Negative Life Events, Social Support, and Self-Efficacy in Anxious Adolescents

I CAN Intervention to Increase Grit and Self-Efficacy: A Pilot Study

In recent years, there has been a growing interest in increasing motivational factors within the domain of psychology. Among these factors, Grit, Mindset, Self-Efficacy, and Well-Being (Flourishing) have been suggested to play an important role in individuals' performance and Well-Being. Thus, cultivating these factors in the general population is important. Previous interventions have displayed substantial effects in certain areas. However, these interventions have primarily been Mindset oriented. This paper presents a novel intervention approach by also emphasizing the importance of brain development; the importance of stimuli for building a network in the brain; the importance of repetition for strengthening the network; and the importance of perseverance and deliberate practice for achievement. The purpose of the current study was to examine the effects of a 35-40 min online intervention to increase the beliefs of 'I CAN' for 38 university students in Norway. The mean age of the 38 participants was 22.55 (SD = 1.59) and they completed a pre-test assessment of the Grit-S Scale, Theories of Intelligence Scale (Mindset), General Self-Efficacy Scale, and Flourishing Scale (Well-Being). This was followed up by the novel intervention and finally a post-test of the scales eight weeks later. The results showed an increase in Grit, Self-Efficacy, and Well-Being. However, only Grit displayed a significant increase. We aimed at creating an intervention where the participants would "turn on the switch", meaning that they develop stronger beliefs. These promising results warrant a further development of the intervention, and studies with a larger group.

Predictors of school-based cognitive behavior therapy outcome for youth with anxiety

Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.

Youth stress generation: an examination of the role of anxiety, anxiety symptoms and cognitive distortions

INTRODUCTION

Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders.

METHODS

Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation).

RESULTS

Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress.

CONCLUSION

Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.

The relationship between negative life events and quality of life in adolescents: Mediated by resilience and social support

Background

Quality of life has become an important indicator for assessing the health care of adolescents. This study aimed to explore the relationship between negative life events and quality of life in adolescents and the potential mediating roles of resilience and social support.

Methods

A stratified cluster sampling technique was used to select 3,860 adolescents as study participants. The Adolescent Self-Rating Life Events Checklist, the Resilience Scale for Chinese Adolescents, the Social Support Rating Scale, and the Adolescent Quality of Life Scale were used by participants to rate their negative life events, resilience, social support, quality of life, respectively. The correlations between study variables were analyzed by the Pearson correlation analyses. The AMOS 26.0 software was used to explore the mediating roles of resilience and social support in negative life events and quality of life.

Results

There was a negative correlation between negative life events and quality of life (β=-0.745, P < 0.05); resilience and social support played an important mediating role in the relationship between negative life events and quality of life (β_Resilience = -0.287, P < 0.05; β_{Social support} = -0.124, P < 0.05). The emotional adjustment dimension of resilience (β = -0.285, P < 0.05) and the subjective support dimension of social support (β = -0.100, P < 0.05) played the largest mediating roles, respectively.

Conclusion

Negative life events were negatively correlated with adolescents' quality of life. Strengthening resilience and social support is expected to weaken and reduce the adverse effects of negative life events on adolescents and further maintain and improve their quality of life.

The Relationship Between Anxiety, Coping, and Disordered-Eating Attitudes in Adolescent Military-Dependents at High-Risk for Excess Weight Gain

Adolescent military-dependents are an understudied population who face unique stressors due to their parents' careers. Research suggests that adolescent military-dependents report more anxiety and disordered-eating than their civilian counterparts. While anxiety symptoms predict the onset and worsening of disordered-eating attitudes, the mechanisms underlying this relationship remain unclear. One factor that may underlie this relationship, and be particularly relevant for military-dependent youth, is coping. Therefore, we examined adolescent military-dependents (N=136; 14.5±1.5 years; 59.6% female; BMI-z: 1.9±0.4) who were at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥ 85th percentile and loss-of-control eating and/or elevated anxiety. Participants completed an interview assessing disordered-eating attitudes and questionnaires on anxiety symptoms and coping strategies at a single time point. Bootstrapping models were conducted to examine the indirect paths between anxiety symptoms and disordered-eating attitudes through five coping subscales (aggression, distraction, endurance, self-distraction, and stress-recognition). Adjusting for relevant covariates, no significant indirect paths through the coping subscales (ps > .05) were found in any models. General coping, non-specific to eating, may not be a pathway between anxiety symptoms and disordered-eating attitudes among adolescents. Future research should examine other potential mediators of this relationship.

Temperament, anxiety, and depression in school-age children who stutter

PURPOSE

The main aim of this study was to gain insight into whether temperament and/or stuttering severity were associated with anxiety and depression in children who stutter. Additionally, the study also provided an indication into the prevalence of anxiety and depression in children who stutter in a clinical cohort.

METHOD

The participants were 132 English-speaking children (105 boys and 27 girls) between 9;0 and 14;11 years old (M = 11;8, SD = 1;10) and their mothers. At their first visit to a specialist center for children who stutter, mothers and children completed the relevant versions of the Early Adolescent Temperament Questionnaire-Revised (EATQ-R; Ellis & Rothbart, 2001) and a screening of children's anxiety and depression, using the Revised Children's Anxiety and Depression Scale (RCADS; Chorpita et al., 2000). Stuttering was evaluated using the Stuttering Severity Instrument Fourth Edition (SSI-4). Correlations were conducted between child and parent versions of the EATQ-R and RCADS; EATQ-R and RCADS; as well as the SSI-4 and RCADS. A comparison was made between those children who scored below the clinical threshold for anxiety and depression, and those who scored above.

RESULTS

Significant correlations were found for all mother and child EATQ-R factors and RCADS scales (except for Obsessive Compulsive Disorder). Correlations were also found between the child- and mother-reported temperament factors of positive reactivity, negative reactivity, and self-regulation and anxiety and depression. Children who scored above the clinical threshold for any category of anxiety or depression had significantly lower positive reactivity and higher negative reactivity scores, compared to those who scored below the threshold. There were no differences between the two groups with regard to SSI-4 scores.

CONCLUSIONS

This is the first study to evaluate associations between temperament and anxiety and depression in children who stutter. Higher negative reactivity scores and lower positive reactivity and self-regulation scores are associated with elevated levels of anxiety and depression in children who stutter. Further, those who score above the clinical threshold have significantly higher levels of negative reactivity and lower levels of positive reactivity compared to those scoring below the threshold. Findings suggest that levels of anxiety that reach clinical threshold are more prevalent in children who stutter than would be expected based on population data. Current findings have implications for both the assessment and therapy of children who stutter presenting at clinics for support.

Negative life events and internalizing problems among Romanian youth

During adolescence individuals face multiple stressful events, but it is not clear how these impact adolescents' adjustment and what factors buffer their negative effects. The present exploratory study investigates the relationship between frequency, proximity, and intensity of negative life events and occurrence of internalizing symptoms in a sample of Romanian adolescents. 2690 youth aged 15-16 from capital city of Romania filled in a series of measures from Youth in Europe Study. Hierarchical regression was employed to test for the explanatory value of individual (gender and family status), relational (parents and peer support), and negative life events on depressive and anxiety symptoms. Frequency and proximity of negative life events explained 35.8% in the displaying of depressive symptoms. After controlling for individual and relational variables, occurrence, proximity, and intensity of negative life events significantly contributed to explaining heightened anxiety symptoms (R² = .246). Adolescents reporting more frequent, earlier in time and more intensive negative events also reported more depressive and anxiety symptoms, thus, supporting the relationship between occurrence of adversities and negative mental health outcomes.

Anxiety Trajectories in Adolescents and the Impact of Social Support and Peer Victimization

This paper examines whether adolescents can be reliably categorized into subgroups based on their patterns of anxiety levels over time and whether low levels of social support from parents, peers, and their school, and high levels of peer victimization, predict a pattern of increasing anxiety. Participants were 3392 youth from the Longitudinal Study of Australia's Children (LSAC). Youth-reported anxiety was measured at three occasions at ages 12/13 years, 14/15 years, and 16/17 years, with social support and victimization assessed at age 12/13 years. Anxiety trajectories were identified using latent class growth mixture modelling, and predictors of class membership were examined using multinomial logistic regression analyses. Three discrete classes of anxiety trajectories were identified. Most youth fell within a stable-low anxiety symptom class (89.5% males; 78.2% females), with smaller percentages in low-increasing (5.6% males; 14.4% females) or high-decreasing (4.9% males; 7.4% females) classes. Low support from parents and teachers, low sense of school belonging, and high peer victimization predicted membership of the low-increasing anxiety trajectory class, irrespective of gender. Social support did not moderate the effect of peer victimization upon the risk of developing anxiety, with peer victimization remaining a risk factor even when adolescents experienced good social support from parents, peers, and school. The findings highlight the need for screening in early adolescence to identify those who are experiencing low social support and high peer victimization and are thus at increased risk of developing anxiety problems. These youth could then be offered targeted intervention to reduce the likelihood of anxiety development.

Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment

Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.

Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.

Sleep Duration and Insomnia in Adolescents Seeking Treatment for Anxiety in Primary Health Care

There is limited knowledge about sleep in adolescents with elevated levels of anxiety treated within primary health care settings, potentially resulting in sleep problems not being sufficiently addressed by primary health care workers. In the current study self-reported anxiety, insomnia, sleep onset latency, sleep duration, and depressive symptoms were assessed in 313 adolescents (12–16 years; mean age 14.0, SD = 0.84, 84.0% girls) referred to treatment for anxiety within primary health care. Results showed that 38.1% of the adolescents met criteria for insomnia, 34.8% reported short sleep duration (<7 h), and 83.1% reported long sleep onset latency (≥30 min). Total anxiety symptoms were related to all sleep variables after controlling for age and sex. Furthermore, all anxiety symptom sub-types were associated with insomnia and sleep onset latency, whereas most anxiety subtypes were associated with sleep duration. Adolescents’ depressive symptoms accounted for most of the anxiety-sleep associations, emphasizing the importance of depressive symptoms for sleep. However, anxiety was associated with insomnia and sleep onset latency also among youth with low levels of depressive symptoms. The findings suggests that primary health care workers should assess sleep duration, sleep onset latency, and insomnia in help-seeking adolescents with anxiety.

Negative Life Events as Predictors of Anxiety Outcomes: An Examination of Event Type

Long-term follow-up studies of anxiety treatment have found that greater exposure to negative life events (NLEs) predicts poorer anxiety outcomes, but none have examined whether specific types of NLEs are differentially associated with child outcomes. This study examined the frequency of NLEs and whether specific types of NLEs were associated with increased risk of having an anxiety disorder 6.5 years post randomization. Participants were 319 adolescents and adults, ages 11 to 26 (M = 17), enrolled in Child/Adolescent Anxiety Multimodal Extended Long-term Study. At their first follow-up visit, participants completed a diagnostic interview and a 40-item Life Events Scale that reflected whether specific events occurred since their last post treatment assessment. Life events were categorized into domains (i.e., family, academic, health, and social) via researcher consensus. Participants reported having experienced an average of four NLEs. Participants with an anxiety disorder at follow-up were significantly more likely to have failed a grade in school (OR = 5.9) and experienced a negative change in acceptance by peers (OR = 4.9; ps < 0.001). After controlling for gender, age, race, and SES, a greater number of NLEs in the academic domain increased the odds of having an anxiety disorder at follow-up (OR = 2.4, p < 0.001). No other domains were predictive of disorder status at follow-up. Findings highlight the value of examining specific NLEs in relation to the long-term child anxiety outcomes.

Internalizing Symptom Profiles Among Youth in Foster Care: A Comparison Study

Background: A high prevalence of anxiety and depression is found among youth in foster care. There is limited knowledge on the anxiety and depression symptom profiles of youth in foster care. We examined latent profiles of anxiety and depression symptoms across three unique youth samples and whether youth in foster care were more or less likely to belong to specific symptom profiles than their peers recruited from clinical or general youth populations. We also investigated if these profiles were predicted by sex and age. Methods: Self-reported anxiety and depression symptoms were assessed by Spence Children's Anxiety Scale and Short Mood and Feelings Questionnaire. Data were pooled from three youth samples (N = 2,005; mean age = 13.9 years, range = 11-18 years) comprising youth in foster care (n = 245), a clinical youth sample (n = 107), and a general population youth sample (n = 1,653). Symptom profiles were identified using latent profile analyses. Multinominal logistic regression was used to predict the latent profile membership. Results: Three profiles that differed both in symptom level and shape were identified and labeled as low, medium, and high symptom profile. Compared to the general population youth sample, youth in foster care had a higher likelihood of belonging to the high symptom profile, but not the medium symptom profile. Youth from the clinical sample had an increased risk of belonging to the medium and high symptom profiles compared to the youth in foster care and general population youth samples. Across samples, girls yielded a higher likelihood of having a medium or high symptom profile. Increasing age was associated with a higher likelihood of being in the high symptom profile. Conclusion: Compared to their counterparts in the general population, youth in foster care are at risk of belonging to a class of youth with high symptom levels across subtypes of internalizing symptoms, indicating the importance of systematic and broad assessment of internalizing symptoms among these youth. Knowledge on the symptom profiles of anxiety subtypes and depression increases our understanding of the treatment needs of youth in foster care.

Associations between screen time, negative life events, and emotional and behavioral problems among Chinese children and adolescents

BACKGROUND

Mental health problems among children and adolescents are a pressing public health issue. This study aimed to investigate the associations between screen time (ST), negative life events (NLEs), and emotional and behavioral problems (EBPs) among Chinese children and adolescents.

METHODS

A total of 5959 boys and girls from 14 elementary and junior high schools of four cities in China were included in this study. EBPs were assessed by the Strengths and Difficulties Questionnaire (SDQ), NLEs were evaluated by the Adolescent Self-Rating Life Events Checklist (ASLEC), and ST data were obtained through self-reporting. Descriptive analyses, chi-squared tests, and logistic regression were performed using SPSS 23.0.

RESULTS

There were significant associations between ST/NLEs and EBPs. Participants with high exposure to ST or NLEs were more likely to have EBPs than those with low exposure to ST or NLEs. The simultaneous associations of ST and NLEs on EBPs were stronger than those of ST or NLEs, individually.

LIMITATIONS

This was a cross-sectional research study; therefore, it could not judge causality or direction. ST and NLEs were retrospective and might have recall biases.

CONCLUSIONS

Our results showed positive associations between ST, NLEs, and EBPs. The results indicate that interventions should be considered to decrease ST and NLEs for children and adolescents.

Evaluation of "Healthy Learning. Together", an Easily Applicable Mental Health Promotion Tool for Students Aged 9 to 18 Years

Schools play an important role in adolescents’ health promotion. Due to the limited resources of teachers, there is a need for short-time interventions that can be easily implemented in a regular class without extensive training. Therefore, the tool “Healthy learning. Together.” was developed within a joint venture research project in Jena, Germany. The tool consists of a box with 60 exercises and a poster exhibition for students in 5th grade and higher. One thousand one hundred and forty four (1144) students (56% female) from nine schools were assessed at an interval of 10 weeks in a parallelized pre-post-design with class-wise assignment to intervention group (IG) and control group (CG). In the IG, regular teachers implemented the health promotion tool. Before and after the intervention social integration, class climate, self-efficacy (as primary outcomes) and mental and physical wellbeing (as secondary outcomes) were measured using standardized questionnaires. ANCOVA analysis revealed that students of the IG showed more positive changes on primary outcomes with small effect sizes. Additional implementation outcomes showed high teacher and student enthusiasm but sometimes low exposure rates. Regarding the relatively small amount of time and preparation for teachers to get noticeable effects, the introduced tool is suitable as a first step into health promotion for schools.