Self-esteem in Early Adolescence as Predictor of Depressive Symptoms in Late Adolescence and Early Adulthood:The Mediating Role of Motivational and Social Factors

Ample research has shown that low self-esteem increases the risk to develop depressive symptoms during adolescence. However, the mechanism underlying this association remains largely unknown, as well as how long adolescents with low self-esteem remain vulnerable to developing depressive symptoms. Insight into this mechanism may not only result in a better theoretical understanding but also provide directions for possible interventions. To address these gaps in knowledge, we investigated whether self-esteem in early adolescence predicted depressive symptoms in late adolescence and early adulthood. Moreover, we investigated a cascading mediational model, in which we focused on factors that are inherently related to self-esteem and the adolescent developmental period: approach and avoidance motivation and the social factors social contact, social problems, and social support. We used data from four waves of the TRAILS study (N = 2228, 51% girls): early adolescence (mean age 11 years), middle adolescence (mean age 14 years), late adolescence (mean age 16 years), and early adulthood (mean age 22 years). Path-analyses showed that low self-esteem is an enduring vulnerability for developing depressive symptoms. Self-esteem in early adolescence predicted depressive symptoms in late adolescence as well as early adulthood. This association was independently mediated by avoidance motivation and social problems, but not by approach motivation. The effect sizes were relatively small, indicating that having low self-esteem is a vulnerability factor, but does not necessarily predispose adolescents to developing depressive symptoms on their way to adulthood. Our study contributes to the understanding of the mechanisms underlying the association between self-esteem and depressive symptoms, and has identified avoidance motivation and social problems as possible targets for intervention

Comparison of Two Ecological Momentary Intervention Modules for Treatment of Depression on Momentary Positive and Negative Affect

Background: Ecological Momentary Assessment (EMA), comprising repeated self-assessments in daily life, have shown promise as an intervention strategy for depression. Whether the content of such assessments influences affect has hardly received attention. The current study consists of two EMA intervention (EMI) modules, enabling us to compare the impact of EMI content on the course of momentary affect during the intervention. Methods: The intervention, implemented as add-on to regular depression treatment, consists of intensive self-monitoring (5x/day, 28 days) and weekly personalized feedback. Patients with depressive complaints (N = 110; M-age = 32.9, SD = 12.2; 44.5% male) were randomly assigned to one of two treatment modules focusing on activities and positive affect ("Do") or on thoughts and negative affect ("Think"). Results: Linear mixed models showed no significant (p > .18) differences between the two modules on both positive and negative affect over time. Across modules positive affect showed an initial decreasing trend, leveling off towards the end of the intervention period. Negative affect did not change significantly over time (p > .06). Limitations: Both modules assessed positive and negative affect, enabling a direct comparison but potentially decreasing the impact of their differential focus. Conclusions: In our sample, the focus of the EMI was not associated with differential effects on momentary affect. This implies that a focus on thoughts and negative affect compared to positive affect and activities may not lead to added adverse effects on mood, which is an often-voiced concern when using EMA in both research and clinical practice

Effect of Daily Life Reward Loop Functioning on the Course of Depression

Engagement in activities increases positive affect (Reward Path 1), which subsequently reinforces motivation (Reward Path 2), and hence future engagement in activities (Reward Path 3). Strong connections between these three reward loop components are considered adaptive, and might be disturbed in depression. Although some ecological nomentary assessment (EMA) studies have investigated the cross-sectional association between separate reward paths and individuals’ level of depression, no EMA study has looked into the association between individuals’ reward loop strength and depressive symptom course. The present EMA study assessed reward loop functioning (5x/day, 28 days) of 46 outpatients starting depression treatment at secondary mental health services and monitored with the Inventory of Depressive Symptomatology—Self-Report (IDS-SR) during a 7-month period. Results of multilevel regression analyses showed significant within-person associations for Reward Path 1 (b = 0.21, p &lt; .001), Reward Path 2 (b = 0.43, p &lt; .001), and Reward Path 3 (b = 0.20, p &lt; .001). Stronger average reward loops (i.e., within-person mean of all reward paths) did not relate to participants’ improvement in depressive symptoms over time. Path-specific results revealed that Reward Paths 1 and 2 may have partly opposite effects on depressive symptom course. Together, our findings suggest that reward processes in daily life might be best studied separately and that further investigation is warranted to explore under what circumstances strong paths are adaptive or not.</p

A healthy peer status:Peer preference, not popularity, predicts lower systemic inflammation in adolescence

In adolescence, sensitivity to peers is heightened, which makes peer experiences highly salient. Recent work suggests that these experiences may influence individuals' immune system functioning. Although there is a need to investigate which types of developmental salient social experiences affect inflammation, no studies have examined the role of peer status in inflammatory activity so far. This study is the first to examine the unique role of different types of peer status (i.e., peer preference and peer popularity) on systemic inflammation in adolescence, and the extent to which this association is moderated by early childhood adversity. Participants were 587 Dutch adolescents from the TRacking Adolescents´ Individual Lives Survey (TRAILS). Data were collected when participants were 11 (SD = .56), 13 (SD = .53) and 16 (SD = .71) years old, respectively. At age 11, early childhood adversity (e.g., hospitalization, death within the family) between 0-5 years was assessed via parent interviews. At age 13, peer preference and peer popularity were assessed with peer nominations of classmates. At age 16, high sensitive C-reactive protein (hsCRP), a marker of low-grade systemic inflammation, was assessed with a venipuncture blood draw. Results showed that adolescents who were rated low on peer preference at age 13 exhibited higher levels of hsCRP at age 16. Importantly, these effects remained after controlling for several covariates, including age, sex, peer victimization, smoking behavior, SES, fat percentage, physical activity and temperament. Additionally, we found a positive effect of peer popularity on hsCRP that depended on early childhood adversity exposure. This suggests that for those adolescents who experienced little early childhood adversity, high levels of peer popularity were associated with high levels of hsCRP. Overall, these findings suggest that it is important to take into account the independent roles of peer preference and peer popularity, as specific types of peer status, to better understand adolescent systemic inflammation.</p

Outcome of anxiety and depression in general health care:a three-wave 3.5-year study of psychopathology, disability and life stress

The outcome of anxiety and depression in general health care settings was examined. At follow-up, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety; mixed anxiety/depression did worst. Life events often triggered improvement except amongst mixed anxiety/depression patients.</p

Mental health care use in adolescents with and without mental disorders

The aim of the study was to estimate the proportion of adolescents with and without a psychiatric diagnosis receiving specialist mental health care and investigate their problem levels as well as utilization of other types of mental health care to detect possible over-and under-treatment. Care utilization data were linked to psychiatric diagnostic data of 2230 adolescents participating in the TRAILS cohort study, who were assessed biannually starting at age 11. Psychiatric diagnoses were established at the fourth wave by the Composite International Diagnostic Interview. Self-, parent-and teacher-reported emotional and behavioral problems and self-reported mental health care use were assessed at all four waves. Of all diagnosed adolescents, 35.3 % received specialist mental health care. This rate increased to 54.5 % when three or more disorders were diagnosed. Almost a third (28.5 %) of specialist care users had no psychiatric diagnosis; teachers gave them relatively high ratings on attention and impulsivity subscales. Diagnosed adolescents without specialist mental health care also reported low rates of other care use. We found no indication of overtreatment. Half of the adolescents with three or more disorders do not receive specialist mental health care nor any other type of care, which might indicate unmet needs

Quality over quantity:A transactional model of social withdrawal and friendship development in late adolescence

The aim of this study was to test a longitudinal, transactional model that describes how social withdrawal and friendship development are interrelated in late adolescence, and to investigate if post-secondary transitions are catalysts of change for highly withdrawn adolescents' friendships. Unilateral friendship data of 1,019 adolescents (61.3% female, 91% Dutch-origin) from the Tracking Adolescents' Individual Lives Survey (TRAILS) cohort were collected five times from ages 17 to 18 years. Social withdrawal was assessed at 16 and 19 years. The transactional model was tested within a Structural Equation Modeling framework, with intercepts and slopes of friendship quantity, quality, and stability as mediators and residential transitions, education transitions, and sex as moderators. The results confirmed the presence of a transactional relation between withdrawal and friendship quality. Whereas higher age 16 withdrawal predicted having fewer, lower-quality, and less-stable friendships, only having lower-quality friendships, in turn, predicted higher age 19 withdrawal, especially in girls. Residential transitions were catalysts of change for highly withdrawn youth's number of friends: higher withdrawal predicted a moderate increase in number of friends for adolescents who relocated, and no change for those who made an educational transition or did not transition. Taken together, these results indicate that the quality of friendships-over and above number of friends and the stability of those friendships-is particularly important for entrenching or diminishing withdrawal in late adolescence, and that relocating provides an opportunity for withdrawn late adolescents to expand their friendship networks

Patients' experience of an ecological momentary intervention involving self-monitoring and personalized feedback for depression

Experts in clinical mental health research count on personalized approaches based on self-monitoring and self-management to improve treatment efficacy in psychiatry. Among other things, researchers expect that Ecological Momentary Interventions (EMI) based on self-monitoring and personalized feedback will reduce depressive symptoms. Clinical trial findings have, however, been conflicting. A recent trial (ZELF-i) investigated whether depression treatment might be enhanced by an add-on EMI with self-monitoring items and feedback focused on positive affect and activities (Do-module) or on negative affect and thinking patterns (Think-module). There was no statistical evidence that this EMI impacted clinical or functional outcomes beyond the effects of regular care, regardless of module content. In apparent contrast, 86% of the participants who completed the intervention indicated they would recommend it to others. In the present study, we used in-depth interviews (n = 20) to better understand the EMI's personal and clinical benefits and downsides. A thematic analysis of the interviews generated six areas of impact with various subthemes. In line with the trial results, few participants reported behavioral changes or symptom improvement over time; the self-assessments mainly amplified momentary mood, in either direction. The most often mentioned benefits were an increase in self-awareness, insight, and self-management (e.g., a stronger sense of control over complaints). Consistently, these domains received the highest ratings in our evaluation questionnaire (n = 89). Furthermore, the EMI instilled a routine into the days of individuals without regular jobs or other activities. Participants reported few downsides. The experiences were rather similar between the two modules. This study suggests that EMI might contribute to health by helping individuals deal with their symptoms, rather than reducing them. Measures on self-awareness, insight, and self-management should be more emphatically involved in future EMI research

ADHD Symptoms and Educational Level in Adolescents:The Role of the Family, Teachers, and Peers

Few studies have explored the contribution of family and school factors to the association between ADHD symptoms and lower education. Possibly, having more ADHD symptoms contributes to poorer family functioning and less social support, and consequently a lower educational level (i.e., mediation). Moreover, the negative effects of ADHD symptoms on education may be stronger for adolescents with poorer family functioning or less social support (i.e., interaction). Using data of the Dutch TRAILS Study (N = 2,229), we evaluated associations between ADHD symptoms around age 11 and educational level around age 14, as well as between ADHD symptoms around age 14 and 16 years and subsequent changes in educational level around age 16 and 19, respectively. We assessed the potential mediating role of family functioning, and social support by teachers and classmates, all measured around ages 11, 14, and 16, while additionally evaluating interactions between ADHD symptoms and these hypothesized mediators. ADHD symptoms were associated with poorer family functioning, less social support by teachers and classmates, and lower education throughout adolescence. No conclusive evidence of mediation was found, because unique associations between family functioning and social support by teachers and classmates and education were largely absent. Furthermore, we found no interactions between ADHD symptoms and family functioning and social support by teachers and classmates. Although social support by teachers and classmates and good family functioning may benefit the wellbeing and mental health of adolescents with high levels of ADHD symptoms, they will not necessarily improve their educational attainment.</p

Educational level and alcohol use in adolescence and early adulthood-The role of social causation and health-related selection-The TRAILS Study

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence and young adulthood. The social causation theory implies that the social environment (e.g. at school) influences adolescents’ drinking behaviour. Conversely, the health-related selection hypothesis posits that alcohol use (along other health-related characteristics) predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, educational gradients in alcohol use may reflect the impact of ‘third variables’ already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use from adolescence to young adulthood in a selective educational system. We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years (waves 2 to 6). First, we evaluated the directionality in longitudinal associations between education and drinking with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11 (wave 1), i.e. IQ, effortful control, and parental SES, both as confounders in these associations, and as predictors of educational level and drinking around age 14 (wave 2). In fixed effects models, lower education around age 14 predicted increases in drinking around 16. From age 19 onward, we found a tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. Childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking. We mainly found evidence for the social causation theory in early adolescence, when lower education predicted increases in subsequent alcohol use. We found no evidence in support of the health-related selection hypothesis with respect to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use