Emotional Maltreatment and Adolescent Depression: Mediating Mechanisms and Demographic Considerations in a Child Welfare Sample

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Childhood maltreatment, emotion regulation difficulties/externalizing problems, and sleep problems in adolescents: Direct and indirect associations among developmental trajectories

BACKGROUND

The deleterious effects of childhood maltreatment, emotion regulation difficulties (ERD), and externalizing problems (EP) on sleep problems has been established. Nevertheless, there is still a need to gain a deeper understanding of the potential direct and indirect mechanisms through which these crucial risk factors influence adolescents' sleep problems, particularly with a developmental perspective. This study thus aimed to examine the direct and indirect associations among developmental trajectories of the focal variables in adolescents.

METHODS

A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69 years, SD = 0.82) completed self-report measures on 3 time points across 1 years. Latent growth curve modeling was used to examine the hypothesized models.

RESULTS

Both the developmental trajectory of childhood maltreatment and the developmental trajectory of ERD/EP were positively and directly related to the developmental trajectory of sleep problems; and the developmental trajectory of childhood maltreatment was indirectly related to the developmental trajectory of sleep problems through the mediating effect of the developmental trajectory of ERD/EP.

CONCLUSIONS

The findings elucidated the direct and indirect longitudinal associations among the focal variables, highlighting that interventions should target childhood maltreatment and ERD/EP to decrease sleep problems in adolescents with a developmental perspective.

From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment

Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.

Association between emotional abuse and depressive symptoms in Chinese children: The mediating role of emotion regulation

BACKGROUND

Emotional abuse has been identified as a risk factor for children's depressive symptoms. However, the specific psychological mechanisms mediating this relation are not well understood.

OBJECTIVE

This longitudinal study examined the relation of emotional abuse to subsequent depressive symptoms and the possible mediating role of emotion regulation among Chinese children.

PARTICIPANTS AND SETTING

The sample included 3633 children (45.5 % girls) with an average age of 9.96 years from a large city in southern China.

METHOD

Participants completed multiple measurements of emotional abuse, emotion regulation, and depressive symptoms on five occasions at six-month intervals, controlling for sex, age, and physical abuse and emotional neglect at Time 1. Latent growth curve modeling was applied to examine the longitudinal relations among the variables.

RESULTS

Results showed (a) emotional abuse was significantly positively associated with subsequent depressive symptoms; (b) cognitive reappraisal mediated the relation between emotional abuse and depressive symptoms, but expressive suppression did not.

CONCLUSIONS

The results highlighted the mediating role of cognitive reappraisal in the relation between emotional abuse and depressive symptoms, suggesting that intervention programs targeting cognitive reappraisal may be effective to reduce the likelihood of depressive symptoms among Chinese children.

Childhood maltreatment and depressive disorders in Chinese children and adolescents: A population-based case-control study

OBJECTIVE

The association between childhood maltreatment (CM) and clinically diagnosed depressive disorders (DD) in children and adolescents remains inconclusive, in large part due to a lack of high-quality epidemiological evidence. This study aimed to investigate the association between CM and DD in a large sample of Chinese children and adolescents.

METHODS

The study subjects were chosen from the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), and a population-based and individually-matched case-control study design was adopted.

RESULTS

CM was in general associated with an odds ratio (OR) of 5.38 (95% CI: 3.33, 8.71) for DD in children and adolescents, and a prominent dose-response association was detected. For the five specific types of CM, emotional abuse was independently related to the highest odds of DD (OR=3.90, 95% CI: 2.75, 5.54), followed by physical neglect (OR=2.04, 95% CI: 1.45, 2.87) and physical abuse (OR=1.51, 95% CI: 1.06, 2.13), while insignificant associations were found between DDs and sexual abuse and emotional neglect. Subsequently performed stratified analyses identified noticeable effect modification by important demographic factors.

CONCLUSION

CM was significantly associated with increased risk of DD in Chinese children and adolescents. The major findings of the current study suggest that victims of CM, especially those who had been emotionally abused, were susceptible to early-onset DD. Targeted interventions should be considered.

The role of school connectedness in the prevention of youth depression and anxiety: a systematic review with youth consultation

Background

School connectedness reflects the quality of students’ engagement with peers, teachers, and learning in the school environment. It has attracted attention from both the health and education sectors as a potentially modifiable protective factor for common mental health problems. However, the extent to which school connectedness may prevent the onset of youth depression or anxiety or promote their remission is unclear. This systematic review examined evidence for prospective relationships between school connectedness and depression and anxiety, and the effect of interventions to improve school connectedness on depression and anxiety.

Methods

We searched MEDLINE, PsycINFO, PubMed, and ERIC electronic databases for peer-reviewed quantitative longitudinal, or intervention studies published from 2011–21 in English examining relationships between school connectedness and anxiety and/or depression. Participants were 14–24 years old when depression and anxiety outcomes were assessed in any education setting in any country. We partnered with five youth advisers (aged 16–21 years) with lived experience of mental health problems and/or the schooling system in Australia, Indonesia, and the Philippines to ensure that youth perspectives informed the review.

Results

Our search identified 3552 unique records from which 34 longitudinal and 2 intervention studies were ultimately included. Studies were primarily from the United States of America (69.4%). Depression and anxiety outcomes were first measured at 14 years old, on average. Most studies found a significant protective relationship between higher levels of school connectedness and depressive and/or anxiety symptoms; more measured depression than anxiety. A few studies found a non-significant relationship. Both intervention studies designed to increase school connectedness improved depression, one through improvements in self-esteem and one through improvements in relationships at school.

Conclusions

These findings suggest that school connectedness may be a novel target for the prevention of depression and anxiety. We were not able to determine whether improving school connectedness promotes remission in young people already experiencing depression and anxiety. More studies examining anxiety, diagnostic outcomes, and beyond North America are warranted, as well as intervention trials.

Trial registration

PROSPERO 2021 CRD42021270967.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14364-6.

Mediating effects of parent-child relationship on the association between childhood maltreatment and depressive symptoms among adolescents

BACKGROUND

Depressive symptoms are the most common mental disorder among adolescents, and its prevalence has been increasing in recent years. Although childhood maltreatment is a contributing factor to depressive symptoms among adolescents, the underlying mechanism of how this factor causes depressive symptoms is unclear.

OBJECTIVE

This study aimed to investigate the mediating effects of parent-child relationship on the association between childhood maltreatment and depressive symptoms among adolescents and to identify how sex and only child status affect this association.

METHODS

A total of 14,500 middle school students were randomly selected from four cities (Shenzhen, Zhengzhou, Nanchang, and Guiyang) in China. A survey questionnaire was administered to collect information on childhood maltreatment, parent-child relationship, and depressive symptoms. Pearson's correlation analysis was used in analyzing the relationship, Bootstrap method was used to test the mediating effects. A moderated mediation analysis has been used to determine the moderated mediation effect.

RESULTS

Childhood maltreatment significantly negatively correlated with parent-child relationship and positively correlated with depressive symptoms (P < 0.001). The indirect effect of parent-child relationship accounted for 20.60% of the total effect between childhood maltreatment and depressive symptoms in all respondents and differed by sex (boys, 17.00%; girls, 25.23%) and only child status (only child, 15.61%; child with siblings, 23.49%). Besides, the indirect effect of the mediation model was moderated by sex and only child status.

CONCLUSIONS

Childhood maltreatment increased the risk of depressive symptoms, and this relationship was partially mediated by parent-child relationship, sex and only child status have moderated the indirect relationship. These findings showed efforts aimed at enhancing the parent-child relationship may prevent or reduce the prevalence of depressive symptoms among adolescents, especially in girls and children with siblings.

Why is my world so dark? Effects of child physical and emotional abuse on child depression: The mediating role of self-compassion and negative automatic thoughts

BACKGROUND

The adverse effects of childhood maltreatment on the mental health of individuals have received increasing attention. However, it is unclear whether the effects of invisible emotional abuse and visible physical abuse differ on child depression and the mediating processes under this relationship.

OBJECTIVE

This study aimed to investigate whether self-compassion and negative automatic thoughts mediated the effects of physical abuse and emotional abuse on child depression and the underlying mechanistic differences.

PARTICIPANTS AND SETTING

Using a two-wave longitudinal design, a total of 946 elementary school students completed the self-report questionnaires at two-time points, including child abuse, self-compassion, negative automatic thoughts, and depression.

METHODS

This study constructed structural equation models (SEM) to examine the mediating role of self-compassion and negative automatic thoughts between emotional/physical abuse and child depression.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that only physical abuse significantly and positively predicted child depression directly (β = 0.16, p < 0.01). Emotional abuse was positively associated with child depression through self-compassion (β = 0.02, p < 0.05) and negative automatic thoughts (β = 0.02, p < 0.05), while physical abuse influenced child depression only via negative automatic thoughts (β = 0.07, p < 0.001).

CONCLUSIONS

The findings showed a strong association between emotional/physical abuse and child depression, but there were mechanistic differences under these relationships. Therefore, we also need to pay equal attention to the adverse effects of emotional abuse on children.

Two-Part Models for Father-Child Relationship Variables: Presence in the Child's Life and Quality of the Relationship Conditional on Some Presence

Parent-child relationship variables are often measured using a two-part approach. For example, when assessing the warmth of the father-child relationship, a child is first asked if they have contact with their father; if so, the level of warmth they feel toward him is ascertained. In this setting, data on the warmth measure is missing for children without contact with their father, and such missing data can pose a significant methodological and substantive challenge when the variable is used as an outcome or antecedent variable in a model. In both cases, it is advantageous to use an analytic method that simultaneously models whether the child has contact with the father, and if they do, the degree to which the father-child relationship is characterized by warmth. This is particularly relevant when the two-part variable is measured over time, as contact status may change. We offer a pragmatic tutorial for using two-part variables in regression models, including a brief overview of growth modeling, an explanation of the techniques to handle two-part variables as predictors and outcomes in the context of growth modeling, examples with real data, and syntax in both R and Mplus for fitting all discussed models.

Emotional maltreatment and neglect impact neural activation upon exclusion in early and mid-adolescence: An event-related fMRI study

Child maltreatment gives rise to atypical patterns of social functioning with peers which might be particularly pronounced in early adolescence when peer influence typically peaks. Yet, few neuroimaging studies in adolescents use peer interaction paradigms to parse neural correlates of distinct maltreatment exposures. This fMRI study examines effects of abuse, neglect, and emotional maltreatment (EM) among 98 youth (n = 58 maltreated; n = 40 matched controls) using an event-related Cyberball paradigm affording assessment of both social exclusion and inclusion across early and mid-adolescence (≤13.5 years, n = 50; >13.5 years, n = 48). Younger adolescents showed increased activation to social exclusion versus inclusion in regions implicated in mentalizing (e.g., superior temporal gyrus). Individual exposure-specific analyses suggested that neglect and EM coincided with less reduction of activation to social exclusion relative to inclusion in the dorsal anterior cingulate cortex/pre-supplementary motor area (dACC/pre-SMA) among younger versus older adolescents. Integrative follow-up analyses showed that EM accounted for this dACC/pre-SMA activation pattern over and above other exposures. Moreover, age-independent results within respective exposure groups revealed that greater magnitude of neglect predicted blunted exclusion-related activity in the parahippocampal gyrus, while EM predicted increased activation to social exclusion in the precuneus/posterior cingulate cortex.

Transactional processes between childhood maltreatment and depressive symptoms from middle childhood to early adolescence: Locus of control as a mediator

BACKGROUND

Previous research has identified a significant, positive relation between childhood maltreatment and depressive symptoms. However, the findings required replication at the within-person level. Moreover, the mediating mechanism of locus of control accounting for their relations has yet to be fully evaluated. Thus, this study examined the dynamic longitudinal relations between childhood maltreatment and depressive symptoms including whether locus of control functioned as a mediator between them after separating between-person effects from within-person effects.

METHODS

A sample of 4110 Chinese children (50.60% boys; M_age = 9.89 at Wave 1) covering the transitional period from middle childhood to early adolescence completed a package of self-report measures on 5 occasions across 2.5 years, using 6-month intervals. Random Intercept Cross-Lagged Panel Models were applied to disaggregate between- and within-person effects. Also, alternative Cross-Lagged Panel Models were applied.

RESULTS

Locus of control played a mediating role in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level.

LIMITATIONS

Some limitations existed in the measures. Moreover, sexual abuse was not investigated in this study.

CONCLUSIONS

The findings highlighted the mediating role of locus of control in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level, suggesting that interventions targeted at promoting internal locus of control may help prevent the developmental pathway from childhood maltreatment to depressive symptoms and vice versa from middle childhood to early adolescence.

Exploring the mediating effect of academic engagement on math and reading achievement for students who have experienced maltreatment

BACKGROUND

Students who experience maltreatment tend to underperform academically relative to their peers, requiring an understanding of academically-related mechanisms that are potential intervention targets. Academic engagement, a multidimensional construct that is influential in students' investment in learning and the school context, is one such mechanism that has been associated with positive academic outcomes and develops through interactions between students and their environment.

OBJECTIVE

The purpose of this study was to examine how maltreatment experiences and trauma symptoms were indirectly associated with academic achievement in adolescence through academic engagement.

PARTICIPANTS AND SETTING

The study was conducting on a subsample of 583 youths from the National Study of Child and Adolescent Wellbeing II (NSCAW II) cohort.

METHODS

Structural equation modeling was used to examine the indirect effect engagement on the relationship between maltreatment and trauma symptomology and academic achievement.

RESULTS

Academic engagement significantly mediated trauma symptoms and later standardized reading (β = -0.02; 95 % CI [-0.04, -0.0004]) and math (β = -0.02; 95 % CI [-0.05, -0.0003]) achievement test scores. However, similar mediating effects were not found for engagement on maltreatment and later standardized reading (β = -0.01; 95 % CI [-0.03, 0.01]) and math (β = -0.01; 95 % CI [-0.03, 0.01]) achievement test scores.

CONCLUSIONS

These findings suggest that variability in academic outcomes was indirectly associated with engagement but only for students who exhibited trauma symptoms rather than experiencing maltreatment alone. The findings suggest future researchers should consider engagement should as an academically-related mechanism to help students who were maltreated succeed academically.

Psychological Distress and Well-Being in Trauma-Exposed Adolescents: A Residualized, Person-Centered Approach to Resilience

Positive adaptation manifests differently in the aftermath of traumatic events. Methodological limitations, however, impede the ability to test conceptualizations of resilience that emphasize the multifaceted nature of these responses. In response, an approach that synthesized a residualized and person-centered conceptualization of resilience examined associations between aspects of resilience in an adolescent sample. In total, 584 racially/ethnically diverse adolescents (age range: 12-17 years; M = 14.98 years; SD = 1.05; 50.9% female; 30.1% White, 29.6% African American, 19.5% Hispanic) self-reported lifetime emotional maltreatment and community violence exposure as well as current levels of depression, posttraumatic stress symptoms (PTSS), violent behavior, and psychological well-being (PWB). Each mental health outcome was regressed on lifetime trauma exposure to create residuals used as indices of resilience. Correlations between the residuals suggested that PWB was more closely related to resilience to depression and PTS, rs = .17-.30, than violent behavior, r = .00. Residuals were subsequently entered into person-centered analyses to identify representative well-being profiles. Cluster analysis identified four groups, including two adaptive profiles defined by (a) lower distress and higher PWB and (b) lower psychopathology and lower PWB, based on adolescents' levels of trauma exposure. These two profiles did not vary regarding impairment, p > .999, suggesting both profiles represent positive adaption to lifetime trauma exposure. Theoretical and clinical implications of distinguishing between these two profiles by assessing PWB in adolescents are discussed, as well as how PWB may manifest within the context of different patterns of psychological distress.

Developmental consequences of emotional abuse and neglect in vulnerable adolescents: A multi-informant, multi-wave study

BACKGROUND

Extant research and theory posit that emotional abuse and emotional neglect-exposure is uniquely harmful during adolescence. Yet, these findings are mostly based on mono-informant, retrospective studies with unselected adults that examine emotional maltreatment in the aggregate. This prevents inferences concerning the unique, prospective risk emotional abuse and neglect, as reported by multiple informants, may confer within at-risk, adolescent samples.

OBJECTIVE

In response, the present study examined how emotional abuse and emotional neglect-exposure in adolescence uniquely related to psychological symptoms and social impairment.

PARTICIPANTS AND SETTING

Our aims were tested in a child welfare system (CWS)-involved sample of adolescents (N = 657; Age_M = 12.49 at baseline) who were participating in a longitudinal study.

METHODS

A multi-informant approach was used to assess emotional abuse/neglect and mental health. Physical abuse and lifetime CWS contact represented covariates in growth curve models.

RESULTS

Emotional abuse predicted symptoms within informant, such that youth-reported emotional abuse predicted youth-reported internalizing, β = 0.21, p = .001, and externalizing, β=0.35, p = .001, symptoms while parent-reported emotional abuse predicted parent-reported externalizing, β=0.30, p <  .001, and internalizing β=0.29, p <  .001, symptoms. Meanwhile, youth-reported emotional neglect predicted heightened self-reported internalizing symptoms, β=0.29, p <  .001, parent-reported externalizing symptoms, β=0.15, p = .002 and social impairment across youth, β=-0.17, p = .01 and parent, β=-0.24, p <  .001, report.

CONCLUSIONS

This study shows the importance of distinguishing between these maltreatment subtypes in adolescence and provides measurement recommendations for future maltreatment research. The manuscript concludes by discussing adolescent emotional abuse and neglect-exposure as a maintenance, as opposed to causal risk, factors.