A longitudinal investigation of the cross-dimensional mediating role of negative life events between neuroticism and depressive symptoms in adolescents

BACKGROUND

Neuroticism has been identified as a significant predictor for depression within the adolescent population However, few longitudinal studies have investigated this association and explored the mediation effect of the negative life events. This study aimed to examine the longitudinal association between neuroticism, negative life events, and depression in a large sample of Chinese adolescents.

METHODS

Data on Five Factor Inventory-Neuroticism Subscale (FFI-N) was collected from 1150 participants aged 14-19 years old at baseline, and data on Adolescent Life Event Questionnaire (ALEQ) and Center of Epidemiological Study-Depression (CES-D) were collected both at baseline and 6-month follow-up. Multilevel modelings were used to analyze the longitudinal associations among neuroticism, negative life events and depression.

RESULTS

Through a longitudinal study design, results from multilevel regression analyses indicated a direct correlation between increased levels of neuroticism and the aggregation of negative life events with the prediction of more severe depressive symptoms. Further, results of multilevel mediations suggested that the negative life events served to partially mediate the relationship between neuroticism and each dimension of depression.

LIMITATIONS

The results cannot be used to make a clinical diagnosis.

CONCLUSION

The current findings suggest the negative life events as a cross-dimensional mediator in the relationship between neuroticism and each dimension of depression. Regulating neuroticism levels and implementing strategies to coping stress derived from daily life events could be integral approaches to reducing the prevalence of depression within the adolescent population.

"Scaling-out" evidence-based interventions to new populations or new health care delivery systems

Background

Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials.

Discussion

In this paper, we introduce a new concept for implementation called “scaling-out” when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest.

Conclusion

In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes “borrow strength” from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.