Psychiatric Morbidity Differences in Male and Female Adolescent Inpatients With Alcohol Use Disorders

Objective: To examine gender differences in demography, cooccurrence of Diagnostic Statistical Manual (third edition, revised; DSM-III-R) axis I disorders and axis II personality disorders, and self-reported psychological distress in adolescent psychiatric inpatients with alcohol use disorders. Method: A consecutive series of 61 adolescent inpatients (36 boys and 25 girls) with either alcohol abuse or dependence were reliably assessed with structured diagnostic interviews for DSM-III-R Axis I and Axis II personality disorders. Results: Boys and girls did not differ in age, ethnicity, socioeconomic status, global functioning, age at first psychiatric contact, or number of hospitalizations. Girls were more likely to meet criteria for oppositional defiant disorder, eating disorders, and additional drug use disorders. Girls were also more likely than boys to meet criteria for at least one personality disorder and borderline personality Contrary to gender patterns in the general population, the proportion of girls and boys with affective disorders and conduct disorders did not differ significantly. Conclusions: Relatively few gender differences were found in adolescent inpatient alcohol abusers even where they would be expected, based on non substance-abuse general population gender patterns. When observed, gender differences were in the direction of greater psychiatric disturbance among girls. Some of the gender patterns observed among alcohol abusing adolescents are at odds with gender differences observed in non substance-abuse samples.     

Neuroticism and Conscientiousness as Moderators of the Relation Between Social Withdrawal and Internalizing Problems in Adolescence

Social withdrawal, or refraining from social interaction in the presence of peers, places adolescents at risk of developing emotional problems like anxiety and depression. The personality traits of neuroticism and conscientiousness also relate to emotional difficulties. For example, high conscientiousness predicts lower incidence of anxiety disorders and depression, while high neuroticism relates to greater likelihood of these problems. Based on these associations, socially withdrawn adolescents high in conscientiousness or low in neuroticism were expected to have lower levels of anxiety and depressive symptoms. Participants included 103 adolescents (59?% female) who reported on their personality traits in 8th grade and their anxiety and depressive symptoms in 9th grade. Peer ratings of social withdrawal were collected within schools in 8th grade. A structural equation model revealed that 8th grade withdrawal positively predicted 9th grade anxiety and depressive symptoms controlling for 8th grade anxiety and depressive symptoms, but neuroticism did not. Conscientiousness moderated the relation of withdrawal with depressive symptoms but not anxiety, such that high levels of conscientiousness attenuated the association between withdrawal and depressive symptoms. This buffering effect may stem from the conceptual relation between conscientiousness and self-regulation. Conscientiousness did not, however, moderate the association between withdrawal and anxiety, which may be partly due to the role anxiety plays in driving withdrawal. Thus, a conscientious, well-regulated personality partially protects withdrawn adolescents from the increased risk of emotional difficulties.     

Gender-related Risk and Protective Factors for Depressive Symptoms and Disordered Eating in Adolescence: A 4-year Longitudinal Study

The interplay between intrapersonal risk (low self-esteem, perfectionism and body dissatisfaction) and interpersonal protection (social support) appears relevant for delineating gender-specific pathways that lead to both depressive and eating psychopathology. The aims of this longitudinal study were to examine gender differences in the levels of depressive symptoms, disordered eating and the co-occurrence of both problems from preadolescence to mid-adolescence and to identify gender-specific risk and protective factors of depressive symptoms and disordered eating. A Spanish community-based sample initially comprising 942 early adolescents (49% females) was assessed at baseline (T1; X _age = 10.8 years) and at 2 and 4-year follow-up (T2 and T3). Gender differences emerged at T2 for disordered eating and at T3 for depressive symptoms and for co-occurring depressive symptoms and disordered eating. Predictors of depressive symptoms were body dissatisfaction, low self-esteem and fear of getting fat, for girls, and body dissatisfaction and low self-esteem, for boys. Predictors of disordered eating were body dissatisfaction, depressive symptoms, BMI and perfectionism, for girls, and low social support and BMI, for boys. In addition, for boys only, social support moderated the effect of body dissatisfaction on depressive symptoms and the effect of depressive symptoms on disordered eating. The hypotheses of the study were partially supported. Clinical implications are derived regarding the components that should be included in programs for preventing depression and eating disorders in both girls and boys.     

Immunocognitive Model of Depression Secondary to Anxiety in Adolescents

There is evidence that anxiety precedes the onset of depression and that rumination contributes to this risk pathway in adolescence. This study examined inflammatory biomarkers as mediators in a risk model of depressive symptoms secondary to anxiety symptoms among adolescents who ruminate. A sample of 140 adolescents (52% female, 54% African American, 40% Caucasian, 6% biracial, mean age at T1?=?16.5 years, SD?=?1.2 years) provided blood samples on two visits (T1 and T2; mean time between T1 and T2?=?13.5 months, SD?=?5.9 months). Self-report anxiety, depression, and rumination measures were given at T1 and the depression measure was given again at a third visit (T3, mean months since T1?=?26.0 months, SD?=?9.0 months). Higher anxiety predicted more interleukin-6, but not more C-reactive protein, for adolescents with high levels of rumination. Moderated mediation analyses (N for analysis after removing cases with missing data and outliers?=?86) indicated that interleukin-6, but not C-reactive protein, at T2 mediated the relationship between anxiety symptoms at T1 and depressive symptoms at T3, conditional on rumination. Anxiety and rumination interacted such that, as rumination increased, anxiety predicted greater inflammation and depressive symptoms. These results demonstrate that established cognitive vulnerabilities for the development of depressive symptoms secondary to anxiety symptoms in adolescence might indirectly operate though biological mechanisms such as inflammation. In addition to highlighting risk factors and potential treatment targets for depression, this study suggests a potential biological mechanism underlying the effects of psychotherapies that reduce rumination on negative affect (e.g., cognitive behavioral therapy).     

Weighing in on the Issue: A Longitudinal Analysis of the Influence of Selected Individual Factors and the Sports Context on the Developmental Trajectories of Eating Pathology Among Adolescents

Eating disorders, and related issues (e.g., body dissatisfaction, weight control behaviors), represent pressing and prevalent health problems that affect American adolescents with alarming frequency and potentially chronic consequences. However, more longitudinal research is needed to elucidate the developmental processes that increase or maintain risk for, and that protect against, eating- and weight-related problems among adolescents. Accordingly, the current study used longitudinal data from 1,050 male and female (68.0 %) adolescents (Grades 9–11)—the majority of whom were European Americans (72.2 %)—who participated in the 4-H Study of Positive Youth Development to (a) describe trajectories of adolescents’ eating pathology and body dissatisfaction, (b) identify individual and contextual correlates of these pathways, (c) examine whether trajectories of eating pathology and body dissatisfaction related to adolescents’ depressive symptoms, and (d) elucidate whether sports participation moderated associations between specific trajectories of eating pathology and body dissatisfaction and adolescents’ depressive symptoms. Results suggest that the diverse pathways of eating pathology and body dissatisfaction that exist across middle adolescence, in combination with adolescents’ sports participation, have important implications for the positive and problematic development of our youth. In addition, the findings underscore the need to evaluate the interindividual differences that exist in regard to how sports participation may relate positively and negatively to developmental outcomes.     

Deficits in Emotional Clarity and Vulnerability to Peer Victimization and Internalizing Symptoms Among Early Adolescents

Peer victimization is a significant risk factor for a range of negative outcomes during adolescence, including depression and anxiety. Recent research has evaluated individual characteristics that heighten the risk of experiencing peer victimization. However, the role of emotional clarity, or the ability to understand one’s emotions, in being the target of peer victimization remains unclear. Thus, the present study evaluated whether deficits in emotional clarity increased the risk of experiencing peer victimization, particularly among adolescent girls, which, in turn, contributed to prospective levels of depressive and anxiety symptoms. In the present study, 355 early adolescents (ages 12–13; 53 % female; 51 % African American) who were part of the Adolescent Cognition and Emotion project completed measures of emotional clarity, depressive symptoms, and anxiety symptoms at baseline, and measures of peer victimization, depressive symptoms, and anxiety symptoms at follow-up. Moderation analyses indicated that deficits in emotional clarity predicted greater peer victimization among adolescent girls, but not adolescent boys. Moderated mediation analyses revealed that deficits in emotional clarity contributed to relational peer victimization, which, in turn, predicted prospective levels of depressive and anxiety symptoms among adolescent girls, but not boys. These findings indicate that deficits in emotional clarity represent a significant risk factor for adolescent girls to experience relational peer victimization, which, in turn, contributed to prospective levels of internalizing symptoms. Thus, prevention programs should target deficits in emotional clarity to prevent peer victimization and subsequent internalizing symptoms among adolescent girls.     

Longitudinal Dynamics of Depressogenic Personality and Attachment Dimensions in Adolescence: An Examination of Associations with Changes in Depressive Symptoms

Depressogenic personality and attachment are two major factors related to the development of adolescents’ depressive symptoms. However, no previous longitudinal studies have examined simultaneously both vulnerability factors in relationship to depressive symptoms. The present study examined associations between intra-individual change in adolescents’ depressogenic personality orientations (i.e., sociotropy and autonomy), dimensions of mother–adolescent attachment (i.e., anxiety and avoidance), and depressive symptoms. The sample of the present research consisted of 289 high school students (mean age = 12.51 years at Time 1, 66 % female) participating in a 3-wave cohort-sequential design. Latent growth curve modeling revealed no significant intra-individual change in depressogenic personality orientations but significant changes in dimensions of attachment and symptoms of depression. Initial levels of sociotropy were not related significantly to changes in attachment dimensions and depressive symptoms. High initial levels of autonomy were associated with increases in attachment anxiety, attachment avoidance, and depressive symptoms. In addition, results suggested that the association between initial levels of autonomy and increases in depressive symptoms was mediated by increases in attachment anxiety and avoidance. The discussion focuses on the status of depressogenic personality and attachment as risk factors for depression.     

Binge eating in anorexia nervosa predicts later onset of substance use disorder: A ten-year prospective,longitudinal follow-up of 95 adolescents

The cooccurrence of binge eating and increased alcohol intake and substance abuse has been reported in clinical and community epidemiological samples. To further investigate the nature and causes of this comorbidity, we examined the 10-year prospective, longitudinal course of illness in 95 nonsubstance abusing adolescents hospitalized for treatment of anorexia nervosa. Survival analysis with Cox regression was used to quantitate the cumulative risk of developing substance use disorder (SUD) as a function of patterns of binge eating vs. dietary restraint within this cohort. Subjects who were binge eating at the time of intake were robustly distinguished from restrictors, having increased risk of SUD as well as greater likelihood of having at least one first-degree relative with SUD. The findings suggest binge eating that develops in the underweight stage of anorexia nervosa may reflect developmental, biological, and genetic risk processes shared in common with SUD.Received Ph.D. in clinical psychology from the University of Pittsburgh. Research interests include the etiology, course, and treatment of eating disorders, and the natural history and treatment of juvenile mood disorders.Received R.N. from Rush-Presbyterian Hospital. Research interests are in the area of adolescent mental health treatment and the treatment of anorexia nervosa.Received R.N. from Northeastern Univeristy. Research interest is the inpatient psychiatric treatment of adolescents.Received R.N. from the University of Windsor and her M.N. from UCLA. Research interest is the outcome studies of treatment effectiveness in adolescent and adult psychiatry.     

How is Anxiety Involved in the Longitudinal Relationship between Brooding Rumination and Depressive Symptoms in Adolescents?

A growing body of research supports the application of Response Styles Theory to adolescent populations. Although the essential dynamic, namely that rumination increases the incidence of depressive symptoms, has been demonstrated among adolescents, a number of important empirical questions remain, such as: what are the gender differences and developmental trends for brooding and reflective rumination?; does a reciprocal relationship exist between brooding or reflective rumination, on the one hand, and depressive symptoms and anxiety, on the other hand, over time? and how do additional variables (i.e., anxiety) impact upon the rumination-depressive symptoms relationship? In this study, self-reported levels of rumination (both brooding and reflective), and anxious and depressive symptoms were measured longitudinally across 4 months in a sample of 976 community adolescents (46 % females), aged 11–16 years old. Mean group differences showed that female adolescents reported engaging in more brooding rumination than male adolescents beginning at 13 years of age. A reciprocal brooding rumination to depressive symptoms relationship and a reciprocal brooding rumination to anxiety relationship were found over time, and they did not differ for boys and girls. We tested the possibility that anxious symptoms would function as a third variable, but the obtained model showed that brooding rumination and anxiety both contributed unique variance in predicting changes in depressive symptoms over time.     

Depression as a Moderator of Sociocultural Influences on Eating Disorder Symptoms in Adolescent Females and Males

This study aimed to explore the role of depression as a moderator of sociocultural influences on eating disorder symptoms. A sample of 509 adolescents (56% female) completed self-report questionnaires assessing depression, body dissatisfaction, drive for thinness, bulimic symptoms and sociocultural influences on appearance from family, peers and the media. Both girls and boys displaying high levels of depressive symptoms perceived stronger media and peer influences on appearance. Among girls, eating disorder symptoms were directly affected by sociocultural influences, in particular media influences, as well as by depression. However, depression played only a limited role as a moderator of these relationships. Among boys, sociocultural influences and depression revealed fewer direct effects on eating disorder symptoms. However, depression had a greater moderating effect on these relationships. Future research into the role of depression may increase the understanding of gender differences in body dissatisfaction, drive for thinness and bulimic symptoms.     

The Association Between Family Factors and Depressive Disorders in Adolescents

The main aim of this study was to examine the familial factors (parental psychopathology and attachment to parents) in depressed adolescents. Another aim was to compare level of psychosocial impairment, use of mental health services, suicidal ideation and attempt, and the clinical features of depression (e.g., severity and age of onset) among depressed adolescents with depressed parent(s) with those whose parent(s) do not have any depression. Result showed that the adolescent depression was significantly associated with an elevated rate of having a depressed mother. Perceived level of attachment to parents, as measured using the Inventory of Parent and Peer Attachment, was significantly lower among depressed adolescents than among adolescents without any psychiatric disorders. Depressed adolescents with depressed parents reported significantly higher suicidal ideation and had more recurrent depressive episodes than depressed adolescents with nondepressed parent(s). Our results imply the importance of shifting our focus from universal programs to family-based prevention and intervention programs for depression.     

Outcome,psychosocial functioning,and prognostic factors in adolescent anorexia nervosa as determined by prospective follow-up assessment

The aim of this prospective longitudinal study was to examine outcome, psychosocial functioning, and prognostic factors in adolescent anorexia nervosa. Thirty-four (88%) out of a consecutive series of 39 inpatients were reinvestigated three and seven years after discharge. The patients and 34 controls matched for age, sex, and occupational status were interviewed using structured interviews on their Diagnostic Statistical Manual, third edition, revised (DSM-III-R) eating disorder diagnoses, specific eating disorder psychopathology, comorbid psychiatric disorders, and psychosocial functioning. At the seven-year follow-up 15 patients (44%) still fulfilled DSM-III-R criteria for some form of eating disorder diagnosis, 21 (62%) for some other psychiatric diagnosis. Patients with a poor outcome showed significantly more problems in most areas of psychosocial functioning than the good-outcome group, but even recovered anorectic patients had more psychosexual difficulties than healthy controls. From a large range of potential prognostic factors, only low body weight at intake and low minimum weight during course of illness proved to be of predictive value.Received M.D. from Rheinische Friedrich-Wilhelms University, Bonn. Major research interests are childhood and adolescent eating disorders including links to affective disorders.Received M.D. from Philipps University. His current interests include follow-up studies of adolescent eating disorders.Received M.D. from Philipps University. His interests are body image disturbances in eating disorders and research in neurophysiology and neuropsychology.Received M.D. from Friedrich-Alexander University, Erlangen, Germany, and Ph.D. from Rupprecht-Karls University, Tübingen. Current research interests are eating disorders, affective disorders, and early onset schizophrenia.     

Age and Gender Differences in the Associations of Self-Compassion and Emotional Well-being in A Large Adolescent Sample

Adolescence is a challenging developmental period marked with declines in emotional well-being; however, self-compassion has been suggested as a protective factor. This cross-sectional survey study (N?=?765, grades 7th to 12th; 53?% female; 4?% Hispanic ethnicity; 64?% White and 21?% Black) examined whether adolescents’ self-compassion differed by age and gender, and secondly, whether its associations with emotional well-being (perceived stress, life satisfaction, distress intolerance, depressive symptoms, and anxiety) also differed by age and gender. The findings indicated that older females had the lowest self-compassion levels compared to younger females or all-age males. Self-compassion was associated with all emotional well-being measures, and gender and/or age moderated the associations with anxiety and depressive symptoms. Among older adolescents, self-compassion had a greater protective effect on anxiety for boys than for girls. Additionally, older adolescents with low and average self-compassion had greater levels of depressive symptoms than those with high self-compassion. These results may inform for whom and at what age self-compassion interventions may be implemented to protect adolescents from further declines in emotional well-being.     

An eight-year follow-up: Outcome from adolescent compared to adult onset anorexia nervosa

Seventy-five women were traced and reassessed on average eight years after the onset of anorexia nervosa. All patients received treatment and 88% were hospitalized at least once. Comparisons between early (11–15 years; N=35), late (16–18 years; N=24) adolescent and adult (19–27 years; N=14) onset revealed no significant differences in outcome for age at onset. For 70% of adolescent and 42% of adult onset patients the outcome was good, meaning that the weight was within ± 15% of norm with regular cyclical menstruation,17% and 21% had an intermediate, and 9% and 21%, respectively, had a poor outcome, 5.3% had died. Taken together, 59% had physically recovered and were free of any eating disorder. Severity of illness reflected in a low body mass index, excessive exercise, and poor psychosocial functioning at intake were poor prognostic indicators;length of illness and food restriction or bulimia as eating patterns were unrelated to outcome. The observation that all women with chronic anorexia nervosa, and even a third of those who had physically recovered from anorexia nervosa, qualified for one or more psychiatric diagnoses suggests that the psychosocial correlates of anorexia nervosa require further study.Supported by grant MH ROI35585-01A1.Received an M.D.-Ph.D. degree from Albert-Ludwig University in Freiburg, Germany. Research interests have been depressive disorders, eating disorders, in particular anorexia nervosa, and more recently women's health.Received M.D. degree from the University of Illinois in Chicago, Illinois. Research interest is in preventive medicine.     

Internalizing Symptoms in Latinos: The Role of Anxiety Sensitivity

Latin American youth in the United States tend to report more internalizing symptoms than white non-Latino youth, yet little is known about the factors that may contribute to such differences. The present study examined the role that anxiety sensitivity, gender, and ethnic minority status may play in the expression of internalizing symptoms across Latin American adolescents (n = 116) and white non-Latino adolescents (n = 72) in the United States and Colombian adolescents in Colombia (n = 163). Results provide evidence that because fear of anxiety related phenomena and physiological symptoms of anxiety in particular may be normative in Latino culture anxiety sensitivity does not amplify somatic complaints for Latin American and Colombian youth as it does for white non-Latino youth. Results further suggest that anxiety sensitivity and being female predicted anxiety and depressive symptoms independent of cultural background. Implications of the findings to our understanding of cultural variability in internalizing symptoms are discussed. R. Enrique Varela, PhD, is an assistant professor of psychology at Tulane University. He received his PhD from the University of Kansas Clinical Child Psychology Program. His research interests are cross cultural manifestations of childhood anxiety and parenting practices in Latin American families. He is also interested in adherence issues in chronically ill children. Carl F. Weems, PhD, is an associate professor of psychology at the University of New Orleans. He received his PhD from Florida International University and did post doctoral work at Stanford Medical School. His research focuses on the developmental psychopathology of anxiety and depression. In particular, his research integrates developmental, cognitive, biological and behavioral theories in attempting to understand the etiology and course of internalizing disorders in childhood. Special areas of interest include the assessment and treatment of childhood anxiety disorders, the role of cognitive behavioral development, brain function, and cognitive processing in anxiety and depression. Steven L. Berman, PhD, is an assistant professor of psychology at the University of Central Florida. He received his PhD from Florida International University. His research interests are identity development including associated anxiety and distress, cross-national comparisons, and the development of identity interventions. Lauren Hensley, MS, is a graduate student in psychology at Tulane University. Her main research interest is anxiety development, with a focus on anxiety sensitivity and children’s responses to traumatic events. Maria Clara Rodriguez de Bernal, MS, is an assistant professor of psychology at Universidad de la Sabana, Bogota, Colombia. Her research interests are in the area of program evaluation dealing with anxiety disorders, posttraumatic stress disorder in particular.     

Family influences,school behaviors,and risk for the later development of an eating disorder

Interviews were conducted with parents of 136 female and 45 male adolescents categorized into risk groups for the later development of an eating disorder. The family and school concomitants of risk status in females were demonstrated to be different from that in males. Risk group female adolescents rated family cohesion, parent-adolescent communication processes, and overall family satisfaction more negatively than the comparison group. Mothers of moderate risk group females reported lower family cohesion than the comparison group; there were no group differences for adolescent females in fathers' ratings of family measures. However, no group differences were found on any of the family measures between male risk and comparison males. For both females and males, there were no significant group differences in family history of eating and mood disorders, or alcohol dependence. Teacher ratings indicated relatively greater internalizing tendencies in the high-risk female group.This investigation was supported by NICHD Grant Number 1R01-HD24700 awarded to Gloria R. Leon.Received Ph.D. from University at Maryla. Research interests include precursors of eating disorders and stress and coping in extreme environments. To whom correspondence should be addressed.Received M.A. from San Diego State University. Research interests include precursors of eating disorders, substance abuse, and personality.Received Ph.D. from Stanford University. Research interests include psychosocial aspects of health promotion and disease prevention.Received B.A. from University of Maine. Research interests life span development and family issues.     

Outcome of early onset anorexia nervosa: What do we know?

Six recent studies on the outcome of early onset anorexia nervosa (AN) are reviewed. It would appear that the intermediate term outcome of early onset AN is not different from that of later onset AN. No prognostic indicators were identified and effect of treatment is unknown. Early onset AN may be a disabling and chronic disorder for 25% of patients seen at psychiatric clinics.Received M.D. from the University of Hong Kong, Faculty of Medicine. Major research intersts are eating disorders and cross-cultural psychiatry.     

The Role of Parenting and Mother-Adolescent Attachment in the Intergenerational Similarity of Internalizing Symptoms

Parental depression has been identified as a risk factor for children's and adolescents' internalizing problems. In the current study, we aimed to investigate the role of maternal parenting behaviors (i.e., responsiveness and autonomy-support) and adolescents' representations of attachment to their mother (i.e., anxiety and avoidance) in the intergenerational similarity of internalizing symptoms. The sample was heterogeneous and consisted of referred (42%) and non-referred adolescents (N=238, 31% female) and their mothers. Both adolescents and mothers reported on internalizing symptoms, parenting behaviors and all adolescents reported on mother-child attachment. Results showed that parenting behaviors and mother-adolescent attachment explain at least part of the intergenerational congruence of internalizing symptoms. Moreover, there were meaningful and specific associations between dimensions of parenting and dimensions of attachment. Higher responsiveness was primarily related to lower avoidance and higher autonomy-support was primarily related to lower anxiety. The current study's results suggest that maternal depressive symptoms relate to maladaptive parenting strategies and insecure attachment representations in adolescents. Further, both attachment anxiety and avoidance seem to relate positively to adolescents' internalizing symptoms. Targeting both parenting and attachment may form a fruitful approach to prevent and treat internalizing problems in adolescence.     

Explaining the Association between Early Adversity and Young Adults’ Diabetes Outcomes: Physiological,Psychological, and Behavioral Mechanisms

Previous studies have documented that early adversity increases young adults’ risk for diabetes resulting in morbidity and comorbidity with adverse health conditions. However, less is known about how inter-related physiological (e.g., body mass index [BMI]), psychological (e.g., depressive symptoms), and behavioral mechanisms (e.g., unhealthy eating and sedentary behavior) link early adversity to young adults’ diabetes outcomes, although these mechanisms appear to stem from early stressful experiences. The current study tested the patterning of these longitudinal pathways leading to young adults’ diabetes using a nationally representative sample of 13,286 adolescents (54% female) over a period of 13 years. The findings indicated that early adversity contributed to elevated BMI, depressive symptoms, and stress-related health behaviors. The impact of these linking mechanisms on hierarchical diabetes outcomes (i.e., prediabetes and diabetes) remained significant after taking their associations with each other into account, showing that these mechanisms operate concurrently. The findings emphasize the importance of early detection for risk factors of young adults’ diabetes in order to minimize their detrimental health effects.