Facing Death in Adolescence: What Leads to Internalization and Externalization Problems?

Higher Self-Esteem Associated With Less Symptoms of Anxiety and Depression Among Young Adults After the Loss of a Parent to Cancer-A Longitudinal Study

Objective: The purpose of the study was to examine associations between self-esteem and symptoms of anxiety and depression among young adults who lost a parent to cancer. Methods: Older adolescents and young adults, aged 16 to 28 years, who had lost their parent to cancer and had accepted an invitation to join a support group, completed a questionnaire 5 to 8 months after the loss and a similar questionnaire about 10 months later (follow-up). Of a total of 77 young adults who participated in the study, 56 completed both questionnaires. Self-esteem was measured with the Rosenberg Self-Esteem Scale. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Univariate and multiple linear regression models were used to analyze the associations. Result: Self-esteem was significantly associated with symptoms of anxiety and depression at baseline and at follow-up. Conclusion: This study reveals that self-esteem is a valuable explanatory variable, and that it is associated with both symptoms of anxiety and depression in bereavement. This new knowledge could be used to guide future support to parentally bereaved young adults.

The longitudinal association between externalizing behavior and frontoamygdalar resting-state functional connectivity in late adolescence and young adulthood

BACKGROUND

Externalizing behavior has been attributed, in part, to decreased frontolimbic control over amygdala activation. However, little is known about developmental trajectories of frontoamygdalar functional connectivity and its relation to externalizing behavior. The present study addresses this gap by examining longitudinal associations between adolescent and adult externalizing behavior and amygdala-anterior cingulate cortex (ACC) and amygdala-orbitofrontal cortex (OFC) resting-state functional connectivity in a sample of 111 typically developing participants aged 11-23 at baseline.

METHODS

Participants completed two-to-four data waves spaced approximately two years apart, resulting in a total of 309 data points. At each data wave, externalizing behavior was measured using the Externalizing Behavior Broadband Scale from the Achenbach Youth/Adult Self-Report questionnaire. Resting-state fMRI preprocessing was performed using FSL. Amygdala functional connectivity was examined using AFNI. The longitudinal association between externalizing behavior and amygdala-ACC/OFC functional connectivity was examined using linear mixed effect models in R.

RESULTS

Externalizing behavior was associated with increased amygdala-ACC and amygdala-OFC resting-state functional connectivity across adolescence and young adulthood. For amygdala-ACC connectivity, externalizing behavior at baseline primarily drove this association, whereas for amygdala-OFC functional connectivity, change in externalizing behavior relative to baseline drove the main effect of externalizing behavior on amygdala-OFC functional connectivity. No evidence was found for differential developmental trajectories of frontoamygdalar connectivity for different levels of externalizing behavior (i.e., age-by-externalizing behavior interaction effect).

CONCLUSIONS

Higher externalizing behavior is associated with increased resting-state attunement between the amygdala and ACC/OFC, perhaps indicating a generally more vigilant state for neural networks important for emotional processing and control.

A meta-analysis of the relationship between parental death in childhood and subsequent psychiatric disorder

OBJECTIVE

To systematically review evidence for an association between parental death in childhood, and the subsequent development of an anxiety, affective or psychotic disorder.

METHODS

Electronic databases (Scopus, Medline (for Ovid), EMBASE and PsychINFO) were searched for peer-reviewed, cohort studies in the English language. Meta-analyses were performed for studies reporting hazard ratios, incidence rate ratios and odds ratios. Two studies reported risk ratios, and these were included in an overall pool of odds, risk and incidence rate ratios. Sensitivity analyses were performed (removal of one study at a time) for all meta-analyses, and study quality assessed using the Newcastle-Ottawa Scale.

RESULTS

Fifteen studies were retained, and where required, data were averaged in advance of pooling. Significant results were observed in studies reporting hazard ratios (k = 4, 1.48 [95% CI = 1.32-1.66]), incidence rate ratios (k = 3, 1.37 [95% CI = 1.01-1.85]), but not odds ratios (k = 4, 0.87 [95% CI = 0.72, 1.05]). However, the overall pooled effect (using odds, incidence rate and risk ratios) was statistically significant (k = 9, 1.22 [95% CI = 1.03-1.44]).

CONCLUSION

Overall, the evidence suggests that there is a positive association between the death of a parent before age 18, and the subsequent development of an anxiety, affective or psychotic disorder. The lack of a significant pooled effect in studies reporting results as odds ratios is likely an artefact of study design.

LIMITATIONS

Data were clustered in four countries making generalizability uncertain. Studies adjusted for a variety of possible confounders, and follow-up after death varied considerably.

Sensation Seeking and Gambling Behavior in Adolescence: Can Externalizing Problems Moderate This Relationship?

Gambling is a widespread phenomenon during adolescence. Among different risk factors involved in the onset of adolescent gambling behaviors, one factor that is studied is the sensation seeking personality trait. However, the literature is heterogeneous and a direct relationship between sensation seeking and gaming behaviors has not always been highlighted. This suggests that the relationship can be influenced by other factors. In particular, we explored the moderating role of externalizing problems in this relationship. A total of 363 adolescents (232 males and 131 females) aged 14 to 20 (M = 16.35, SD = 1.36) completed a battery of questionnaires aimed to assess their gambling behaviors, as well as the levels of externalizing problems and sensation seeking. The results showed that sensation seeking was associated with gambling severity, but this relationship was significant when externalizing problems were high and medium. On the contrary, when externalizing problems were low, the relationship between sensation seeking and gambling severity was not significant. Overall, sensation seeking in adolescence can favor the implementation of risk behaviors, such as gambling, but only in association with the presence of externalizing problems. Limitations, strengths, and social and clinical implications of the present study are discussed.

The Centrality of Events Scale for Italian Adolescents: Integrating Traumatic Experience Into One's Identity and Its Relation to Posttraumatic Stress Disorder Symptomatology

Adolescents could develop areas of vulnerability, especially if they have had to deal with highly stressful and traumatic life events. Stressful experiences can work as traumatic memories that become central to one's life and core topics for one's identity and for the attribution of meaning to life experience. The present work evaluates (a) the internal structures of the 20-item Centrality of Event Scale in the Italian context and (b) the impact of stressful and traumatic experience during adolescence. The present work includes a convenience sample of 872 Italian adolescents -528 males, 344 females- aged between 11 and 21 years (M = 15.85; SD = 2.09). We performed a confirmatory factor analysis that confirmed a three-factor solution. Moreover, the perception of stressful event as central in the participants' lives was significantly correlated with the presence of PTSD symptomatology, as measured by the Impact of Event Scale Revised. We found that participants with PTSD symptoms had significantly higher CES scores. These data show the validity of the CES with adolescent samples, emphasizing the sensitivity of this instrument in detecting the impact of negative life experiences even in a sample of adolescents.