COVID-19 Distress Impacts Adolescents' Depressive Symptoms, NSSI, and Suicide Risk in the Rural, Northeast US

OBJECTIVE

Widespread concern exists about the impacts of COVID-19 and related public health safety measures (e.g., school closures) on adolescent mental health. Emerging research documents correlates and trajectories of adolescent distress, but further work is needed to identify additional vulnerability factors that explain increased psychopathology during the pandemic. The current study examined whether COVID-19-related loneliness and health anxiety (assessed in March 2020) predicted increased depressive symptoms, frequency of non-suicidal self-injury (NSSI), and suicide risk from pre-pandemic (late January/early February 2020) to June 2020.

METHOD

Participants were 362 middle and high school adolescents in rural Maine (M age = 15.01 years; 63.4% female; 76.4% White). Data were collected during a time in which state-level COVID-19 restrictions were high and case counts were relatively low. Self-reports assessed psychopathology symptoms, and ecological momentary assessment (EMA) was used to capture COVID-19-related distress during the initial days of school closures.

RESULTS

Loneliness predicted higher depressive symptoms for all adolescents, higher NSSI frequency for adolescents with low pre-pandemic frequency (but less frequent NSSI for adolescents with high pre-pandemic frequency), and higher suicide risk for adolescents with higher pre-pandemic risk. Health anxiety predicted higher NSSI frequency for adolescents with high pre-pandemic frequency, and secondary analyses suggested that this pattern may depend on adolescents' gender identity.

CONCLUSIONS

Results underscore the impact of COVID-19 on adolescent mental health, with benefits for some but largely negative impacts for most. Implications for caretakers, educators, and clinicians invested in adolescent mental health are discussed.

Reimagining rumination? The unique role of mental imagery in adolescents' affective and physiological response to rumination and distraction

Rumination is associated with increased risk for depression whereas distraction helps draw attention away from negative experiences, lowering risk. Many individuals who ruminate do so in the form of mental imagery and imagery-based rumination is more highly associated with depressive symptom severity than ruminating in the form of verbal thoughts. We do not yet understand why imagery-based rumination may be especially problematic nor how to intervene to reduce imagery-based rumination, however. Adolescents (N = 145) underwent a negative mood induction followed by experimental induction of rumination or distraction in the form of mental imagery or verbal thought while affective, high-frequency heart rate variability, and skin conductance response data were collected. Rumination was associated with similar affective, high-frequency heart rate variability, and skin conductance response regardless of whether adolescents were induced to ruminate in the form of mental imagery or verbal thought. Distraction led to greater affective improvement and greater increases in high-frequency heart rate variability, but similar skin conductance responses when adolescents were inducted to distract themselves in the form of mental imagery compared with verbal thought. Findings emphasize the importance of considering mental imagery in clinical contexts when assessing rumination and when intervening using distraction.

Friends' discussions of interpersonal and noninterpersonal problems during early and middle adolescence: Associations with co-rumination

Friendships are important sources of support during adolescence. However, a growing literature indicates some adolescents co-ruminate, or talk with friends about problems in a way that is excessive, speculative, and negatively focused, which confers risk for internalizing problems. Still, previous research had not examined the types of problems co-ruminators discuss. Using self-reported co-rumination and observations of friends' conversations about problems, the present study of early and middle adolescents addressed this gap. Participants (N = 628) were approximately half female (52% of the sample) and primarily European American and African American (63% and 29% of the sample, respectively). Adolescents who reported greater co-rumination spent more time discussing interpersonal problems with friends, including problems with families, peers, and romantic interests. Interpersonal problems may lend themselves to co-rumination because they can be ambiguous, multifaceted, and difficult to resolve. In contrast, co-rumination was not related spending more time discussing noninterpersonal problems. In addition, middle adolescents were observed to spend more time than early adolescents discussing problems related to developmentally salient tasks (e.g., romantic relationships, academics), and girls spent more time than boys discussing interpersonal problems. Taken together, the findings contribute to a more comprehensive understanding of co-rumination. Moreover, the study has applied implications in that findings suggest that adolescents experiencing interpersonal problems may be at elevated risk of co-ruminating. In addition to steering these adolescents away from co-rumination, fostering better problem-solving skills for interpersonal problems may lead to the resolution of these problems before they become topics of co-rumination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Suicidal Mental Imagery: Investigating a Novel Marker of Suicide Risk

Rates of suicidal ideation and behavior are high and increasing in emerging adulthood. Research focused on suicidal ideation as a predictor of suicidal behavior has nearly exclusively conceptualized suicidal ideation as verbal thoughts about suicide. Emerging research suggests, however, that mentally imagining suicide may be even more impairing than verbal thoughts about suicide. Thirty-nine emerging adults with a lifetime history of suicidal cognitions completed self-report assessments of characteristics of their suicidal cognitions, histories of suicide plans and behavior, and the degree to which their suicidal cognitions took the form of mental imagery or verbal thought. Suicidal mental imagery predicted more intense and longer duration of suicidal cognitions, a higher likelihood of having made a suicide plan, and a higher likelihood of having made a suicide attempt over and above suicidal verbal thoughts. Thus, suicidal mental imagery could provide a novel target for suicide assessment and intervention for emerging adults.

Imagery- and Verbally-Based Brooding Rumination in Adolescence: Differential Associations with Depressive Symptoms

Background:

Brooding rumination, or perseverative dwelling on negative cognitions, prolongs negative affect and is associated with heightened risk for depressive symptoms. Emerging research suggests that brooding rumination may be associated with more severe depressive symptoms when individuals brood in the form of mental imagery relative to verbal thoughts.

Objective:

The present study tested whether rumination was more highly associated with depressive symptom severity when adolescents ruminated in the form of mental imagery compared with verbal thoughts.

Methods:

Adolescents (N = 145) were recruited from the community surrounding a public university in the Northeastern United States. Of these adolescents, 136 were retained in analyses based on their reports of engaging in brooding rumination at least some of the time [age range: 13-17 years; M(SD)age = 15.40(1.24) years; 60.29% female, 32.35% male, 4.41% transgender, 2.94% other genders). In this cross-sectional study, adolescents reported on their trait levels of brooding rumination, whether they tend to ruminate in the form of mental imagery, verbal thought, or both, and completed a measure of depressive symptom severity. Moderated regression analyses were used to test whether the strength of the relation between brooding rumination and depressive symptom severity varied based on rumination style.

Results:

Imagery-based brooding rumination occurred in the majority of adolescents, and imagery-based rumination was more highly associated with depressive symptom severity than verbally-based rumination for female adolescents and those adolescents high in trait brooding rumination.

Conclusion:

Findings emphasize the potential utility of assessing and intervening on imagery-based rumination.

Emotion regulation deficits and depression-related maladaptive interpersonal behaviours

ABSTRACTCoyne's interpersonal theory of depression posits that those with depressive symptoms engage in maladaptive interpersonal behaviours that, although intended to assuage distress, push away social supports and increase depressive symptoms (Coyne, 1976). Excessive reassurance seeking, negative feedback seeking, and conversational self-focus are three behaviours implicated in Coyne's theory, yet their correlates- apart from depressive symptoms- are poorly understood. The current study considered the potential role of intrapersonal emotion regulation deficits as an additional vulnerability factor for these behaviours. Mediation models further tested whether linkages between emotion regulation deficits and maladaptive interpersonal behaviours helped to explain short-term increases in depressive symptoms, as further suggested by theory. Older adolescents (N = 291, M age = 18.9) completed self-report measures of emotion regulation deficits, depressive symptoms, and the three maladaptive interpersonal behaviours during an initial lab visit and again four weeks later. A series of multiple regression models suggested that emotion regulation difficulties are uniquely associated with each of the behaviours over and above the impact of depressive symptoms. Mediation analyses suggested that only excessive reassurance seeking mediated the association between initial emotion regulation deficits and increased depressive symptoms over time. The clinical implications of these findings are discussed.

Social-cognitive risk for suicide and new relationship formation: False perception, self-fulfilling prophecy, or both?

OBJECTIVE

This study examined the impact of social-cognitive constructs associated with increased suicide risk (i.e., perceived burdensomeness and thwarted belongingness) on relationship formation during real-time interactions of older adolescents with strangers in a dyadic context.

METHOD

Two hundred and seventy-four older adolescents (61.9% female, M age = 18.96 years) were paired with same-gender strangers and completed a laboratory-based interaction task. Both target participants and their partners answered questions about their interaction at three time points during the 45-min session. Structural equation modeling was used to test hypothesized models.

RESULTS

Perceived burdensomeness and thwarted belongingness predicted interpersonal consequences during the interaction. In the first model, thwarted belongingness led targets to inaccurately perceive their partners' assessments of the interaction. This misperception negatively impacted the participants' own desires for friendship. In the second model, thwarted belongingness predicted decreases in targets' desire to continue the conversation, whereas perceived burdensomeness predicted higher levels of desire to continue the conversation. For females, thwarted belongingness in particular was related to new relationship formation in these models. Overall, those who desired to continue talking were more likely to like their partner at the end of the conversation.

CONCLUSIONS

Results add to our understanding of how perceived burdensomeness and thwarted belongingness contribute to increased social alienation, which could serve to increase suicide risk.

Long-Term Predictive Validity of the Juvenile Sex Offender Assessment Protocol-II: Research and Practice Implications

The current study evaluated the predictive validity of the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) scores in a sample of juveniles who recidivated sexually or nonsexually as adults. Participants included 166 juveniles who had previously sexually offended and were followed into adulthood for an average of 10.75 years. Results of area under the receiver operating characteristic curve (AUC) analyses supported the predictive validity of the J-SOAP-II Total Score, Scale 1, and Static Score in regard to adult sexual recidivism, and predictive validity was found for all J-SOAP-II scores (except Scale 1) in regard to adult nonsexual recidivism. Implications for future research on the assessment of risk factors and treatment needs for adolescents who commit sexual offenses are discussed.

Relations of friendship experiences with depressive symptoms and loneliness in childhood and adolescence: A meta-analytic review

Well-established psychological theories indicate that interpersonal relationships and emotional well-being are linked in fundamental ways (Coyne, 1976; Sullivan, 1953). Indeed, difficulties in close relationships can contribute to emotional adjustment problems, and emotional problems can adversely affect close relationships. Moreover, different close relationships are especially significant in terms of development and adjustment at different stages of the life span. The current review focuses on childhood and adolescence, developmental stages at which friendships are particularly important. This article presents the results of 16 meta-analyses including 589 unique effects from 233 studies that examine concurrent and longitudinal associations between youths' friendship experiences (number of friends, positive friendship quality, negative friendship quality) and their emotional adjustment (depressive symptoms and loneliness). Studies examining these associations are mixed in regard to whether significant effects emerge. The current research synthesis provides more stable estimates of the effects. In fact, relatively small but significant concurrent and longitudinal associations emerged between the 3 indices of friendship with depressive symptoms and loneliness. The results also suggest that friendship experiences may be more closely linked with loneliness than depressive symptoms and that negative friendship quality may be related to friendship experiences more strongly than number of friends or positive friendship quality. Interestingly, some of the relations were found to be stronger for younger youth. Implications for prevention and intervention efforts are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Peer Socialization of Non-Suicidal Self-Injury in Adolescents' Close Friendships

Non-suicidal self-injury (NSSI), or self-harming behavior without intent to die (Nock Current Directions in Psychological Science, 18, 78-83, 2009), is associated with distress and impairment across domains, including increased risk for suicidality (Kiekens et al. Journal of Affective Disorders, 239, 171-179, 2018). In adolescence, prevalence of NSSI is high (Swannell et al. Suicide and Life-threatening Behavior, 44, 273-303, 2014), and peer influence regarding NSSI is thought to be strong (Brechwald and Prinstein Journal of Research on Adolescence, 21, 166-79, 2011). Although concern regarding "clusters" of NSSI has long been documented, peer socialization of NSSI in adolescence is understudied. This paper tests peer influence on NSSI frequency within adolescent friendship dyads. Emotion regulation difficulties and friendship quality were evaluated as factors that may influence susceptibility to peer influence effects. Adolescents (N = 196, M age = 15.68, 69.9% female, 87.6% White) nested within 93 friendship dyads reported on their own NSSI frequency, difficulties in emotion regulation, and friendship quality at three time points spaced 3 months apart. Cross-lagged Actor-Partner Interdependence Models examined peer influence effects over time. Friends' Time 1 frequency of NSSI uniquely predicted adolescents' own NSSI frequency over 3 and 6 months, controlling for initial similarity among friends as well as individual risk factors for NSSI. Peer influence effects were strongest in adolescents with higher levels of emotion regulation difficulty but did not vary as a function of friendship quality. Friends' NSSI frequency is a significant and unique predictor of increases in adolescents' own NSSI frequency over time. Implications for interventions that leverage the important developmental context of peer relationships are discussed.

Birds of a Feather Want to Talk Together: The Impact of Depressive Symptoms on Initial Stages of Friendship Formation in Older Adolescence

Introduction: Peer relationships play a vital role in adolescents’ lives and are considered to be especially critical for youth who experience elevated depressive symptoms. Unfortunately, depressed youth tend to have difficulties with existing friendships (e.g., fewer and lower quality friendships), which may exacerbate their symptoms. Little is known, however, about how depressed youth approach the initial stages of friendship formation, which may have implications for the types of social support they can access.

Method: Using a conversation task designed to build intimacy, older adolescents (N = 228, M age = 19.54 years) with and without elevated depressive symptoms interacted with a previously unknown, same-gender partner.

Results: Results suggested that adolescents with elevated symptoms experienced interactions differently (e.g., speculated more about their conversation partner and thought their partner was speculating more about them, experienced more negative affect) than nondepressed peers. The depression status of the potential friend also mattered, as participants paired with partners of similar emotional adjustment status wanted to talk more and felt closer to one another than did mismatched partners.

Discussion: Findings underscore that depressive symptoms impact even the earliest stages of friendship formation. From the perspective of interpersonal theories of depression, implications for bolstering depressed adolescents’ relationships are discussed.

When Does Co-Rumination Facilitate Depression Contagion in Adolescent Friendships? Investigating Intrapersonal and Interpersonal Factors

Research supports the notion that adolescents' mental health is impacted by peers via contagion processes. A growing area of interest has been how co-rumination may influence depressive symptoms within friendships. The current study examined particular conditions under which co-rumination is especially likely to facilitate depression contagion. Participants were adolescents (N = 480, 49% female, M age = 14.6 years, 59.5% European American) paired in friendship dyads and assessed over 9 months. Characteristics of the adolescent (personal distress), of the friend (excessive reassurance seeking), and of the friendship (friendship quality) were considered. Moderated mediation analyses indicated that co-rumination facilitated depression contagion only under conditions of adolescents' high personal distress, friends' high excessive reassurance seeking, and high positive friendship quality. This research underscores the importance of attending to how and under what conditions depression contagion occurs within friendships in order to support adolescents' positive social and emotional development.

Social-Cognitive and Social-Behavioral Correlates of Suicide Risk in College Students: Contributions from Interpersonal Theories of Suicide and Depression

Joiner's interpersonal-psychological theory of suicide (IPTS) is predated by literature examining maladaptive interpersonal behaviors associated with depression; however, research has not examined the potential relevance of such behaviors for the IPTS. The current study aimed to expand understanding of suicide risk by examining two maladaptive interpersonal behaviors in the context of Joiner's IPTS model. Structural equation modeling examined associations between depressive symptoms, social-cognitive predictors of suicide, maladaptive interpersonal behaviors, and suicide risk in 228 college students (53.9% female; M = 19.5 years, SD = 1.8). Social-cognitive IPTS variables mediated the relation between depressive symptoms and maladaptive interpersonal behavior. Both social-cognition and maladaptive interpersonal behavior mediated the effect of depressive symptoms on suicide risk. Findings have the potential to add to our understanding of the interplay of social-cognitive factors and interpersonal behaviors associated with suicide risk. Directions for future research are discussed.

Co-Rumination Exacerbates Stress Generation among Adolescents with Depressive Symptoms

Through stress generation, individuals' own thoughts and behaviors can actually lead to increases in their experience of stress. Unfortunately, stress generation is especially common among individuals who are already suffering from elevated depressive symptoms. However, despite the acknowledgement that some individuals with depressive symptoms generate greater stress than others, few studies have identified specific factors that could exacerbate stress generation among individuals with depressive symptoms. The present study examines co-rumination as a factor that might exacerbate stress generation among adolescents with depressive symptoms using a short-term longitudinal design. Considering these processes among adolescents was critical given that many youth experience increases in depressive symptoms at this developmental stage and that co-rumination also becomes more common at adolescence. Participants were 628 adolescents (326 girls; 302 boys) who reported on their depressive symptoms, experiences of stress, and co-rumination with a best friend. Interpersonal stressors (peer and family stress) and non-interpersonal stressors (school and sports stress) were assessed. Consistent with past research, adolescents with depressive symptoms experienced greater interpersonal and non-interpersonal stress over time. Importantly, co-rumination interacted with both depressive symptoms and gender in predicting increases in peer stress. Depressive symptoms predicted the generation of peer stress only for girls who reported high levels of co-rumination with friends. Implications for protecting youth with depressive symptoms against stress generation are discussed.

Girls' and boys' problem talk: Implications for emotional closeness in friendships

This research highlights the critical role of gender in the context of problem talk and social support in adolescents' friendships. Early- and middle-adolescents' (N = 314 friend dyads; Ms = 13.01 and 16.03 years) conversations about problems were studied using observation and a short-term longitudinal design. Mean-level gender differences emerged in that girls participated in problem talk more than boys and responded in a more positive and engaged manner to friends' statements about problems (e.g., by saying something supportive, asking a question) than did boys. Interestingly, boys used humor during problem talk more than girls. Despite mean-level differences, there were not gender differences in the functional significance of participating in problem talk and positive engaged responses in that these behaviors predicted increased friendship closeness for both boys and girls. In contrast, humor during problem talk predicted increased closeness only for boys, highlighting an understudied pathway to closeness in boys' friendships.

Co-rumination mediates contagion of internalizing symptoms within youths' friendships

Peer contagion of internalizing symptoms was examined within youths' friendships over 6 months. Children (Grades 3 and 5) and adolescents (Grades 7 and 9) paired in 274 reciprocal same-sex friendship dyads completed measures of depressive and anxiety symptoms, co-rumination, and self-disclosure. Depression contagion was present for all youth, and anxiety contagion was found in the sample of girls and older boys. Although normative self-disclosure did not mediate the contagion effects, co-rumination mediated the depression contagion effect for adolescents and the anxiety contagion effect in the sample of girls and older boys. Implications for interventions with youth at risk for developing internalizing symptoms are discussed.

How girls and boys expect disclosure about problems will make them feel: implications for friendships

Although girls disclose to friends about problems more than boys, little is known about processes underlying this sex difference. Four studies (Ns = 526, 567, 769, 154) tested whether middle childhood to mid-adolescent girls and boys (ranging from 8 to 17 years old) differ in how they expect that talking about problems would make them feel. Girls endorsed positive expectations (e.g., expecting to feel cared for, understood) more strongly than boys. Despite common perceptions, boys did not endorse negative expectations such as feeling embarrassed or worried about being made fun of more than girls. Instead, boys were more likely than girls to expect to feel "weird" and like they were wasting time. Sex differences in outcome expectations did help to account for girls' greater disclosure to friends.

Relational and Overt Aggression in Childhood and Adolescence: Clarifying Mean-Level Gender Differences and Associations with Peer Acceptance

Research on relational aggression has drawn attention to how girls may be likely to aggress, but the role of gender is not fully understood. There are opposing views regarding whether relational aggression is most common among girls. Current findings demonstrate that when gender differences in relational aggression are assessed with peer nominations, gender differences favoring girls are more likely: a) in adolescence than childhood and b) when statistical overlap with overt aggression is controlled. Results also indicated that associations of relational aggression with peer acceptance depend on the aggressor's gender, the peer rater's gender, and whether overlap with overt aggression is controlled. Associations of relational aggression with lower acceptance became non-significant when overt aggression was controlled, suggesting that relational aggression displayed in isolation may not damage acceptance. In fact, in mid-adolescence, girls' relational aggression predicted greater liking by boys. Reducing relational aggression among adolescent girls may be especially challenging if the behavior is linked with acceptance by boys.

Conversational Self-Focus in Adolescent Friendships: Observational Assessment of an Interpersonal Process and Relations with Internalizing Symptoms and Friendship Quality

Although youth with internalizing symptoms experience friendship difficulties, surprisingly little is known about their problematic interpersonal behaviors. The current observational study identifies a new construct, conversational self-focus, defined as the tendency to direct the focus of conversations to the self and away from others. Results indicated that youth with internalizing symptoms were especially likely to engage in self-focus when discussing problems with friends and that doing so was related to their friends perceiving the relationship as lower in quality, particularly helping. Content analyses further indicated that self-focused youth talked about themselves in ways that were distracting from their friends' problems and that they changed the subject abruptly. Last, conversational self-focus was not redundant with related constructs of rumination and self-disclosure. This research highlights the importance of intervention efforts aimed at teaching self-focused youth ways to cope with distress that are more effective and will not damage their friendships.

Relational and Overt Aggression in Childhood and Adolescence: Clarifying Mean-Level Gender Differences and Associations with Peer Acceptance

Research on relational aggression has drawn attention to how girls may be likely to aggress, but the role of gender is not fully understood. There are opposing views regarding whether relational aggression is most common among girls. Current findings demonstrate that when gender differences in relational aggression are assessed with peer nominations, gender differences favoring girls are more likely: a) in adolescence than childhood and b) when statistical overlap with overt aggression is controlled. Results also indicated that associations of relational aggression with peer acceptance depend on the aggressor's gender, the peer rater's gender, and whether overlap with overt aggression is controlled. Associations of relational aggression with lower acceptance became non-significant when overt aggression was controlled, suggesting that relational aggression displayed in isolation may not damage acceptance. In fact, in mid-adolescence, girls' relational aggression predicted greater liking by boys. Reducing relational aggression among adolescent girls may be especially challenging if the behavior is linked with acceptance by boys.