

This prospective cohort study of women and children belongs to the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood.

SETTING

Dniprodzerzhynsk, a city of some 250,000 inhabitants in south central Ukraine.

PARTICIPANTS

All 4398 women who visited antenatal clinics between December 25, 1992 and July 23, 1994, planned to continue their pregnancy, and were permanent residents of the city were invited to participate. Of the 4398 invitees, 2148 agreed and 1020 of the mother-child pairs were available for complete follow-up until the children were 16 years old.

MEASUREMENTS

When study children reached ages 3 and 7, their mothers completed questionnaires about their children's exposure to and impact from a standard list of recent stressful life events. From the data on event prevalence and severity, we assigned each child to low, medium, or high early life stress. When the children became age 16, they completed questionnaires about their history of smoking and drinking.

FINDINGS

In multivariate analysis that controlled for current level of family income, current family type, current school type, year of child's birth, lifetime smoking and current drinking by mother, and education of mother and father, girls with high stress at age 3 had 2.2 times (95% confidence interval: 1.23-4.08) higher odds than girls with low stress to start smoking early.

CONCLUSIONS

Our study may be the first to use a longitudinal study design to examine early life stress as a risk factor for early smoking initiation in adolescence.

Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress

Depression is a debilitating mental illness with clear developmental patterns from childhood through late adolescence. Here, we present data from the Gene Environment Mood (GEM) study, which used an accelerated longitudinal cohort design with youth (N = 665) starting in 3rd, 6th, and 9th grades, and a caretaker, who were recruited from the general community, and were then assessed repeatedly through semistructured diagnostic interviews every 6 months over 3 years (7 waves of data) to establish and then predict trajectories of depression from age 8 to 18. First, we demonstrated that overall prevalence rates of depression over time, by age, gender, and pubertal status, in the GEM study closely match those trajectories previously obtained in past developmental epidemiological research. Second, we tested whether a genetic vulnerability-stress model involving 5-HTTLPR and chronic peer stress was moderated by developmental factors. Results showed that older aged adolescents with SS/SL genotype, who experienced higher peer chronic stress over 3 years, were the most likely to be diagnosed with a depressive episode over time. Girls experiencing greater peer chronic stress were the most likely to develop depression. This study used repeated assessments of diagnostic interviewing in a moderately large sample of youth over 3 years to show that depression rates increase in middle to late adolescence, or postpubertally, and that the gender difference in depression emerges earlier in adolescence (age 12.5), or postpubertally. Additionally, genetically susceptible older adolescents who experience chronic peer stress were the most likely to become depressed over time.

Increased Pre- and Early-Adolescent Stress in Youth with a Family History of Substance Use Disorder and Early Substance Use Initiation

Individuals with a family history of substance use disorders (Family History Positive) are more likely to have early-onset substance use (i.e., prior to age 15), which may contribute to their higher rates of substance use disorders. One factor that may differentiate Family History Positive youth who engage in early-onset substance use from other Family History Positive youth is exposure to stressors. The aim of this study was to quantify how exposure to stressors from age 11-15 varies as a function of family history of substance use disorders and early-onset substance use. Self-reported stressors were prospectively compared in a sample of predominately (78.9%) Hispanic youth that included 68 Family History Positive youth (50% female) who initiated substance use by age 15 and demographically matched non-users with (n = 136; 52.9% female) and without (n = 75; 54.7% female) family histories of substance use disorders. Stressors were assessed at 6-month intervals for up to 4 years. Both the severity of stressors and the degree to which stressors were caused by an individual's own behavior were evaluated. All three groups differed from one another in overall exposure to stressors and rates of increase in stressors over time, with Family History Positive youth who engaged in early-onset substance use reporting the greatest exposure to stressors. Group differences were more pronounced for stressors caused by the participants' behavior. Family History Positive users had higher cumulative severity of stressors of this type, both overall and across time. These results indicate greater exposure to stressors among Family History Positive youth with early-onset substance use, and suggest that higher rates of behavior-dependent stressors may be particularly related to early-onset use.

A Review of the Direct and Interactive Effects of Life Stressors and Dispositional Traits on Youth Psychopathology

Stressors and dispositional traits have been implicated in youth psychopathology; however, the direct effects from stressors or traits alone may be insufficient for explaining maladaptive development. Evidence for the impact of stressors and dispositional traits has largely progressed within separate lines of inquiry, resulting in disunited etiological models and variable empirical support. Existing research on the concurrent effects of stressors and traits has also been hindered by several conceptual issues-including mixed evidence for specificity effects, inconsistent operationalization of stressors, and inadequate coverage of dispositional traits across development-making it difficult to draw conclusions across studies. The current review aims to unify these independent lines of inquiry by evaluating prior research according to three theoretical frameworks: (1) additive, (2) diathesis-stress, and (3) social push models. Implications for assessment, prevention, and intervention efforts in clinical child and adolescent psychopathology are discussed.

Longitudinal relations between stress and depressive symptoms in youth: coping as a mediator

The present prospective study examined the relations among stressful life events, coping, and depressive symptoms in children at varied risk for depression. Participants were 227 children between 7 and 17 years old (mean age = 12.13 years, SD = 2.31, 54.6 % female) who were part of a longitudinal study of depressed and nondepressed parents and their children. Youth completed measures assessing stressful life events and coping strategies at four time points over 22 months. Children's depressive symptoms were assessed at each time point by clinical interviews of parents and children, and children's self-report. Structural equation modeling indicated that stressful life events significantly predicted subsequent depressive symptoms. Bootstrap analyses of the indirect effects in three different models revealed that primary control engagement coping and disengagement coping strategies partially mediated the relation between stressful life events and children's depressive symptoms across time. Regarding the direction of effects, more consistent relations were found for coping as a mediator of the link from stress to depressive symptoms than from symptoms to stress. Thus, one potential mechanism by which stressful life events may contribute to depressive symptoms in children is through less use of primary control coping and greater use of disengagement coping strategies. This is consistent with the view that the adverse effects of stress may contribute to impairments in the ability to cope effectively.

Treadmill exercise alleviates stress-induced impairment of social interaction through 5-hydroxytryptamine 1A receptor activation in rats

Brain-derived neurotrophic factor (BDNF) and its receptors tyrosine kinase B (trkB), and cyclic adenosine monophosphate response element binding protein (CREB) have been suggested as the neurobiological risk factors causing depressive disorder. Serotonin (5-hydroxytryptamine, 5-HT) plays an important role in the pathogenesis of depression. We in-vestigated the effect of treadmill exercise on social interaction in relation with BDNF and 5-HT expressions following stress in rats. Stress was induced by applying inescapable 0.2 mA electric foot shock to the rats for 7 days. The rats in the exercise groups were forced to run on a motorized treadmill for 30 min once a day for 4 weeks. Social interaction test and western blot for BDNF, TrkB, pCREB, and 5-HT1A in the hippocampus were performed. The results indicate that the spend time with unfamiliar partner was decreased by stress, in contrast, treadmill exercise increased the spending time in the stress-induced rats. Expressions of BDNF, TrkB, and pCREB were decreased by stress, in contrast, treadmill exercise enhanced expressions of BDNF, TrkB, and pCREB in the stress-induced rats. In addition, 5-HT1A receptor expression was de-creased by stress, in contrast, treadmill exercise enhanced 5-HT1A expression in the stress-induced rats. In the present study, treadmill exercise alleviated stress-induced social interaction impairment through enhancing hippocampal plasticity and serotonergic function in the hippocampus. These effects of treadmill exercise are achieved through 5-HT1A receptor activation.

Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach

Background

Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions.

Objective

(1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes.

Methods

The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches.

Results

The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015.

Conclusions

There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.

Depressive symptoms in young, urban schoolchildren: environmental, social, and cognitive risk

This study examined relations among stressors, perceived social competence, attributional style, and depressive symptoms in young urban schoolchildren. Data were collected from 85 5- to 11-year-olds, mostly African American, who attended a public elementary school in a low-income urban area. Social competence was examined as a potential mediator, and attributional style was examined as a potential moderator of the relation between stressful life events and depressive symptoms. Separate analyses were conducted by age and gender. For older children and girls, main effects were found for stressful life events as predictors of depressive symptoms. Mediational analyses indicated that perceived peer acceptance served as a mediator of the relation between stressful life events and depressive symptoms for girls. In addition, attributional style moderated the relation between stressors and depressive symptoms in the older children. Together, findings suggest that significant relations exist among stressful life events, social and cognitive processes, and depressive symptoms in young urban children and that these relations are influenced by gender and development.

Stressor experience negatively affects life satisfaction in adolescents: the positive role of sense of coherence

PURPOSE

The aim of the present study was to investigate the association between different normative stressors, sense of coherence and life satisfaction separately for gender in Norwegian adolescents. The interaction effect of stress by sense of coherence in relation to life satisfaction was also investigated.

METHODS

The data are based on a cross-sectional sample of 1239 adolescents (13-18 years) from public elementary and secondary schools in Central Norway. Hierarchical multiple regression analysis was used to evaluate the association between stressors, sense of coherence and life satisfaction, separately for gender.

RESULTS

The results showed significant differences between genders, where boys reported higher scores than girls on sense of coherence and life satisfaction, whereas girls scored higher than boys on five of seven stressor domains. All stressors were significantly and inversely associated with life satisfaction in both genders; however, all associations were stronger for girls compared to boys. Sense of coherence showed a significant strong and positive association with life satisfaction, controlled for age and each individual stressor. A significant although weak interaction effect of stress related to romantic relationships by sense of coherence was found in association with life satisfaction for boys; the other interaction effects were nonsignificant in both genders.

CONCLUSION

The results give support for a significant unique role of stressor experience and sense of coherence in relation to life satisfaction in both genders during adolescence, where the associations were especially strong in girls.

Stress-Induced Depression Is Alleviated by Aerobic Exercise Through Up-Regulation of 5-Hydroxytryptamine 1A Receptors in Rats

PURPOSE

Stress is associated with depression, which induces many psychiatric disorders. Serotonin, also known as 5-hydroxy-tryptamine (5-HT), acts as a biochemical messenger and regulator in the brain. It also mediates several important physiological functions. Depression is closely associated with an overactive bladder. In the present study, we investigated the effect of treadmill exercise on stress-induced depression while focusing on the expression of 5-HT 1A (5-H1A) receptors in the dorsal raphe.

METHODS

Stress was induced by applying a 0.2-mA electric foot shock to rats. Each set of electric foot shocks comprised a 6-second shock duration that was repeated 10 times with a 30-second interval. Three sets of electric foot shocks were applied each day for 7 days. For the confirmation of depressive state, a forced swimming test was performed. To visualize the expression of 5-HT and tryptophan hydroxylase (TPH), immunohistochemistry for 5-HT and TPH in the dorsal raphe was performed. Expression of 5-H1A receptors was determined by western blot analysis.

RESULTS

A depressive state was induced by stress, and treadmill exercise alleviated the depression symptoms in the stress-induced rats. Expressions of 5-HT, TPH, and HT 1A in the dorsal raphe were reduced by the induction of stress. Treadmill exercise increased 5-HT, TPH, and HT 1A expressions in the stress-induced rats.

CONCLUSIONS

Treadmill exercise enhanced 5-HT synthesis through the up-regulation of 5-HT1A receptors, and improved the stress-induced depression. In the present study, treadmill exercise improved depression symptoms by enhancing 5-HT1A receptor expression. The present results suggest that treadmill exercise might be helpful for the alleviation of overactive bladder and improve sexual function.

Aerobic exercise, ball sports, dancing, and weight lifting as moderators of the relationship between stress and depressive symptoms: an exploratory cross-sectional study with swiss university students

This exploratory study was designed to compare four types of exercise activities in Swiss university students. A sample of 201 medical students (136 women, 65 men; M age = 23.2 yr., SD = 2.4) and 250 exercise and health sciences students (144 women, 106 men; M age = 22.3 yr., SD = 2.2) participated in the study. They completed the Perceived Stress Scale, the Depression Scale, and the Office in Motion Questionnaire. Interaction effects between stress and exercise activities were analysed using hierarchical regression analyses, after controlling for age, sex, and academic discipline. Frequent participation in ball sports and dancing were associated with decreased depressive symptoms among students with elevated perceived stress, whereas no such relationship existed among their peers with lower perceived stress. No stress-moderating effect was found for aerobic exercise. Weight lifting was only associated with lower depressive symptoms among students with low perceived stress. The present findings suggest that, among Swiss university students, certain exercises may have better potential to moderate the relationship between perceived stress and depressive symptoms than others. Future research could analyze whether personalized exercise programs created to satisfy participants' individual needs are more beneficial for stress management.

The relationship between stress and body satisfaction in female and male adolescents

This study investigated the relationship between stress and body satisfaction in adolescence. A sample consisting of 515 adolescents aged 12-16 years completed a series of self-report questionnaires assessing general and specific aspects of adolescent stress, body satisfaction and the psychological constructs of self-esteem, depressive symptoms and body importance. Results revealed a significant association between higher body dissatisfaction and higher ratings of peer stress, lower self-esteem and greater body importance for female and male adolescents. These findings suggest that adolescent stress relates to satisfaction with the body and that this stress is specifically focused on the peer environment for both genders during adolescence. This may have implications for intervention programmes aimed at improving body satisfaction, suggesting that the inclusion of stress management training in these programmes could specifically focus on difficulties within the peer domain.

Chronic and Episodic Stress in Children of Depressed Mothers

The goal of this study was to examine chronic and episodic stress in children of mothers with and without a history of major depressive disorder (MDD) during the children's lives. Participants were 255 mothers selected according to their history of MDD (present vs. absent during child's life) and their children (age 8-14; 53% girls, 81% Caucasian). Mothers' and children's histories of MDD were assessed using diagnostic interviews, and their depressive symptoms were assessed via self-report measures. Children's levels of chronic and episodic stress were assessed using a semistructured contextual threat interview. Children of mothers with a history of recurrent MDD, compared to single MDD or no depression, experienced more chronic stress within several domains including peers, mother-child relations, and other family member relations as well as greater episodic dependent interpersonal stress. Each of these group differences was maintained after excluding children with a history of MDD themselves and controlling for their current depressive symptoms. However, only the group difference in chronic peer stress was maintained when controlling for mothers' current depression. The results suggest that children exposed to recurrent maternal MDD experience higher levels of both chronic and episodic stress, at least some of which they contribute to themselves (dependent interpersonal stress) and which is at least partially independent of the effects of children's depression. In addition, much of this stress is associated primarily with current depression in the mother, though it appears that chronic peer stress may remain elevated even after the remission of maternal depression.

Adolescent health and adaptation in Canada: examination of gender and age aspects of the healthy immigrant effect

Introduction

A longstanding and widely held assumption is that immigrants suffer from ill health and adaptation problems. Yet recent studies show that immigrants report the same or better state of health compared to their native-born counterparts. This phenomenon, known as the healthy immigrant effect, has been found in studies of specific health conditions of adults. The present study focuses instead on adolescents and extends its examination of the healthy immigrant effect, measuring both health and adaptation.

Methods

Using data from population samples in the Canadian Community Health Survey (2007), foreign-born immigrant adolescents (n = 920) were compared to non-immigrant adolescents (n = 13,572) for their self-report to questionnaire items for health (general health, mental health, chronic illnesses with psychosomatic symptoms, and psychological illnesses) and adaptation (daily life stress, life satisfaction, and sense of belonging). Adolescents’ gender, age, and length of residence were analyzed for the effects.

Results

Immigrant adolescents were better than non-immigrant peers on the four health measures, and did not differ from non-immigrants on the three adaptation measures despite having less household income and more family members in the household. Immigrant girls exhibited more resilient adaptability, while young immigrant boys and older non-immigrant girls displayed some potential vulnerability. Length of residence, on the other hand, did not contribute to differences for the health and adaptation of immigrant adolescents.

Conclusions

The healthy immigrant effect was confirmed in a community population sample of adolescents in Canada. Foreign-born immigrant adolescents experience better health, as well as good adaptation equal to their native-born peers. These outcomes call for further research on sustaining good health and adaptation of the immigrant population, in particular by providing age-related effective services and prevention strategies.

"Sleep well, our tough heroes!"--in adolescence, greater mental toughness is related to better sleep schedules

Mental toughness (MT) is understood as the display of confidence, commitment, challenge, and control. The aim of this study was to explore the extent to which greater MT is associated with subjectively assessed sleep among adolescents. A total of 284 adolescents (M = 18.26 years) completed a series of questionnaires assessing MT, psychological functioning, and sleep. Greater MT was significantly associated with better sleep quality, shorter sleep onset latency, fewer awakenings after sleep onset, and longer sleep duration. Greater MT was also associated with less perceived stress and less depressive symptoms. MT was directly and indirectly associated with sleep quality. Mentally tough adolescents report good sleep quality and sleep schedules, along with psychological wellbeing.

Differential Reporting of Adolescent Stress as a Function of Maternal Depression History

The depression-distortion hypothesis posits that depressed mothers report child characteristics in a negatively-biased manner, motivating research on discrepant reporting between depressed mothers and their children. However, the literature has predominately focused on report discrepancies of youth psychopathological and behavioral outcomes, with limited focus on youth stress despite the marked increase of stressful events during adolescence. The current study investigated whether the presence versus absence of a maternal history of major depressive disorder differentially influenced reporting of adolescent stress when compared to her child's report, utilizing a community sample of diverse adolescents. As hypothesized, mothers with a history of depression were more likely to report more youth stress than their children reported. Specifically, mothers with a history of depression were more likely than nondepressed mothers to report more familial, social, and youth-dependent stressors relative to their children; nondepressed mothers were more likely to report less independent stressors than their children.

Two prospective studies of changes in stress generation across depressive episodes in adolescents and emerging adults

The stress generation hypothesis was tested in two different longitudinal studies examining relations between weekly depression symptom ratings and stress levels in adolescents and emerging adults at varied risk for depression. The participants in Study 1 included 240 adolescents who differed with regard to their mothers' history of depressive disorders. Youth were assessed annually across 6 years (Grades 6-12). Consistent with the depression autonomy model, higher numbers of prior major depressive episodes (MDEs) were associated with weaker stress generation effects, such that higher levels of depressive symptoms predicted increases in levels of dependent stressors for adolescents with two or more prior MDEs, but depressive symptoms were not significantly related to dependent stress levels for youth with three or more prior MDEs. In Study 2, the participants were 32 remitted-depressed and 36 never-depressed young adults who completed a psychosocial stress task to determine cortisol reactivity and were reassessed for depression and stress approximately 8 months later. Stress generation effects were moderated by cortisol responses to a laboratory psychosocial stressor, such that individuals with higher cortisol responses exhibited a pattern consistent with the depression autonomy model, whereas individuals with lower cortisol responses showed a pattern more consistent with the depression sensitization model. Finally, comparing across the two samples, stress generation effects were weaker for older participants and for those with more prior MDEs. The complex, multifactorial relation between stress and depression is discussed.

Gender difference in interactions between MAOA promoter uVNTR polymorphism and negative familial stressors on body mass index among Chinese adolescents

OBJECTIVES

Monoamine oxidase A (MAOA) modulates metabolism of serotonin and dopamine metabolism, neurotransmitters involved in regulation of appetite and food intake. The gene coding for MAOA contains a 30-bp tandem repeat (uVNTR) polymorphism in its promoter region that has been previously identified to be associated with obesity with mixed findings in the literature. Our goals were to replicate the population effects of this functional polymorphism on obesity risk, and to further explore gender differences and interaction effects with negative stressors.

METHODS

Analyses were conducted with data on genotypes, measured weight and height, and self-reported behavioural characteristics among 1101 Chinese adolescents 11-15 years old living in Wuhan, China.

RESULTS

Girls with the high-activity allele had significantly lower body mass index (BMI; β = -0.25 ± 0.98, P = 0.011) compared to those with the low activity allele. Experience of negative familial stressors (e.g., death or illness of family members, hit or scolded by parents and increased quarrelling with parents, parents argued frequently) significantly weakened this protective genetic effect on BMI (P for interaction = 0.043). Stratified analyses showed a significant protective genetic effect on BMI only within the stratum of low stress level (β = -0.44 ± 0.14, P = 0.002). No similar effect was observed among boys.

CONCLUSIONS

Our findings confirm the genetic effects of MAOA uVNTR polymorphism on BMI in a Chinese adolescent population and suggest potential genetic interactions with negative familial stressors.

Association between parent and child distress and the moderating effects of life events in families with and without a history of pediatric cancer

OBJECTIVE

Examined the associations between parental and child distress, and moderating effects of child exposure to life events, in families with and without a history of pediatric cancer. 

METHODS

Children with cancer and their parents (N = 255) and healthy comparison dyads (N = 142) completed self-report measures of depression, anxiety, and posttraumatic stress symptoms. Children reported on the total number of stressful life events they had experienced. Correlations between parental and child symptoms were examined. Moderating effects of child exposure to life events were tested using multiple regression. 

RESULTS

Parent and child symptoms were significantly related only in the cancer group. Child exposure to life events attenuated this relationship. Moderation effects were significant at or below average levels of life stress. 

CONCLUSIONS

The experience of childhood cancer may strengthen the link between parent and child psychological functioning. However, child exposure to other life events may weaken this link.

During early and mid-adolescence, greater mental toughness is related to increased sleep quality and quality of life

The aim of this study was to explore the association between mental toughness, subjective sleep, physical activity, and quality of life during early and mid-adolescence. A total of 1475 participants (mean age = 13.4 years; range: 11–16 years) took part in the study. They completed questionnaires related to mental toughness, physical activity, subjective sleep, and quality of life. Greater mental toughness was related to more favorable quality of life and increased subjective sleep. Mental toughness was not related to physical activity. Increased mental toughness, favorable quality of life, and sleep are related during early and mid-adolescence. Against our expectations, mental toughness was not related to physical activity.

Early childhood risk and resilience factors for behavioural and emotional problems in middle childhood

BACKGROUND

Mental disorders in childhood have a considerable health and societal impact but the associated negative consequences may be ameliorated through early identification of risk and protective factors that can guide health promoting and preventive interventions. The objective of this study was to inform health policy and practice through identification of demographic, familial and environmental factors associated with emotional or behavioural problems in middle childhood, and the predictors of resilience in the presence of identified risk factors.

METHODS

A cohort of 706 mothers followed from early pregnancy was surveyed at six to eight years post-partum by a mail-out questionnaire, which included questions on demographics, children's health, development, activities, media and technology, family, friends, community, school life, and mother's health.

RESULTS

Although most children do well in middle childhood, of 450 respondents (64% response rate), 29.5% and 25.6% of children were found to have internalising and externalising behaviour problem scores in the lowest quintile on the NSCLY Child Behaviour Scales. Independent predictors for problem behaviours identified through multivariable logistic regression modelling included being male, demographic risk, maternal mental health risk, poor parenting interactions, and low parenting morale. Among children at high risk for behaviour problems, protective factors included high maternal and child self-esteem, good maternal emotional health, adequate social support, good academic performance, and adequate quality parenting time.

CONCLUSIONS

These findings demonstrate that several individual and social resilience factors can counter the influence of early adversities on the likelihood of developing problem behaviours in middle childhood, thus informing enhanced public health interventions for this understudied life course phase.

Associations between trajectories of perceived racial discrimination and psychological symptoms among African American adolescents

Many African American adolescents experience racial discrimination, with adverse consequences; however, stability and change in these experiences over time have not been examined. We examined longitudinal patterns of perceived racial discrimination assessed in Grades 7-10 and how these discrimination trajectories related to patterns of change in depressive and anxious symptoms and aggressive behaviors assessed over the same 4-year period. Growth mixture modeling performed on a community epidemiologically defined sample of urban African American adolescents (n = 504) revealed three trajectories of discrimination: increasing, decreasing, and stable low. As predicted, African American boys were more frequent targets for racial discrimination as they aged, and they were more likely to be in the increasing group. The results of parallel process growth mixture modeling revealed that youth in the increasing racial discrimination group were four times more likely to be in an increasing depression trajectory than were youth in the low stable discrimination trajectory. Though youth in the increasing racial discrimination group were nearly twice as likely to be in the high aggression trajectory, results were not statistically significant. These results indicate an association between variation in the growth of perceived racial discrimination and youth behavior and psychological well-being over the adolescent years.

Effort-reward imbalance at school and depressive symptoms in Chinese adolescents: the role of family socioeconomic status

Depression is a major mental health problem during adolescence. This study, using a sample of Chinese adolescents, examined the separate and combined effects of perceived school-related stress and of family socioeconomic status (SES) on the prevalence of depressive symptoms. A total of 1774 Chinese students from Grades 7–12 were recruited into our questionnaire survey. School-related stress was measured by the Effort-Reward Imbalance Questionnaire-School Version, family SES was assessed by a standardized question, and depressive symptoms were evaluated by the Center for Epidemiological Studies Depression Scale for Children. Multivariate logistic regression was applied, adjusting for age, gender, grade, smoking, alcohol drinking and physical activity. It was found that high school-related stress and low family SES were associated with elevated odds of depressive symptoms, respectively. The effect of school-related stress was particularly strong in low SES group. In adolescents with both high stress at school and low SES, the odds ratio was 9.18 (95% confidence interval = 6.53–12.89) compared to the reference group (low stress at school and high SES). A significant synergistic interaction effect was observed (synergy index = 2.28, 95% confidence interval = 1.56–3.32). The findings indicated that perceived school-related stress, in terms of effort-reward imbalance, was related to depressive symptoms in this sample of Chinese adolescents. The strong interaction with family SES suggests that health promoting efforts in school settings should be targeted specifically at these socially deprived groups.

Managing stress: the influence of gender, age and emotion regulation on coping among university students in Botswana

This study focused on the influence of gender, age and emotion regulation on coping strategies among university students in Botswana. Sixty-four males and 64 females, ranging in age from 18 to 29 years completed the Difficulty in Emotion Regulation Scale and the Coping Strategy Inventory. Female students used wishful thinking and problem-focused disengagement more than male students; however, there were no other significant gender differences in coping strategies. Older students were more likely to use problem-solving, cognitive restructuring and express emotion coping strategies. In addition, problems in emotion regulation significantly predicted problem-and emotion-focused engagement, problem- and emotion-focused disengagement and coping strategies. There was a unique finding that non-acceptance of emotional responses, a type of emotion suppression, was positively correlated with problem solving, cognitive restructuring, expressing emotion, social support, problem avoidance and wishful thinking coping strategies. Cultural context and implications for student well-being and university support are discussed.

The role of socially prescribed perfectionism in the link between perceived racial discrimination and African American adolescents' depressive symptoms

Research examining the social origins of perfectionism has focused on negative evaluative experiences in the family, with less attention to negative social evaluations in other contexts and situations relevant for African American adolescents. The experience of racial discrimination is common for African American youth, and may trigger maladaptive perfectionistic beliefs if the youth perceive that they do not meet others' standards (socially prescribed perfectionism) or internalize discriminatory messages. Thus, the present study examined longitudinal associations among racial discrimination, socially prescribed perfectionism, and depressive symptoms among a community sample of urban and predominantly low income African American adolescents (n = 492; 46.7 % female). In each of grades 7, 8 and 9, participants reported their experiences with racial discrimination, perfectionistic beliefs, and depressive symptoms. Analyses revealed that experiences with racial discrimination in grade 7 were associated with socially prescribed perfectionism in grade 8 which, in turn, was linked with depressive symptoms in grade 9. Results suggest that prospective associations between the experience of racial discrimination and depressive symptoms are due, in part, to increased socially prescribed perfectionism. Implications for interventions targeting depression in African American are discussed.

Stress and paediatric obesity: what we know and where to go

Childhood obesity is a public health epidemic and is associated with substantial negative physical and psychosocial health consequences. Stress is thought to be one contributor to the development and maintenance of obesity in children and adolescents, yet the linkage between stress and paediatric obesity is a poorly understood phenomenon. This paper furthers the understanding of stress in the context of paediatric obesity by firstly presenting a focused review of what is known about links between chronic and acute stress and paediatric obesity risk and then synthesizing important areas from the literature. These critical areas of focus include the following: (1) physiological stress reactivity; (2) stress-induced eating; (3) stress and physical activity; (4) parent and family influences; and (5) stress in at-risk populations. This review is geared toward facilitating future research on the stress-obesity connection in youth.

Contextual risk and promotive processes in Puerto Rican youths' internalizing trajectories in Puerto Rico and New York

Research on ethnic-minority youths' mental health has rarely examined developmental trajectories for the same ethnic group in contexts where they are a minority versus where they are the majority or mechanisms accounting for differences in trajectories across such contexts. This study examines Puerto Rican youth residing in two contexts, one in which they are in their home culture of Puerto Rico and one in which they are a minority group, in New York. We explore the relationship among social context, minority status, risk, resilience, and trajectories of internalizing symptoms after adjusting for factors related to migration. We found that youths' reports of internalizing symptoms declined over time. Youths in New York had higher levels of internalizing symptoms than did youths in Puerto Rico, but they had similar trajectories. Differences in internalizing symptoms across the two social contexts were accounted for by experiences of discrimination and exposure to violence. Parental monitoring was associated with fewer internalizing symptoms across the two sites, although this effect diminished over time. Contrary to what was expected, family religiosity was associated with higher levels of internalizing symptoms. This association was stronger in New York than in the Puerto Rico site.

Timing of Stressful Life Events Affects Stability and Change of Neuroticism

Neuroticism is a predictor of many health problems. To study the determinants of within–subject change in neuroticism, three hypotheses were tested: (i) subjects who experienced stressful life events (SLEs) show an increase in neuroticism; (ii) high baseline neuroticism moderated this effect; and (iii) recent SLEs had a greater impact on neuroticism than distant SLEs. Data came from the Finnish Twin Cohort. Neuroticism data were collected in 1975 and 1981 and SLEs data in 1981 (n = 21 085). By entering baseline neuroticism as a predictor for neuroticism at follow–up, the outcome measure was change in neuroticism. Changes in neuroticism were predicted from SLE indices or their interaction with baseline neuroticism. Timing of SLEs was taken into account by distinguishing recent from distant SLEs. To control for confounding by shared genes and environments, both within–twin pair and between–twin pair effects were tested for monozygotic and dizygotic twin pairs separately. Neuroticism's six–year stability was high (r = .58, p < .001). Exposure to SLEs modestly increased neuroticism (βs > .55, ps < .001), unconfounded by shared genes. This effect was not moderated by high baseline neuroticism. Recent SLEs (.09 < βs < .15) had more impact than distant SLEs (.03 < βs < .11; ps < .01). In conclusion, the findings strongly supported a model of environmentally driven SLEs causing dynamic fluctuations around a person's set point of neuroticism. Copyright © 2013 John Wiley & Sons, Ltd.

Adolescent depression: stress and reward dysfunction

After participating in this educational activity, the physician should be better able to 1. Evaluate the relationship between reward processes, stress, and depression. 2. Assess the characteristics of the three etiological models of stress and reward processes. 3. Identify the biological basis for stress and reward processes. Adolescence is a peak period for the onset of depression, and it is also a time marked by substantial stress as well as neural development within the brain reward circuitry. In this review, we provide a selective overview of current animal and human research investigating the relationship among reward processes, stress, and depression. Three separate, but related, etiological models examine the differential roles that stress may play in relation to reward dysfunction and adolescent depression. First, the reward mediation model suggests that both acute and chronic stress contribute to reward deficits, which, in turn, potentiate depressive symptoms or increase the risk for depression. Second, in line with the stress generation perspective, it is plausible that premorbid reward-related dysfunction generates stress--in particular, interpersonal stress--which then leads to the manifestation of depressive symptoms. Third, consistent with a diathesis-stress model, the interaction between stress and premorbid reward dysfunction may contribute to the onset of depression. Given the equifinal nature of depression, these models could shed important light on different etiological pathways during adolescence, particularly as they may relate to understanding the heterogeneity of depression. To highlight the translational potential of these insights, a hypothetical case study is provided as a means of demonstrating the importance of targeting reward dysfunction in both assessment and treatment of adolescent depression.