Longitudinal associations among adolescents' internalizing problems, well-being, and the quality of their relationships with their mothers, fathers, and close friends

Risk factors for subsequent suicidal acts among 12-25-year-old high-risk callers to a suicide prevention hotline in China: a longitudinal study

BACKGROUND

A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap.

METHODS

This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used.

RESULTS

During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts.

CONCLUSIONS

While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers' high psychological distress and suicide intent.

The Relation between Residential Mobility and Internalizing and Externalizing Problems in Adolescence: The Role of Subjective Moving Experience, Gender, and Friendship Quality

Adolescent residential mobility can be a stressful life event, potentially aggravating internalizing or externalizing problems. However, the longitudinal effects of residential mobility are understudied and may be context-dependent. This study investigates the longitudinal associations between adolescent residential mobility and internalizing and externalizing problems. Additionally, this study examines for whom residential moves are most detrimental by including subjective moving experience, gender, and friendship quality before the move as moderators. Longitudinal data from 2,029 adolescents (51% female) from the TRacking Adolescents' Individual Lives Survey (TRAILS) were used (Mage [SD] at T1 = 11.1 [0.55], T2 = 13.6 [0.52], and T3 = 16.3 [0.70]). Results from stepwise multi-level random-effect models showed that adolescents who experienced an unpleasant move remained stable in internalizing problems, while others decreased over time. Adolescents who moved increased stronger in externalizing problems than adolescents who did not move, independent of whether they experienced the move as unpleasant. Gender and friendship quality before the move did not moderate the relation between residential mobility and internalizing or externalizing problem development. These results emphasize that residential moves in adolescence, especially when experienced as unpleasant, can have long-lasting negative effects on adolescent development.

Individual and environmental factors in internalizing disorders in children and adolescents

BACKGROUND

Literature has emphasized the role of biopsychosocial factors in internalizing disorders; however, the role of developmental competencies of a child have not been explored much in this context. The current study aimed to understand the differences in developmental competencies, temperament, parenting practices and psychosocial adversities between children with and without internalizing disorders.

METHOD

The sample consisted of 200 children and adolescents aged seven to 18 years, with equal number of those with and without an internalizing disorder; and one of their parents. Psychopathology, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events, family environment and abnormal psychosocial situations were measured using standardized tools.

FINDINGS

Discriminant analysis revealed that temperamental domains of sociability and rhythmicity, developmental competencies of adaptive behaviour and self-concept, parenting practices involving father's involvement and overall positive parenting differentiated the clinical and control groups better. Among psychosocial adversities, family environment domains of cohesion and organization, and subjective stress from life events and abnormal psychosocial situations were the most important discriminators.

CONCLUSION

The current study reveals that specific individual factors involving temperament and developmental competencies and environmental factors involving parenting practices and psychosocial adversities are significantly associated with internalizing disorders. This has implications for the mental health care of children and adolescents with internalizing disorders.

Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators

Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.

Assessing the Prevalence Rates of Internalizing Symptomatology Among Multiracial Adolescents in the United States: A Systematic Review

This systematic review aimed to investigate the prevalence of internalizing symptomatology among Multiracial adolescents in the United States and to report on the methods utilized to measure Multiracial race and internalizing symptoms. A comprehensive search was conducted in Ovid MEDLINE, Embase, APA PsycInfo, and Web of Science Core Collection. The search was confined to peer-reviewed studies reporting the prevalence of any internalizing symptom among Multiracial adolescents between 10 and 24 years in the United States. Study selection, data abstraction, and quality assessments were managed by four team members. Between 2000 and 2023, nine studies provided prevalence estimates and used various methods to measure Multiracial race and internalizing symptoms. Prevalence estimates displayed considerable variability depending on symptom examined and measurement method utilized. For all internalizing symptomatology, estimates ranged between 7.5 and 55.2%; for depressive symptomatology, estimates ranged between 12.8 and 51.0%. No information on the prevalence of anxiety symptoms alone were provided. This review represents a pioneering attempt to report the prevalence of internalizing symptomatology among Multiracial adolescents in the United States, revealing significant gaps in current knowledge and methodological inconsistencies in the field. There exists a need for more comprehensive epidemiological research with this growing population.

Association between friendship quality and subjective wellbeing among adolescents: a systematic review

BACKGROUND

Social integration with friends has an important role in shaping adolescents' behavior and determining their wellbeing. Friendship features such as companionship, trust, closeness, intimacy, and conflicts all form the concept of friendship quality. The quality of friendships can either enhance or impede mental development during adolescence. Therefore, this systematic review was conducted to understand the association between friendship quality and adolescents' mental wellbeing.

METHODS

In November 2020 and later in August 2022, the search for evidence was conducted on five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO). Only peer-reviewed quantitative studies published from January 2000 to August 2022 that investigated friendship quality as their exposure variable in relation to six constructs of subjective wellbeing (mood, loneliness, life satisfaction, happiness, self-esteem, and subjective wellbeing) were included. After screening for eligibility, two reviewers independently extracted the data based on population characteristics, study design, exposure and outcome variables, outcome measures used, and results. Risk of bias assessment was performed utilizing the NIH Quality Assessment Tool. Narrative evidence synthesis was performed based on the constructs of subjective wellbeing.

RESULTS

Forty-three articles out of 21,585 records were included in the review. The relationship between friendship quality and depression has been investigated extensively in the literature and negative (beneficial) associations were found in eighteen studies out of twenty-three. Poor peer relationship was associated with loneliness in nine studies out of ten. All seven studies on life satisfaction and quality of peer connection found a positive association. In five studies, better peer relationship was found to be associated with happiness. A positive association between friendship quality and self-esteem was observed in five out of six applicable studies. Friendship quality was found to be positively associated with subjective well-being in all of five included studies.

CONCLUSIONS

Although majority of the included studies were cross-sectional in nature, this review demonstrates the paramount value of promoting healthy friendship to adolescents' subjective wellbeing constructs. Interventions that aim to promote subjective wellbeing among adolescents should consider the development and maintenance of healthy friendships.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020219312.

Dyadic associations between COVID-19-related stress and mental well-being among parents and children in Hong Kong: An actor-partner interdependence model approach

The spread of COVID-19 and its subsequent social distancing policies have profoundly impacted the lives of parents and children. Prolonged exposure to parenting-related responsibilities and heightened levels of family conflict under stay-at-home orders coupled with reduced access to support systems and resources have rendered parents and children more prone to stress and mental health difficulties. Drawing on a transactional model of parent-child interactions, the present study applied an actor-partner interdependence model approach to examine the transactional relationship between COVID-19-related stress and mental well-being among parents and children. Data from 109 Chinese parent-child dyads in Hong Kong were included in the study. Parents and their 8- to 10-year-old children completed a questionnaire on COVID-19-related stress, parent-child relationships, and mental well-being. The results showed that 53.2% and 30.3% of the parents and children, respectively, showed poor mental well-being, indicating possible emotional problems. Both actor and partner effects of parent COVID-19-related stress were found. Parent COVID-19-related stress was indirectly related to lower levels of parent and child mental well-being, through the mediation of parent-child conflict. To facilitate psychological adjustment following the COVID-19 outbreak, effective family-based mental health and parenting interventions are needed to promote family cohesion and alleviate stress-induced psychological symptoms. Even in the time of social distancing, telepsychotherapy and other online non-psychotherapeutic interventions can serve as a valid alternative for parents and children who experience excessive distress. Implications for psychological services, family-friendly policies, and social protection measures are also discussed.

The Roles of Social Media Use and Friendship Quality in Adolescents' Internalizing Problems and Well-being

Adolescents spend increasing amounts of time using social media, but whether social media use has a beneficial or harmful role in internalizing problems and well-being during adolescence remains under debate. The present study explored associations of social media use and friendship quality with adolescents' internalizing problems and well-being both concurrently and longitudinally, including the exploration of interactive effects between social media use and friendship quality and the examination of gender differences. Online questionnaire data collected in Spring 2018 and Spring 2019 from 1,298 Dutch adolescents aged 11-17 years (mean age 13.7 ± 1.1 years, 53.2% girls) were used. Path analyses showed that, cross-sectionally, girls (not boys) who used social media more frequently had more internalizing problems and lower well-being. Boys and girls with higher-quality friendships reported fewer concurrent internalizing problems and higher concurrent and longitudinal well-being; the association with internalizing problems was significantly stronger for girls as for boys. We found no significant interaction between social media use and friendship quality. Thus, the present study indicates that social media use and friendship quality have unique roles in adolescents' internalizing problems and well-being. Furthermore, the findings support the importance of gender-specific approaches to decrease adolescents' internalizing problems and enhance their well-being.