Identifying Salient Stressors of Adolescence: A Systematic Review and Content Analysis

Perspectives on Self-Management and Meditation: A Qualitative Study of Adolescents With Type 1 Diabetes Mellitus and Their Parents

BACKGROUND

One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices.

METHODS

Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach.

RESULTS

Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being.

CONCLUSION

Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

How Needs-Supplies Fit Processes With Teachers, Peers, and Parents Relate to Youth Outcomes: A Theoretical and Methodological Extension of Self-Determination Theory

According to self-determination theory (SDT), relationships that support the needs for autonomy, competence, and relatedness are essential to youth development. It is yet unknown whether adolescents differ in what constitutes "optimal" supplies of support. This research proposes methodological extensions to analyze how the degree of fit or misfit between needs versus supplies in support (i.e., from teachers, parents, and peers) relates to engagement in class, academic achievement, and well-being. Data were collected on 389 adolescents (M(age) = 14.3, SD(age) = 2.1, 58% female, low to high SES). Extending SDT's contention that "the more supplies the better", results suggest that the impact of supplies actually depends on the level of needs, and that commensurate (for parents) or surplus supplies (for teachers, peers) are most optimal. Therefore, while some youth require strongly supportive relationships to experience optimal development, others require much lower support, and may even suffer from higher support.

Family Environmental Risk and Perceived Stress in Adolescent Depressive Symptoms: A Network Analysis

This study, grounded in the Process-Person-Context-Time framework, investigates the complex interplay of family environmental factors and their influence on adolescent depressive symptoms, focusing on the role of 'perceived stress'. Using network analysis, we examined data from 735 junior high students (52.1% female adolescents) from three provinces in China (Jiangsu, Shandong, and Henan), with an average age of 13.81 ± 0.92 years, ranging from 12 to 16 years, exploring the relationships between depressive symptoms, perceived stress, and seven family risk factors. The analysis identified three distinct communities. The incorporation of perceived stress led to its integration into a community that included depressive symptoms, parental restrictive monitoring, and family economic strain. Perceived stress emerged as the strongest predictor of depressive symptoms, surpassing parental restrictive monitoring. Furthermore, it overtook depressive symptoms as the node with the strongest bridging connection within its community. These findings underscore the importance of interventions targeting both family conditions and the internal processing of these stressors by adolescents, especially in challenging family environments, to mitigate the risk of depression and promote resilience.

Multidimensional stressors and depressive and anxiety symptoms in adolescents: A network analysis through simulations

BACKGROUND

Existing research has established associations between various stressors and adolescent mental health, primarily from a variable-level perspective. However, a symptom-level understanding about which stressors and symptoms might play a important role is scarce.

METHODS

The sample consisted of 15,570 adolescents aged 10 to 19. Participants completed questionnaires which assessed multidimensional stressors, depressive symptoms, anxiety symptoms, and demographic information. Network analysis was conducted to explore the relationships between stressors and depressive and anxiety symptoms. Additionally, to identify effective targets for the treatment and prevention of adolescent mental health issues, symptom-specific intervention simulations were performed on the network to investigate changes in symptom values in response to the alleviation and aggravation of specific stressors and symptoms.

RESULTS

Findings revealed that academic stressors exhibited stronger associations with anxiety symptoms than other stressors, particularly nervousness. Family relationships were more closely linked to depressive symptoms than other stressors, particularly suicidal ideation. Academic stressors emerged as an effective intervention target, and uncontrollable worry as an important prevention target. With the exception of academic stressors, simulating aggravation interventions on symptoms resulted in more changes in overall symptom activation than alleviation interventions.

LIMITATIONS

A cross-sectional design did not uncover network changes over time and the sample was non-clinical.

CONCLUSIONS

This study highlights the importance of addressing academic stressors to alleviate adolescents' depressive and anxiety symptoms and reveals that uncontrollable worry is a key prevention target. The findings are helpful for clinicians and educators to develop effective strategies to protect adolescents' mental health.

School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents

PURPOSE

Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life.

METHODS

We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups.

RESULTS

Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes.

CONCLUSION

Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.

Reconceptualizing emotion regulation and coping strategy usage in eating disorders research: The utility of a regulatory flexibility framework

Emotion regulation and coping strategies are often conceptualized in eating disorder (ED) research as inherently adaptive or maladaptive, and successful regulation is often defined as greater overall use of adaptive strategies. However, recent empirical work outside of the field of EDs challenges this categorical conceptualization of strategies, demonstrating that adaptiveness is determined by the ability to flexibly implement and adjust strategies based on contextual demands (i.e., regulatory flexibility). Despite evidence that emotion regulation and coping strategies are best conceptualized in terms of flexibility in the broader literature, few ED studies have adopted this model. We review the current conceptual framework of emotion regulation and coping strategies used in ED research and present regulatory flexibility as an alternative approach to conceptualizing these strategies. The lack of research on regulatory flexibility among individuals with EDs limits our understanding of the role of emotion regulation and coping difficulties in ED risk and maintenance. Adopting a regulatory flexibility model of strategies in EDs may extend knowledge of the role of emotion regulation difficulties in the development and maintenance of EDs. We highlight the potential utility of investigating regulatory flexibility and present recommendations for future research on regulatory flexibility in EDs. PUBLIC SIGNIFICANCE STATEMENT: Research on emotion regulation and coping strategy usage in eating disorders often view regulatory strategies as inherently adaptive or maladaptive. However, recent studies support defining strategies in terms of flexibility. Adopting a regulatory flexibility model of strategies in eating disorders research may advance knowledge of the role of emotion regulation difficulties in the development and maintenance of eating disorders, ultimately enhancing prevention and treatment efforts.

The Effectiveness of School-Based Skills-Training Programs Reducing Performance or Social Anxiety: Two Randomized Controlled Trials

Background

Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking.

Objective

The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills.

Methods

Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (M age = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed.

Results

The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health.

Conclusions

A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety.

Trial registration

International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-023-09736-x.

Associations between parental conflict and social and monetary reward responsiveness in adolescents with clinical depression

Increased rates of depression beginning in adolescence are thought to be attributed in part to marked developmental changes in reward systems and interpersonal relationships. Blunted reward response has been observed in depression and this may be shaped in part by social experiences, raising questions about the combined associations of parental conflict, depression, and reward response in both social and monetary domains. The present study used the reward positivity (RewP), an event-related potential that indexes both monetary and social reward processing, to examine the unique and combined associations of parental conflict and depressive symptoms on reward responsiveness in adolescents with clinical depression (N = 70) 14-18 years of age (M = 15.81, SD = 1.46; 65.7% female). Results indicated that depressive symptoms interacted with maternal conflict in characterizing the RewP to social, but not monetary, rewards. Specifically, higher levels of current depressive symptoms and potentiated maternal conflict together were associated with an attenuated RewP to social rewards in this clinical sample. We found no significant effects of paternal conflict. This investigation highlights maternal conflict as an important environmental factor for reward responsiveness and also emphasizes the utility of examining social reward responsiveness in depression in order to better understand the impacts of contextual factors.

Lifestyle characteristics in adolescent female football players: data from the Karolinska football Injury Cohort

BACKGROUND

Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year.

METHODS

We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years).

RESULTS

12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up.

CONCLUSION

Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.

Living with COVID-19: Subjective Well-Being in the Second Phase of the Pandemic

While there is ample evidence of the decline in mental health among youth during the onset of the COVID-19 pandemic, less is known about the determinants of recovery, which is the focus of this study. Drawing on a stress process framework, this study examines the associations of changes in direct, pandemic-related, and indirect, lockdown-related stressors with life satisfaction. A novel representative, longitudinal sample of British 16-25-year-olds is used, drawing on 6 data collections between February 2021 to May 2022 (N = 6000, 51% female, 24% ethnic minority, 46% in work, 35% with higher education). Using linear fixed-effects regression models, the findings suggest a substantial improvement in life satisfaction among youth. An increasing frequency of social contacts, receding worries about career prospects and job skills learning contributed significantly to increases in life satisfaction, whereas direct, health-related COVID-19 stressors did not affect life satisfaction. Sub-group analysis suggests that women's, adolescents', and students' life satisfaction responded more strongly to the stressors considered in this study. The findings highlight the positive effects of less stringent lockdown restrictions, economic recovery, and opportunities for job skills learning on youth's happiness.

School Engagement in Times of Confinement: A Stress Process Approach

The first COVID-19 confinement induced dramatic changes in the lives of adolescents, but little is known about the processes that affected youth engagement with school during this period. This study addressed this issue by uncovering a stress process model of school engagement during confinement, based on confinement stressors and adolescent resources. Data were collected from 406 French adolescents and their parents (grades 6 through 9, 47% girls). The results showed that multiple stressors (parental anxiety, lack of Internet or computer, low relevant and unclear school activities) and resources (academic self-concept, parental support and teacher support) affected engagement, and that some effects intertwined (e.g., effects of low relevant and unclear school activities were moderated and mediated by academic self-concept). Implications are drawn on ways to tackle stress processes and help adolescents stay engaged with schoolwork during confinement.