Results of an Italian school-based expressive writing intervention trial focused on peer problems

This study investigated the effectiveness of an expressive writing intervention in a sample of Italian early adolescents on internalizing and post-traumatic stress symptoms and coping strategies. Participants were 153 Italian adolescents (48% male), attending 7th grade (M = 12.24 yrs, SD = 0.47). Youth were randomly assigned either to write about personal emotional events related to problems they recently experienced with peers, or trivial topics. Data were collected before and 2 months following the intervention. Analyses revealed no overall intervention effects on symptoms. However, level of peer victimization moderated the effects of the intervention on coping strategies, such that victimized youth in the intervention showed increases in cognitive restructuring and avoidance coping, relative to other groups. Thus, expressive writing affected coping strategies but not internalizing problems in our early adolescent sample.     

A closer look at co-rumination: gender, coping, peer functioning and internalizing/externalizing problems

Co-rumination, defined as repetitive, problem-focused talk explains higher levels of friendship quality in youth (Rose, 2002) and increased levels of anxiety/depression in females. Middle adolescents (N = 146) participated in a study of co-rumination, individual coping, externalizing/internalizing problems, and peer functioning. Consistent with past research, girls reported higher levels of co-rumination and internalizing symptoms. Co-rumination was also positively correlated with self-reports, but not teacher reports, of anxiety/depression and aggressive behavior. Both self-reported number of friends and teacher-rated social acceptance were negatively associated with co-rumination. Co-rumination partially accounted for the significant indirect effect of gender on internalizing symptoms. Additionally, co-rumination was associated with internalizing and externalizing symptoms but not individual coping efforts. Finally, co-rumination accounted for a unique amount of variance in internalizing symptoms, controlling for externalizing problems and secondary control coping. Theoretical implications and the importance of including broad domains of adjustment and peer functioning in future investigations of co-rumination are discussed.     

Adolescent vulnerability and the distress of rejection: Associations of adjustment problems and gender with control,emotions, and coping

We examined adjustment problems as risks for patterns of emotions, appraisals, and coping with rejection, and explored whether these processes could account for sex (boy/girl) differences in coping. Young adolescents (N = 669, grades 6–8) completed questionnaires, which assessed responses to peer rejection threat with two short scenarios. Using structural equation modeling to test a multivariate process model, adolescents with heightened social anxiety had the most maladaptive responses to rejection threat, including elevated emotional reactions, more self-blame, and coping using more social isolation, rumination and opposition. Adolescents reporting more depressive symptoms felt less control and anticipated using less adaptive coping (less support seeking, distraction, and negotiation), whereas aggressive adolescents responded with more anger and coped via opposition. Moreover, as anticipated, sex differences in coping, symptoms, emotions, and appraisals were found. However, coping differences between boys and girls were mostly nonsignificant after accounting for symptoms, aggression, emotional reactions, and appraisals.     

Individual differences in adolescent health symptoms: the effects of gender and coping

Previous studies have suggested that adult men and women experience different types and severities of physical and psychological health symptoms. This study examined whether in the case of adolescents these reported gender differences in physical and psychological health symptoms could actually be the result of differences in coping styles. Five hundred and forty-six adolescents were questioned on their coping styles and symptoms. We found gender differences in physical and psychological health symptoms (e.g. anger, depression, tension, negative moods), as well as in coping styles. We also found that the relation between health symptoms and coping varied significantly by gender. The results of this study suggest that doctors, school counselors and family therapists may want to take gender differences in coping styles into account when seeing adolescent patients for physical or psychological health symptoms, and find ways to help the adolescents cope more effectively with their stressors.     

Maternal cigarette smoking during pregnancy and the trajectory of externalizing and internalizing symptoms across childhood: Similarities and differences across parent,teacher, and self reports

Maternal smoking during pregnancy (MSDP) has been associated with symptoms of externalizing (e.g., hyperactivity) and internalizing (e.g., emotional) disorders in childhood. The present research addresses two new questions about the nature of this relation: (1) Do the associations between MSDP and externalizing and internalizing symptoms vary by who reports the symptoms? and (2) Is MSDP associated with changes in symptomatology across childhood? We address these questions with two cohorts from the Longitudinal Study of Australian Children (LSAC). Parents and teachers completed the Strengths and Difficulties Questionnaire up to six times every two years between child ages 4 and 14 in the older cohort (N = 3841) and up to four times between child ages 4 and 10 in the younger cohort (N = 3714); the study children also completed the same questionnaire up to three times starting at age 10. Across the two cohorts, MSDP was associated with more externalizing symptoms as reported by parents, teachers, and self. MSDP was also associated with increases in externalizing symptoms across childhood when teachers assessed the symptoms but not when parents assessed them. Finally, MSDP was not consistently associated with the average level of internalizing symptoms, but it was associated with increases in these symptoms across childhood. The present research indicates a robust association between MSDP and the average level of externalizing symptoms in childhood regardless of who reports the symptoms. It also indicates that whether MSDP is associated with the trajectory of externalizing symptomatology depends on who reports on the symptoms.     

Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems

Mentalization, the high-order function of detecting and interpreting one’s own and others’ mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization’s associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = −0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.     

Parent Psychopathology and Youth Internalizing Symptoms in an Urban Community: A Latent Growth Model Analysis

The present study examined the developmental trajectories of youth depression and anxiety symptoms from 6th through 12th grade in a low-income, urban sample (N = 141; mean age = 11.75 years; 88.7% African American). The study also tested the independent contribution of parent mood disorders, anxiety disorders, and substance use disorders assessed in early childhood to initial levels and rate of change in depression and anxiety symptoms from 6th through 12th grade. Possible gender differences in symptom course and strength of parent psychopathology predictors were examined using multiple-group analysis. Results indicated that depression symptoms declined over time for males, whereas depression symptoms initially declined, but then increased for females. In contrast, male and female adolescents each showed a decline in anxiety symptoms throughout adolescence. Findings also indicated that parent mood disorders were the only predictor of youth depression and anxiety symptoms for male and female adolescents in 6th grade. Parent anxiety disorders uniquely predicted the rate of change in depression symptoms among male adolescents. These results underscore the importance of targeting parents with mood and anxiety disorders in urban families in order to reduce the risk for internalizing difficulties in their adolescent youth.     

HIV-Related Stigma,Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12–24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.     

The immigrant paradox on internalizing symptoms among immigrant adolescents

Understanding the immigrant paradox on health outcomes among UK's immigrant adolescents will greatly complement the research on immigrants that has already been established there by economists and interdisciplinary fields. This study used the first Longitudinal Study of Young People in England 2004–2010 database (N = 15,770) to determine a) whether there was evidence of the immigrant paradox on internalizing mental health symptoms between first generation (n = 753) and second plus generation (n = 3042) 14/15 year old immigrant adolescents in England and b) whether differences (if any) were moderated by ethnicity group membership (Black African, Black Caribbean, Indian, Pakistani, Bangladeshi, Asian Other, White Immigrant). Findings demonstrate that overall first generation adolescent immigrants had statistically fewer internalizing symptoms as compared to second plus generation, and that this was especially true for Black African adolescents. Effect sizes measures however indicated that these differences were negligible. Implications for protective factors and future studies are briefly discussed.     

Child Routines and Parental Adjustment as Correlates of Internalizing and Externalizing Symptoms in Children Diagnosed with ADHD

Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood, and the presence of comorbid externalizing and internalizing symptoms often result in severe negative long-term consequences. Multiple etiological factors contribute to the development of co-occurring symptoms. Family stability and consistency appear to be particularly important in effectively managing behavioral concerns. One important factor in producing consistency and stability is the use of routines. The current study examined how routines may be related to internalizing/externalizing symptoms in a clinical sample (N = 371) of children with ADHD (M age = 9.13, SD = 1.96; 77 % male). After controlling for child age, gender, and parental adjustment, routines predicted both internalizing and externalizing symptoms. Specific subtypes of routines including Household, Discipline, and Homework Routines were found to significantly predict symptomatology. A positive relation was found between parental and child adjustment problems; however, support for routines moderating the relation between parent and child adjustment was not supported.     

A multidimensional approach to understanding the emergence of sex differences in internalizing symptoms in adolescence

Women are more vulnerable to internalizing disorders (e.g., depression and anxiety). This study took an integrative developmental approach to investigate multidimensional factors associated with the emergence of sex differences in internalizing symptoms, using data from the Adolescent Brain Cognitive Development (ABCD) study. Indices of sex hormone levels (dehydroepiandrosterone, testosterone, and estradiol), physical pubertal development, task-based functional brain activity, family conflict, and internalizing symptoms were drawn from the ABCD study’s baseline sample (9- to 10-year-old; N = 11,844). Principal component analysis served as a data-driven dimensionality reduction technique on the internalizing subscales to yield a single robust measure of internalizing symptoms. Moderated mediation analyses assessed whether associations between known risk factors and internalizing symptoms vary by sex. Results revealed direct and indirect effects of physical pubertal development on internalizing symptoms through family conflict across sexes. No effects were found of sex hormone levels or amygdala response to fearful faces on internalizing symptoms. Females did not report overall greater internalizing symptoms relative to males, suggesting that internalizing symptoms have not yet begun to increase in females at this age. Findings provide an essential baseline for future longitudinal research on the endocrine, neurocognitive, and psychosocial factors associated with sex differences in internalizing symptoms.     

Rates of psychotropic medication use in children with ASD compared to presence and severity of problem behaviors

There is a scarcity of research on the relationship between presence of problem behaviors and psychotropic medication use in children with autism spectrum disorder (ASD). Participants in the current study were children and adolescents ages 3–17 years who were sorted into four groups: ASD on psychotropic medication (N = 100), ASD not on psychotropic medication (N = 147), typically developing on medication (N = 48), and typically developing not on medication (N = 168). A one-way multivariate analysis of covariance (MANCOVA) was conducted to determine the relationship between medication use and rates of internalizing and externalizing behaviors. Post hoc analyses revealed that children with ASD on psychotropic medication evinced significantly more externalizing behaviors than children with ASD not on medication. However, the two groups did not significantly differ on rates of internalizing behaviors. These results suggest that psychotropic medications may often be prescribed to manage externalizing behaviors. Implications of these findings are discussed in relation to the existing literature.     

Sleep and stress in adolescents: the roles of pre-sleep arousal and coping during school and vacation

Study objectivesThis study explored the relationship between stress and actigraphy-measured and self-reported sleep in adolescents during periods of restricted (school) and unrestricted (vacation) sleep opportunities. We further examined whether (1) cognitive pre-sleep arousal (PSA) mediated the relationship between stress and sleep onset latency (SOL), and (2) coping moderated the effect of stress on PSA.MethodsParticipants were 146 (77 females) adolescents (M = 16.2, SD = 1.0) recruited from the community. Actigraphy assessed daily sleep over the last week of a school-term and the following two-week vacation. The following self-report measures were administered during both school and vacation: the Pittsburgh Sleep Quality Index, Inventory of High-School Students Recent Life Experiences (stress), Pre-Sleep Arousal Scale, and the Brief COPE (coping).ResultsPath analyses showed that during both school and vacation, higher cognitive PSA mediated the relationship between higher stress and longer self-report SOL (p < 0.01). During vacation, higher PSA also mediated the relationship between higher stress and longer actigraphy SOL (p < 0.05). During vacation (but not school), problem-focused coping moderated the mediating effects of PSA (p < 0.05), such that more frequent use of coping was associated with weaker association between stress and cognitive PSA, and shorter actigraphy and self-report SOL.ConclusionsCognitive PSA and coping may be two modifiable factors influencing how stress affects adolescents' sleep onset. Interventions that reduce cognitive arousal at bedtime may therefore shorten adolescents’ sleep onset during both school and vacation. Further, the use of problem-focused coping strategies might be protective against the effects of stress on sleep onset, especially during vacation periods.Statement of significanceThis paper expands the understanding of the stress-sleep association in adolescents by examining the mediating role of cognitive pre-sleep arousal and the moderating effects of coping. By examining these associations during both school and vacation periods, findings are likely to be applicable to both restricted and relatively unconstrained sleep conditions. Practically, our findings suggest that interventions directed towards the reduction of cognitive pre-sleep arousal may improve adolescents' sleep onset latency. Additionally, fostering healthy coping, especially problem-focused coping strategies such as problem solving, may mitigate the effects of stress on adolescents' sleep.     

Risk-Taking Propensity in Older Adolescents: Internalizing Symptoms,Gender, and Negative Reinforcement

Objective: Engagement in risk behaviors, including substance use, risky sex, and violence, tends to increase throughout adolescence into young adulthood. One motivational process that may underlie risk behaviors during adolescence is negative reinforcement. Moreover, gender and internalizing symptoms (e.g., depression and anxiety) may both convey risk for negative reinforcement–based risk taking. Along these lines, the aims of the current study were to (a) examine gender differences in negative reinforcement–based risk-taking propensity and (b) examine internalizing symptoms as a moderator of the relationship between gender and negative reinforcement–based risk-taking propensity. Method: Participants included 103 youth between the ages of 18 and 21 (50.49% female, age M(SD) = 19.41(1.06)) who were recruited from a large Mid-Atlantic university between September 2013 and November 2014. Participants completed self-report assessments of internalizing symptomatology and a computerized behavioral analog assessment of negative reinforcement–based risk-taking propensity. Results: Results indicated that, overall, female older adolescents were riskier under conditions of negative reinforcement than male older adolescents. In addition, internalizing symptoms significantly moderated the relationship between gender and negative reinforcement–based risk-taking propensity such that the relationship between gender and negative reinforcement–based risk-taking propensity was nonsignificant at high levels of internalizing symptoms, and female gender was significantly positively predictive of heightened negative reinforcement–based risk-taking propensity at low levels of internalizing symptoms. Conclusions: Thus, although female youth overall were riskier, the predictive utility of gender for negative reinforcement–based risk taking may be most relevant at low levels of internalizing symptoms. Results are discussed in terms of implications for future prevention and intervention.     

Association of stress coping strategies with Internet addiction in college students: The moderating effect of depression

BackgroundThis study examined the association between stress-related coping strategies and Internet addiction and the moderating effect of depression in a sample of Taiwanese college students.MethodA total of 500 college students (238 men and 262 women) participated in this study. Internet addiction was assessed using the Chen Internet Addiction Scale. Participants’ stress coping strategies and depressive symptoms were measured using the Coping Orientation to Problems Experienced and the Beck Depression Inventory-II, respectively. We used t and chi-square tests to examine differences in demographic characteristics, depression, and stress coping strategies between participants with and without Internet addiction. Significant variables were used in a logistic regression model to examine the association between stress coping strategies and Internet addiction and the moderating effect of depression on the association.ResultsResults indicated that use of restraint coping was negatively associated with Internet addiction (odds ratio [OR] = 0.886, 95% confidence interval [CI]: 0.802–0.977), whereas denial (OR = 1.177, 95% CI: 1.029–1.346) and mental disengagement (OR = 2.673, 95% CI: 1.499–4.767) were positively associated with Internet addiction. Depression had a moderating effect on the association between denial and Internet addiction (OR = 0.701, 95% CI: 0.530–0.927).ConclusionsStress coping strategies and depression are important factors to evaluate when developing intervention programs targeting college undergraduate students with Internet addiction.     

Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity

The psychiatric sequelae associated with childhood experience(s) of trauma is complex and distinguishable from that of adult trauma exposure. Categories of impairment associated with experiences of early trauma include internalizing and externalizing emotional and behavioral problems, posttraumatic stress symptomatology, and dissociation. The present study assessed the relationship between the type of trauma experience (i.e., non-interpersonal or interpersonal) and the manifestation of a wide range of psychiatric symptomatology using prospective longitudinal data from a community sample of ethnically diverse children and adolescents (N = 1676; ages 4–18). The study also examined the relationship between different types of trauma experiences (e.g., direct, vicarious, interpersonal) and levels of various symptom domains (e.g., anxiety, posttraumatic stress, conduct problems). A number of factors relevant to the relationship between early trauma experience and subsequent impairment including temperament, socioeconomic status, sex, and age were included in the analyses. Results indicated that interpersonal traumas involving significant interpersonal proximity were associated with externalizing problems (i.e., oppositional defiant and conduct problems). Direct trauma experiences and emotionality were positively associated with almost all symptom domains. Implications for the relationship between trauma and developmental psychopathology are discussed.     

The effects of parental mental health and social-emotional coping on adolescent eating disorder attitudes and behaviors

This study examined whether social-emotional coping skills moderate the association between parental mental health symptoms and adolescent disordered eating attitudes and behaviors in a clinical sample of adolescents with internalizing and/or externalizing symptoms. Fifty-nine adolescent-parent dyads (N = 118 total participants) recruited from a metropolitan area in the Northeastern United States completed assessments at baseline and 12-month follow-up. Generally, higher parental depression and anxiety were only found to be associated with greater disordered eating attitudes and behaviors among adolescents who reported poorer (versus stronger) emotional awareness/expression skills and less (versus greater) ability to regulate emotions. Results may suggest that adolescents who lack the ability to effectively recognize, express, and manage negative emotions that arise in the context of a challenging home environment may be at greater risk for engaging in maladaptive coping behaviors, such as disordered eating. Thus, bolstering adolescent social-emotional coping skills may help protect against adolescent disordered eating.     

Stress and coping mechanisms among adolescents living in orphanages: An experience from Klang Valley,Malaysia

Introduction

Health issues often differ from one population to another. Assessing different aspects of the health condition is a vital step toward developing and designing appropriate prevention and treatment programs to reduce health problems in any group or population. This study aimed to assess both the prevalence of stress and the coping mechanisms as well as identify the predictors of stress levels among adolescents in Malaysian orphanages.

Methods

Overall, 307 male and female adolescents (aged 13‐18 y old) living in 9 private orphanages located in Klang Valley, Malaysia, participated in this cross‐sectional study. Brief COPE scale and Depression, Anxiety and Stress Scale‐21 were used as the main instruments in the current study.

Results

The results of the current study showed female adolescents and participants with a higher level of education were more likely to experience stress. The results also showed significant differences between boys and girls in using of coping mechanisms in self‐distraction (t = ?2.39, P = .01), substance use (t = 2.12, P = .03), use of emotional support (t = ?2.70, P = .001), humor (t = 2.28, P = .02), and religion (t = ?2.19, P = .02). Denial, venting, religion, humor, planning, and active coping were identified as predictors of stress among participants.

Discussion

The results showed a high prevalence of stress and a negative coping pattern among participants. The finding of the current study also showed the urgency of taking immediate action to reduce stress and improve coping methods among Malaysian institutional adolescents.     

Test of the stress sensitization model in adolescents following the pipeline explosion

PurposeThe stress sensitization model states that early traumatic experiences increase vulnerability to the adverse effects of subsequent stressful life events. This study examined the effect of stress sensitization on development of posttraumatic stress disorder (PTSD) symptoms in Chinese adolescents who experienced the pipeline explosion.MethodsA total of 670 participants completed self-administered questionnaires on demographic characteristics and degree of explosion exposure, the Childhood Trauma Questionnaire (CTQ), and the Posttraumatic Stress Disorder Checklist—Civilian Version (PCL-C). Associations among the variables were explored using MANOVA, and main effects and interactions were analyzed.ResultsOverall MANOVA tests with the PCL-C indicated significant differences for gender (F = 6.86, p = .000), emotional abuse (F = 6.79, p = .000), and explosion exposure (F = 22.40, p = .000). There were significant interactions between emotional abuse and explosion exposure (F = 3.98, p = .008) and gender and explosion exposure (F = 2.93, p = .033).ConclusionsBeing female, childhood emotional abuse, and a high explosion exposure were associated with high PTSD symptom levels. Childhood emotional abuse moderated the effect of explosion exposure on PTSD symptoms. Thus, stress sensitization influenced the development of PTSD symptoms in Chinese adolescents who experienced the pipeline explosion as predicted by the model.