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Zhou HY, Zhu WQ, Xiao WY, Huang YT, Ju K, Zheng H, Yan C. Feeling unloved is the most robust sign of adolescent depression linking to family communication patterns. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:418-430. [PMID: 36404680 DOI: 10.1111/jora.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/25/2023]
Abstract
Using network analysis, this study investigated how family communication patterns (Conversation and Conformity) were related to and predictive of adolescent overall depression severity and specific symptoms. A community sample of adolescents (10-17 years, n = 1327) completed the Children's Depression Inventory and the Revised Family Communication Pattern Instrument. Depressive symptoms were also re-assessed 6 months later. Results showed that Conversation orientation protected against, whereas Conformity orientation increased the risk of adolescent depression. Family communication particularly influenced the child's feeling of being unloved, and feeling unloved was the only symptom prospectively predicted by two communication orientations at baseline. These findings revealed the path linking family factors to adolescent depression and may have implications for future family-based interventions.
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Affiliation(s)
- Han-Yu Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Centre, Shanghai, China
| | - Wen-Qi Zhu
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Wen-Yi Xiao
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ya-Ting Huang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Kang Ju
- Shanghai Changning Mental Health Centre, Shanghai, China
| | - Hong Zheng
- Shanghai Changning Mental Health Centre, Shanghai, China
| | - Chao Yan
- Shanghai Changning Mental Health Centre, Shanghai, China
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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Li J, Wang R, He J, Wang L, Li L. Comparison of the effect of hostility on the level of depression of drug addicts and non-addicts and the mediating role of sense of life meaning between them. BMC Psychiatry 2023; 23:350. [PMID: 37210486 DOI: 10.1186/s12888-023-04856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND The level of depression among drug addicts is generally higher than normal. Hostility and sense of life meaning may influence depression and become risk factors for depression. This study has three research purposes. First, to analyze whether drug use can aggravate hostility and depression levels. Second, to assess whether the hostility has different effects on depression among drug addicts and non-addicts. Third, to examine whether the sense of life meaning has a mediating role between different groups (drug addicts and non-addicts). METHODS This study was conducted from March to June 2022. 415 drug addicts (233 males and 182 females) and 411 non-addicts (174 males and 237 females) were recruited in Chengdu, Sichuan Province. After signing informed consent, their psychometric data were obtained using the Cook-Medley Hostility Scale (CMI), Beck Depression Inventory (BDI) and Meaning in Life Questionnaire (MLQ) questionnaires. Linear regression models were used to assess the impact of hostility and depression among drug addicts and non-addicts. Bootstrap mediation effect tests were used to further test the mediation effect of sense of life meaning between hostility and depression. RESULTS The results showed four main outcomes. First, compared with non-addicts, drug addicts had higher levels of depression. Second, hostility exacerbated depression in both drug addicts and non-addicts. Compared with non-addicts, hostile affect had a greater effect on depression in drug addicts. Third, the sense of life meaning among females was higher than males. Fourth, for drug addicts, the sense of life meaning showed a mediating effect between social aversion and depression, while for non-addicts, the sense of life meaning showed a mediating effect between cynicism and depression. CONCLUSIONS Depression is more severe in drug addicts. More attention should be paid to the mental health of drug addicts, because the elimination of negative emotions is conducive to reintegration into society. Our results provide a theoretical basis for reducing depression among drug addicts and non-addicts. As a protective factor, we can reduce their hostility and depression by improving the sense of life meaning.
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Affiliation(s)
- Jiaoyang Li
- Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China
| | - Rufang Wang
- Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China.
| | - Jingzhen He
- Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China
| | - Linghui Wang
- The Second Drug Rehabilitation Center in Chengdu, Chengdu, China
| | - Lin Li
- The Drug Rehabilitation Center in Chengdu, Chengdu, China
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Chen X, Hou C, Yao L, Ma Y, Li Y, Li J, Gui M, Wang M, Zhou X, Lu B, Fu D. The association between chronic heart failure and frailty index: A study based on the National Health and Nutrition Examination Survey from 1999 to 2018. Front Cardiovasc Med 2023; 9:1057587. [PMID: 36698928 PMCID: PMC9868664 DOI: 10.3389/fcvm.2022.1057587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Objective This study aims to explore the association between the frailty index and chronic heart failure (CHF). Methods We collected data from the National Health and Nutrition Examination Survey (NHANES) (1998-2018) database to assess the association between CHF and frailty. Demographic, inquiry, laboratory examinations, and characteristics were gathered to compare CHF and non-CHF groups. Multiple logistic regression analysis was performed to explore the relationship between frailty and CHF. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence interval (CI) for mortality from all causes and cardiovascular disease (CVD). Results A total of 16,175 participants with cardiac and cerebrovascular disease were categorized into CHF (n = 1,125) and non-CHF (n = 15,050) groups. In patients with CHF, the prevalence of frailty, pre-frailty, and non-frailty were 66.31, 30.93, and 2.75%, respectively. In multiple logistic regression, patients with CHF who were male (OR = 0.63, 95% CI: 3.11-5.22), whose annual family income was over $20,000 (OR = 0.52, 95% CI: 0.37-0.72, p < 0.001), or with normal hemoglobin level (OR = 0.77, 95% CI: 0.68-0.88, P < 0.001) had a lower likelihood of frailty. CHF patients with hypertension (OR = 3.60, 95% CI: 2.17-5.99, P < 0.0001), coronary heart disease (OR = 1.76, 95% CI: 1.10-2.84, P = 0.02), diabetes mellitus (OR = 1.89, 95% CI: 1.28-2.78, P < 0.001), and stroke (OR = 2.52, 95% CI: 1.53-4.15, P < 0.001) tended to be frail. Survival analysis suggested that pre-frailty and frailty were related to poor all-cause deaths (HR = 1.48, 95% CI: 1.36-1.66; HR = 2.77, 95% CI: 2.40-3.18) and CVD mortality (HR = 1.58, 95% CI: 1.26-1.97; HR = 2.55, 95% CI: 2.02-3.21). CHF patients with frailty were strongly connected with all-cause death (HR = 2.14, 95% CI: 1.27-3.62). Conclusion Frailty was positively associated with CHF. Patients with CHF who were male, whose annual family income was over $20,000, or with normal hemoglobin level were negatively correlated to frailty. For patients with cardiac and cerebrovascular disease as well as CHF, frailty was strongly connected with all-cause death.
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Martin J, Asjadi K, Hubbard L, Kendall K, Pardiñas AF, Jermy B, Lewis CM, Baune BT, Boomsma DI, Hamilton SP, Lucae S, Magnusson PK, Martin NG, McIntosh AM, Mehta D, Mors O, Mullins N, Penninx BWJH, Preisig M, Rietschel M, Jones I, Walters JTR, Rice F, Thapar A, O’Donovan M. Examining sex differences in neurodevelopmental and psychiatric genetic risk in anxiety and depression. PLoS One 2021; 16:e0248254. [PMID: 34473692 PMCID: PMC8412369 DOI: 10.1371/journal.pone.0248254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Anxiety and depression are common mental health disorders and have a higher prevalence in females. They are modestly heritable, share genetic liability with other psychiatric disorders, and are highly heterogeneous. There is evidence that genetic liability to neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD) is associated with anxiety and depression, particularly in females. We investigated sex differences in family history for neurodevelopmental and psychiatric disorders and neurodevelopmental genetic risk burden (indexed by ADHD polygenic risk scores (PRS) and rare copy number variants; CNVs) in individuals with anxiety and depression, also taking into account age at onset. We used two complementary datasets: 1) participants with a self-reported diagnosis of anxiety or depression (N = 4,178, 65.5% female; mean age = 41.5 years; N = 1,315 with genetic data) from the National Centre for Mental Health (NCMH) cohort and 2) a clinical sample of 13,273 (67.6% female; mean age = 45.2 years) patients with major depressive disorder (MDD) from the Psychiatric Genomics Consortium (PGC). We tested for sex differences in family history of psychiatric problems and presence of rare CNVs (neurodevelopmental and >500kb loci) in NCMH only and for sex differences in ADHD PRS in both datasets. In the NCMH cohort, females were more likely to report family history of neurodevelopmental and psychiatric disorders, but there were no robust sex differences in ADHD PRS or presence of rare CNVs. There was weak evidence of higher ADHD PRS in females compared to males in the PGC MDD sample, particularly in those with an early onset of MDD. These results do not provide strong evidence of sex differences in neurodevelopmental genetic risk burden in adults with anxiety and depression. This indicates that sex may not be a major index of neurodevelopmental genetic heterogeneity, that is captured by ADHD PRS and rare CNV burden, in adults with anxiety and depression.
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Affiliation(s)
- Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Kimiya Asjadi
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Leon Hubbard
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Kimberley Kendall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Antonio F. Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Bradley Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Bernhard T. Baune
- Department of Psychiatry, University of Münster, Münster, Nordrhein-Westfalen, Germany
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Dorret I. Boomsma
- Dept. of Biological Psychology & EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, Netherland
| | - Steven P. Hamilton
- Psychiatry, Kaiser Permanente Northern California, San Francisco, California, United States of America
| | | | - Patrik K. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas G. Martin
- Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrew M. McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Divya Mehta
- Centre for Genomics and Personalised Health, Faculty of Health, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Ole Mors
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - Niamh Mullins
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Vrije Universiteit Medical Center and GGZ inGeest, Amsterdam, Netherland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Ian Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - James T. R. Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Frances Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Michael O’Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
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Mak JKL, Reynolds CA, Hägg S, Li X, Ericsson M, Pedersen NL, Jylhävä J, Kuja-Halkola R. Sex differences in genetic and environmental influences on frailty and its relation to body mass index and education. Aging (Albany NY) 2021; 13:16990-17023. [PMID: 34230219 PMCID: PMC8312411 DOI: 10.18632/aging.203262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Frailty is influenced by numerous genetic and environmental factors. However, sex differences in how these factors affect frailty, and the gene-environment interplay among frailty and two of its well-established risk factors, unhealthy body mass index (BMI) and low education, are less clear. In a large sample of 42,994 Swedish twins, we used structural equation models to estimate the genetic (heritability) and environmental sources of variance in frailty, defined as the frailty index (FI), separately in men and women. Genetic and individual-specific environmental factors contributed approximately equally to the FI variance. The heritability of FI was slightly, but significantly, higher in women (52%) than in men (45%), yet we found only weak-to-no indication of different sources of genetic variance influencing frailty across sexes. We observed a small-to-moderate genetic overlap between FI and BMI, and that the correlation between FI and education was largely explained by environmental factors common to twins in a pair. Additionally, genetic factors accounted for more of FI variation at both low and high BMI levels, with similar patterns in both sexes. In conclusion, the twin-based heritability of frailty is higher in women than in men, and different mechanisms may underlie the associations of frailty with BMI and education.
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Affiliation(s)
- Jonathan K. L. Mak
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Chandra A. Reynolds
- Department of Psychology, University of California, Riverside, CA 92521, USA
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xia Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Malin Ericsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Melbourne School of Psychological Sciences, MDHS, The University of Melbourne, Melbourne, Australia
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Abstract
The prevalence and clinical characteristics of depressive disorders differ between women and men; however, the genetic contribution to sex differences in depressive disorders has not been elucidated. To evaluate sex-specific differences in the genetic architecture of depression, whole exome sequencing of samples from 1000 patients (70.7% female) with depressive disorder was conducted. Control data from healthy individuals with no psychiatric disorder (n = 72, 26.4% female) and East-Asian subpopulation 1000 Genome Project data (n = 207, 50.7% female) were included. The genetic variation between men and women was directly compared using both qualitative and quantitative research designs. Qualitative analysis identified five genetic markers potentially associated with increased risk of depressive disorder in females, including three variants (rs201432982 within PDE4A, and rs62640397 and rs79442975 within FDX1L) mapping to chromosome 19p13.2 and two novel variants (rs820182 and rs820148) within MYO15B at the chromosome 17p25.1 locus. Depressed patients homozygous for these variants showed more severe depressive symptoms and higher suicidality than those who were not homozygotes (i.e., heterozygotes and homozygotes for the non-associated allele). Quantitative analysis demonstrated that the genetic burden of protein-truncating and deleterious variants was higher in males than females, even after permutation testing. Our study provides novel genetic evidence that the higher prevalence of depressive disorders in women may be attributable to inherited variants.
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Takahashi Y, Pingault JB, Yamagata S, Ando J. Phenotypic and aetiological architecture of depressive symptoms in a Japanese twin sample. Psychol Med 2020; 50:1381-1389. [PMID: 31179952 DOI: 10.1017/s0033291719001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The phenotypic and aetiological architecture of depression symptomatology has been mostly studied in Western samples. In this study, we conducted a genetically informed factor analysis to elucidate both the phenotypic and aetiological architectures of self-reported depression among a Japanese adult twin sample. METHODS Depressive symptoms assessed by Zung's Self-rating Depression Scale were self-rated by 425 twin pairs (301 monozygotic and 124 dizygotic twin pairs) in a community sample in Japan. RESULTS An exploratory factor analysis extracted three symptom domains representing cognitive, affective and somatic symptomatology. A confirmatory factor analysis demonstrated that a bi-factor solution fitted better than the alternative solutions, implying that depression may be defined as a combination of a single general construct and three factors specific to each of the three symptom domains. A multivariate genetic analysis with the bi-factor solution showed that the general factor was substantially heritable (47%), and that only the affective symptom domain was significantly heritable (29%) among the three specific factors, their remaining variance being explained by non-shared environmental influences. CONCLUSIONS Depression symptomatology appears to be adequately captured by a substantially heritable general factor. The heritability of this factor (47%) in a Japanese adult sample is in line with commonly reported heritability estimates for depression. The three specific factors - cognitive, affective and somatic - are mostly explained by non-shared environmental factors, which include measurement error. The extent to which these specific factors are uniquely associated with correlates of depression when the general factor is accounted for should be investigated in future studies.
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Affiliation(s)
- Yusuke Takahashi
- The Hakubi Center for Advanced Research and Graduate School of Education, Kyoto University, Kyoto, Japan
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jean-Baptiste Pingault
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK
| | - Shinji Yamagata
- Graduate School of Education and Human Development, Nagoya University, Aichi, Japan
| | - Juko Ando
- Faculty of Letters, Keio University, Tokyo, Japan
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Intergenerational Continuity in Depression: The Importance of Time-Varying Effects, Maternal Co-morbid Health Risk Behaviors and Child's Gender. J Youth Adolesc 2018; 47:2143-2168. [PMID: 29330733 DOI: 10.1007/s10964-017-0805-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
Intergenerational continuity in depressive symptoms is well established between mother and child, but there are still important facets of this relationship that are underexplored. We examine intergenerational continuity in depressive symptoms between mother-child dyads as a flexible function of child age and account for the potential moderating role of maternal co-morbid health risk behaviors. Using prospective, self-report data collected yearly from 413 mother-child dyads (210 mother-son dyads and 203 mother-daughter dyads) between child ages 12-17, the results indicate that the effect of maternal depressive symptoms on daughters' depressive symptoms steadily increases throughout adolescence whereas the effect of maternal depressive symptoms on sons' depressive symptoms is relatively small, stable, and non-significant during mid-adolescence before increasing in effect in later adolescence. A positive interactive effect between maternal depressive symptoms and intimate partner violence is observed for sons and maternal depressive symptoms and substance use for daughters. A negative interactive effect of maternal depressive symptoms and substance use is observed among sons. Overall, this study identifies particular subgroups for whom intervention programming is most beneficial and suggests targeting health risk behaviors of mothers to lessen the impact of maternal depressive symptoms on offspring.
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