Parent psychopathology and youth internalizing symptoms in an urban community: a latent growth model analysis

The trajectory of depression and anxiety among children and adolescents over two years of the COVID-19 pandemic

Longitudinal research examining children's mental health (MH) over the course of the COVID-19 pandemic is scarce. We examined trajectories of depression and anxiety over two pandemic years among children with and without MH disorders. Parents and children 2-18 years completed surveys at seven timepoints (April 2020 to June 2022). Parents completed validated measures of depression and anxiety for children 8-18 years, and validated measures of emotional/behavioural symptoms for children 2-7 years old; children ≥10 years completed validated measures of depression and anxiety. Latent growth curve analysis determined depression and anxiety trajectories, accounting for demographics, child and parent MH. Data were available on 1315 unique children (1259 parent-reports; 550 child-reports). Trajectories were stable across the study period, however individual variation in trajectories was statistically significant. Of included covariates, only initial symptom level predicted symptom trajectories. Among participants with pre-COVID data, a significant increase in depression symptoms relative to pre-pandemic levels was observed; children and adolescents experienced elevated and sustained levels of depression and anxiety during the two-year period. Findings have direct policy implications in the prioritization and of maintenance of educational, recreational, and social activities with added MH supports in the face of future events.

Intergenerational Transmission of Depressive Symptoms from Mothers to Adolescents: A Moderated Mediation Model

Substantial literature investigating the intergenerational transmission of depressive symptoms has primarily focused on mothers and adolescents, whereas less is known about the potential role of fathers, especially their parenting behaviors. This study aimed to address this gap by examining the mediating role of maternal parenting, and the moderating role of paternal parenting in this intergenerational transmission pathway. A total of 528 Chinese community adolescents (Mage = 12.70 ± 1.49 years; 48.7%, girls) and their mothers participated. After adolescent sex, age, maternal educational levels, and monthly household income were controlled for, both maternal warmth and rejection mediated the association between maternal and adolescent depressive symptoms. More importantly, paternal warmth buffered the adverse effect of maternal depressive symptoms and maternal rejection on adolescent depressive symptoms. These findings highlight the buffering role of paternal parenting in blocking the intergenerational transmission risk of depressive symptoms from mothers to adolescents and emphasize the need for father-focused interventions.

Anxiety and Depression from Childhood to Young Adulthood: Trajectories and Risk Factors

This study aimed to (1) evaluate how population levels of anxiety and depression grow and correlate from middle childhood through early adulthood, and (2) determine whether sex, family socioeconomic status, parental education, academic achievement, learning disabilities, or externalizing symptoms predict anxiety and/or depression levels and growth trajectory. We used two longitudinal samples (N = 445, 448) of Portuguese children. Mean depression levels increased from mid-childhood through adolescence before stabilizing in early adulthood and were most strongly predicted by academic achievement and learning disabilities. Mean anxiety levels increased until adolescence before decreasing across early adulthood and were most strongly predicted by academic achievement, learning disabilities, and externalizing symptoms. Quadratic models of growth fit best for both depression and anxiety, and depression and anxiety growth trajectories were strongly correlated. Though anxiety and depression trajectories differ in pattern and predictors, the two are highly interrelated and pathways to comorbid anxiety and depression should be characterized.

Longitudinal relationship between maternal distress and pediatric mood symptoms in youth with mood disorders

Parents of a child with a mood disorder report significant levels of distress and burden from caregiving. This study examined whether maternal distress varies over time with levels of mood symptoms in youth with mood disorders, and whether expressed emotion (EE) and family functioning moderate these associations. We recruited youth (ages 9-17 years) with mood disorders and familial risk for bipolar disorder (BD) for a randomized trial of family-focused therapy compared to standard psychoeducation. Participants were assessed every 4-6 months for up to 4 years. Using repeated-measures mixed effects modeling, we examined the longitudinal effects of youths' mood symptoms and maternal distress concurrently, as well as whether each variable predicted the other in successive study intervals. Secondary analyses examined the moderating effects of EE and ratings of family cohesion and adaptability on maternal distress. In sample of 118 youth-mother dyads, levels of self-reported parental distress decreased over time, with no differences between treatment conditions. Youths' depressive symptoms and, most strongly, mood lability were associated with greater maternal distress longitudinally; however, maternal distress did not predict youths' mood symptoms or lability. The effect of youth symptoms on maternal distress was greater among mothers who were high EE. Family cohesion was associated with reduced concurrent ratings of maternal distress, whereas family adaptability was associated with reduced maternal distress at successive follow-ups. While maternal distress decreases over time as youths' symptoms decrease, mothers of youth with mood disorders experience significant distress that is directly linked to the youths' depressive symptom severity and lability. Improved family functioning appears to be an important mechanism by which to intervene.

Mexican-Origin Youths' Trajectories of Internalizing Symptoms from Childhood into Adolescence and Associations with Acculturation Processes

We examined depression and anxiety symptom trajectories in Mexican-origin youth (N = 674) and tested longitudinal associations with acculturation dimensions. We used eight waves of data from the California Families Project, collected annually from 5th (M_age = 10.86, SD = 0.51) to 12th (M_age = 16.79, SD = 0.50) grade. Major depression disorder (MD) and generalized anxiety disorder (GAD) symptoms were assessed by structured psychiatric interview. Cultural measures, selected based on theory and empirical evidence, included English/Spanish use, familism, traditional gender role (TGR) attitudes, and ethnic pride. Symptom trajectories were modeled using latent growth analyses, and parallel process growth models examined covariation between internalizing and acculturation trajectories. Models adjusted for child sex, nativity, mother's education, and family income. MD symptoms decreased across adolescence on average, with steeper decreases among boys and children born in Mexico. GAD symptoms also decreased on average, with higher mean levels among girls. Age 10 Spanish use, familism, and ethnic pride were inversely related to age 10 MD symptoms. Steeper increases in Spanish use, familism, and ethnic pride predicted decreasing MD. Higher age 10 MD predicted increasing Spanish use and decreasing English use. Greater age 10 TGR attitudes predicted higher age 10 GAD but steeper declines in GAD and MD. Increasing ethnic pride slopes predicted decreasing GAD. Greater childhood TGR attitudes, and the maintenance of Spanish use, familism, and ethnic pride into adolescence, were associated with more optimal trajectories of MD and GAD symptoms. Interventions for Mexican-origin youth internalizing problems should encourage the retention of heritage culture strengths, including familism and ethnic pride.

Friendship Quality Moderates the Relation Between Maternal Anxiety and Trajectories of Adolescent Internalizing Symptoms

The current study examined the moderating role of friendship quality on the relation between maternal anxiety and internalizing symptoms in a 3-year prospective study of adolescent development. Participants included 177 adolescents (M _age = 16.05, SD _age = 0.91) and their mothers. Mothers reported their own levels of anxiety; youth completed self-reports of internalizing symptoms and friendship quality. Positive friendship quality moderated the relation between maternal anxiety and initial levels of internalizing symptoms. Maternal anxiety was associated with steeper increases in internalizing symptoms over time, but only for those with greater negative peer interactions. Findings underscore the important role of both parental and peer relationships in the development of internalizing symptoms and highlight specific avenues for clinical interventions.

Do emotional difficulties and peer problems occur together from childhood to adolescence? The case of children with a history of developmental language disorder (DLD)

Children and adolescents with developmental language disorder (DLD) are, overall, vulnerable to difficulties in emotional adjustment and in peer relations. However, previous research has shown that different subgroups follow different trajectories in respect to the quality of peer relations. Less is known about the trajectories of emotional development. We consider here the possibility that development in these two domains is interrelated: that is, the trajectories of emotional and peer problems will proceed in parallel. We conducted longitudinal joint trajectories analyses of emotional and peer relations in a sample of young people identified as having DLD at the age of 7 years and seen at intervals up to 16 years. Potential influences on joint trajectory group membership were examined. Findings revealed five distinct joint trajectories. Emotional and peer difficulties do occur together from childhood to adolescence for just over half of the sample, but not all. The variables most clearly associated with group membership were pragmatic language ability, prosociality and parental mental health. This is the first study to examine joint longitudinal trajectories of emotional and peer difficulties in individuals with DLD. We demonstrate that development in individuals with DLD is heterogeneous and identify three key variables associated with personal and social adjustment from childhood to adolescence. Theoretical and clinical implications of these findings are discussed.

Perceived Demands of Schooling, Stress and Mental Health: Changes from Grade 6 to Grade 9 as a Function of Gender and Cognitive Ability

The link between perceived demands of school, stress and mental health in relation to gender is complex. The study examined, with two waves of longitudinal data at age 13 and age 16, how changes in perceived academic demands relate to changes in perceived stress, taking into account gender and cognitive ability, and to investigate how these factors affect the level of psychosomatic and depressive symptoms at the age of 16. A nationally representative sample including about 9000 individuals from the Swedish longitudinal Evaluation Through Follow up database born in 1998 was included. A growth modelling approach was applied to examine relations over time. The results show girls to have a considerably higher self-reported level of mental health problems at the end of compulsory school than boys. This gender difference is entirely accounted for by perceived school demands and stress in grades 6 and 9. Students who were stronger in inductive than vocabulary ability reported lower levels of perceived academic demands and less stress in grade 6. There is a need to develop interventions for minimizing the consequences of stress among adolescents and modify those particular aspects of academic demands which cause stress and poor mental health, especially among girls. Copyright © 2016 John Wiley & Sons, Ltd.

Depressive symptom trajectories in late adolescence and early adulthood: A systematic review

OBJECTIVE

In adolescents and young adults, depressive symptoms are highly prevalent and dynamic. For clinicians, it is difficult to determine whether a young person reporting depressive symptoms is at risk of developing ongoing mood difficulties or whether symptoms form part of a transient maturational process. Trajectory analyses of longitudinally assessed symptoms in large cohorts have the potential to untangle clinical heterogeneity by determining subgroups or classes of symptom course and their risk factors, by interrogating the impact of known or suspected risk factors on trajectory slope and intercept and by tracing the interrelation between depressive symptoms and other clinical outcomes over time.

METHOD

We conducted a systematic review of trajectory studies conducted in cohorts including people aged between 15 and 25 years.

RESULTS

We retrieved 47 relevant articles. These studies suggest that young people fall into common mood trajectory classes and that class membership and symptom course are mediated by biological and environmental risk factors. Furthermore, studies provide evidence that high and persistent depressive symptoms are associated with a range of concurrent health and behavioral outcomes.

CONCLUSION

Findings could assist in the formulation of novel concepts of depressive disorders in young people and inform preventive strategies and predictive models for clinical practice.

Latent class profiles of depressive symptoms from early to middle childhood: predictors, outcomes, and gender effects

BACKGROUND

There has been little available data to inform the predictors and outcomes of latent class trajectories of depressive symptoms beginning during preschool and continuing throughout school age. Further, the extant literature in this domain has been limited by the use of parent report checklists of nonspecific 'internalizing' psychopathology rather than diagnostic interviews for depression.

METHODS

To address these gaps in the literature, this study applied growth mixture modeling to depressive symptom severity endorsed by children and/or their caregivers (N = 348) during a structured clinical interview in a 10-year longitudinal dataset spanning from preschool into late school age.

RESULTS

Three distinct trajectories of depressive symptom severity were found in boys and girls. For boys, but not girls, the high depression severity latent class increased in depressive symptoms from preschool through school age, followed by a decline in depressive symptom severity during later school age. For girls, the high depression severity latent class remained stable across time. Early childhood social adversity, familial history of affective disorder, preschool-onset ODD/CD, and school age functional impairment differentiated high-risk trajectory classes among both boys and girls.

CONCLUSIONS

Extending the literature on trajectories of depressive symptoms to the preschool period, these findings incorporate structured clinical interviews of depressive symptom severity and indicate gender differences as well as psychosocial predictors and functional outcomes among children in high severity latent classes. The findings from this study suggest that increased attention to screening for depressive symptoms in early childhood is of significant public health importance.

Developmental trajectories of anxiety and depression in early adolescence

Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1,065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.

Early-life predictors of internalizing symptom trajectories in Canadian children

BACKGROUND

Previous research examining the development of anxious and depressive symptoms (i.e., internalizing symptoms) from childhood to adolescence has often assumed that trajectories of these symptoms do not vary across individuals. The purpose of this study was to identify distinct trajectories of internalizing symptoms from childhood to adolescence, and to identify risk factors for membership in these trajectory groups. In particular, we sought to identify risk factors associated with early appearing (i.e., child onset) symptoms versus symptoms that increase in adolescence (i.e., adolescent onset).

METHOD

Drawing on longitudinal data from the National Longitudinal Survey of Children and Youth, latent class growth modeling (LCGM) was used to identify distinct trajectories of internalizing symptoms for 6,337 individuals, from age 4-5 to 14-15. Multinomial regression was used to examine potential early-life risk factors for membership in a particular trajectory group.

RESULTS

Five trajectories were identified as follows: "low stable" (68%; reference group), "adolescent onset" (10%), "moderate stable" (12%), "high childhood" (6%), and "high stable" (4%). Membership in the "adolescent onset" group was predicted by child gender (greater odds for girls), stressful life events, hostile parenting, aggression, and hyperactivity. Membership in the "high stable" and "high childhood" trajectory groups (i.e., child-onset) was additionally predicted by maternal depression, family dysfunction, and difficult temperament. Also, several significant gender interactions were observed.

CONCLUSIONS

Causal mechanisms for child and adolescent depression and anxiety may differ according to time of onset, as well as child gender. Some early factors may put girls at greater risk for internalizing problems than boys.

Different trajectories of depressive symptoms in children and adolescents: predictors and differences in girls and boys

The development of depressive symptoms in childhood and adolescence can follow different pathways. This study examined heterogeneity in the development of self-reported depressive symptoms and the predictive influence of mothers' depressive symptoms, the number of life events, and loss events via growth mixture modeling over a four-year period in a large community sample of German children and adolescents (N = 3,902; mean age 11.39 years; 49.6% female). This procedure was conducted for the total sample as well as for separate samples of girls and boys. Four different classes of trajectories for the total and the girls' model were identified, but only three classes for the boys. Girls showed higher intercepts and stronger increases in symptoms over time, whereas boys displayed stronger decreases. In the total model, mothers' depressive symptoms and the number of life events significantly increased the level of depressive symptoms. In the gender models, only mothers' depressive symptoms showed significant influence on the level of symptoms in girls and boys, whereas for life events this was only true for boys. In every model, the significant predictors discriminated at least between some classes. Loss events showed no significant influence in any model. In sum, there are meaningful differences in the development of depressive symptoms in girls and boys. These results have several implications for prevention and future research.

Identifying target groups for the prevention of depression in early adolescence: the TRAILS study

BACKGROUND

Depression in adolescence is associated with long-term adverse consequences. The aim of the present study is to identify target groups at increased risk of developing depression in early adolescence, such that prevention is associated with the largest health benefit at population-level for the least effort.

METHODS

The analyses were conducted on data of the first (age range 10-12) and fourth (age range 17-20) wave of a population-based cohort study (N=1538). The Composite International Diagnostic Interview (CIDI) was used to assess onset of major depression in early adolescence. High-risk groups were identified using exposure rate, incidence rate and population attributable fraction.

RESULTS

Prevention of depression onset in early adolescence is best targeted at children with one of the following risk profiles: a high body mass index in combination with (1) maternal depression (2) female gender, and (3) parental emotional rejection.

LIMITATIONS

Age of onset of depression was assessed retrospectively.

CONCLUSIONS

Only a few risk indicators are needed to identify a relatively small group which accounts for a substantial percentage of the new cases of depression in early adolescence.

Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.

The co-occurrence of anxiety disorders in African American parents and their children

This study examined the co-occurrence of anxiety disorders, specifically the relationship between parent and youth anxiety, in a community-based sample of 100 African American parents and their biological child between the ages of 6 and 17 years. Data were provided by both the parent and child. Parents completed the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) Client Version about their own experiences with anxiety and related disorders and the Parent version for the child's experiences. Children were administered the ADIS-IV Child version to assess their experiences with anxiety and related disorders. Fifty-five parents met criteria for at least one anxiety disorder while 34 children met criteria for at least one anxiety disorder. Two logistic regressions were subsequently conducted to predict the presence of any form of psychopathology from the ADIS-IV and the presence of an anxiety disorder in African American offspring. Results indicated that African American offspring with an anxious parent were 4 times more likely to meet criteria for both an anxiety disorder and other forms of psychopathology.

History of interpersonal violence, abuse, and nonvictimization trauma and severity of psychiatric symptoms among children in outpatient psychiatric treatment

In a clinical sample of child psychiatry outpatients, chart review data were collected for 114 consecutive admissions over a 1-year period at a Child and Adolescent Outpatient Psychiatry Clinic. Data included history of documented maltreatment, potentially traumatic domestic or community violence, neglect or emotional abuse, and noninterpersonal stressors as well as demographics, psychiatric diagnoses, and parent-rated child emotional and disruptive behavior problems. On a bivariate and multivariate basis, any past exposure to interpersonal violence-but not to noninterpersonal traumas-was related to more severe disruptive behavior problems, independent of the effects of demographics and psychiatric diagnoses. Noninterpersonal trauma and psychiatric diagnoses were associated with emotional problems; exposure to interpersonal violence appeared to partially account for this relationship despite not being independently associated with emotional problem severity. History of exposure to interpersonal violence warrants clinical and research attention as a severity marker and potential treatment focus in psychiatric outpatient services for children, particularly those with disruptive behavior problems.