long-term sequelae of sub-clinical depressive symptoms in early adolescence joe allen joanna chango...

Long-term Sequelae of Sub-clinicalDepressive Symptoms in Early Adolescence

Joe AllenJoanna ChangoDavid SzwedoMegan Schad

University of Virginia

Copies of related papers are available at:WWW.TEENRESEARCH.ORG

Collaborators:Maryfrances Porter, Ph.D.Kathleen McElhaney, Ph.D.F. Christy McFarland, Ph.D.Ann Spilker

Farah Williams, Ph.D.Jill Antonishak, Ph.D.Joanna ChangoCaroline White

Elie HesselEmily Marston, Ph.D.Glenda Insabella, Ph.D.Erin Miga, Ph.D.Amanda Hare, Ph.D.

Depressive Symptoms as Uniquely Problematic in

Adolescence

Social Relationship Quality:Why Teens Care/ Why We Care

Links to numerous adult mental health indices• Anxiety, Depression, Antisocial Personality Disorder, etc.

Links to physical health• Self-care

• Cardiovascular reactivity to Stress

• Immune Functioning

• Weight/obesity Links to Survival

There’s a reason teens care so desperately about their peer relationships.

Adolescence as Sensitive Period for Developing Relationship Competence

Development of Neural Structures• Prefrontal and Parietal Cortex

Development of Sophisticated Social Perspective-taking Capacity

First experience with True Adult-like Relationships

Early Adolescent Depressive Symptoms

Concurrent Effects:

• Reduced Energy for Developmental Tasks

• Negative Bias Regarding Relationships/Hopelessness

• Self-fulfilling nature/vicious cycle

Impairment at a critical point in social development?

Primary Question

How Are Adolescent Depressive SymptomsLinked to Future Social Functioning?

Sample 184 Adolescents, their Parents, Best Friends, Other Friends,

Romantic Partners

Intensive Interviews and Observations with all parties (Total N over first 13 years ~ 3200).

Equal numbers of Males and Females

Socio-economically Diverse (Median Family Income= $40- $60K)

31% African American; 69% European American

Very Low Attrition (98% participation rate in current phase)

Depressive Symptoms

Adolescence: Childhood Depression Inventory (Kovacs & Beck, 1977)

27-items based on the Beck Depression Inventory• Screening Cutoffs – For possible depression

• Clinical Cutoffs – For likely depression

• Aggregated Scores across 3 assessments (ages 14,15, 16)

Adulthood: Beck Depression Inventory (Beck & Steer, 1987) 21-items

assessing concurrent symptoms.• Aggregated Scores Across Ages 23, 24

Functioning with Peers

Adolescence: Inventory of Parent and Peer Attachment (Armsden &

Greenberg, 1987) 21-item inventory summing Communication, Trust, and Alienation (reverse-scored)• Aggregated from three assessments (Age 14, 15, & 16)

Adulthood: UCLA Loneliness Scale (Russell et al., 1980) 20 -item

inventory• linked to long-term mental and physical health risks

• Aggregated from two assessments (Age 23 & 24)

Depressive Symptoms

Loneliness.52***

Simple Prediction of Future Loneliness(Correlations)

Ages 14-16 Age 23-24

Depressive Symptoms

Loneliness.41***

Simple Prediction of Future Loneliness*(Correlations)

Ages 14-16 Age 23-24

• Excluding most severely depressed adolescents (10% of sample)

Long-term Links are Found Even Among those with very mild levels of Depressive Symptoms

Depressive Symptoms

Loneliness.34***

Predicting Loneliness Over and Above Covariates

Peer Attachment

-.11+

Concurrent Depression

.43***

Ages 14-16 Age 23-24

Predictions Even After Accounting forBaseline Functioning & Concurrent

Depression

Gender & Income

Depressive Symptoms Predicting Loneliness (Categorical Description)

Loneliness (Age 23-24)

Depressive Symptoms (Age 14-16)

Below Median

Above Median

Below Screening Cutoff

Above Cutoff

Depressive Symptoms Predicting Loneliness (Categorical Description)

Loneliness (Age 23-24)

Depressive Symptoms (Age 14-16)

Below Median

Above Median

Below Screening Cutoff

80 68

Above Cutoff

Depressive Symptoms Predicting Loneliness (Categorical Description)

Loneliness (Age 23-24)

Depressive Symptoms (Age 14-16)

Below Median

Above Median

Below Screening Cutoff

80 68

Above Cutoff

24

Depressive Symptoms Predicting Loneliness (Categorical Description)

Loneliness (Age 23-24)

Depressive Symptoms (Age 14-16)

Below Median

Above Median

Below Screening Cutoff

80 68

Above Cutoff

0!! 24

EVERY Teen who was even mildly depressed in adolescence was above the median in adult loneliness.

Limitations

All Based on Teen Self-Report

Need to Begin to Explore Possible Mediators of Long-term Links

Maternal Relationship Quality

Adolescence: Inventory of Parent and Peer Attachment (Armsden &

Greenberg, 1987) 21-item inventory summing Communication, Trust and Alienation (reverse-scored)• Early adolescence: Aggregated from Age 14, 15, & 16

• Late adolescence: Aggregated from Age 18, 19, & 20

Adulthood: Maternal Report: Network of Relationships Inventory

(Furman & Buhrmester, 1985) Total positivity (Six 3-item scales)• Age 23

Depressive Symptoms

Maternal Relationship

Quality

-.30***

Simple Continuity(Correlations)

Ages 14-16 Age 23

-.31***

Simple Continuity *(Correlations)

Ages 14-16

• Excluding most severely depressed adolescents (10% of sample)

Age 23

Long-term Effects are Found Even Among those with very mild levels of Depressive Symptoms

Depressive Symptoms

Maternal Relationship

Quality

-.39***

Predicting Maternal Relationship Quality Over and Above Covariates

Maternal Attachment

-.03

Concurrent Depression

.18*

Ages 14-16 Age 23

Depressive Symptoms

Maternal Relationship

Quality

Gender & Income

Even Mild Adolescent Depressive Symptoms Have Clear Long-term Sequelae

Key Question: Mediating Pathways?

Potential Peer Pathway:

Avoidance?

Social Avoidance Peers

Late Adolescence:

Social Avoidance Social Anxiety Scale for Adolescents (La Greca & Lopez, 1998) 14-item inventory.

Aggregated from 3 assessments (Ages 19, 20, & 21)

Attachment to Peers

Depressive Symptoms

Avoidance of Peers

Loneliness

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

.25***-.18**

.25***

Depressive Symptoms

.39***.41***

.30***

Gender & Income

Attachment to Peers

Depressive Symptoms

Avoidance of Peers

Loneliness

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

.25***-.18**

.25***

Depressive Symptoms

.41***

.30***

Gender & Income

.39***

Attachment to Peers

Depressive Symptoms

Avoidance of Peers

Loneliness

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

.25***-.18**

.25***

Depressive Symptoms

.41***

.30***

Direct and Indirect Effects on Future Loneliness

Gender & Income

.39***

Potential Parent Pathway:

Disrupted Relationship

Depressive Symptoms

Attachment to Mother

Attachment to Mother

Maternal Relat. Quality

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

-.14**

.53*** .35***

-.29***

Depressive Symptoms

.22**

.30***

Gender & Income

Depressive Symptoms

Attachment to Mother

Attachment to Mother

Maternal Relat. Quality

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

-.14**

.53*** .35***

-.29***

Depressive Symptoms

.22**

.30***

Gender & Income

Depressive Symptoms

Attachment to Mother

Attachment to Mother

Maternal Relat. Quality

Early AdolescentPredictors

(Age 14-16)

Late-Adolescent Intervening Variables

(Age 18-20)

Early Adult Outcomes

(Age 23-24)

-.14**

.53*** .35***

-.29***

Depressive Symptoms

.22**

.30***

Direct and Indirect Effects on Maternal Relationship Quality

Gender & Income

Attachment to Peers

Depressive Symptoms

Attachment to Mother

Attachment to Mother

Avoidance of Peers

Loneliness

Maternal Relat. Quality

Early Adolescent(Age 14-16)

Late-Adolescent (Age 18-20)

Early Adult (Age 23-24)

.25***-.18**

.18**

-.14**

.53*** .35***

-.29***

.25***

Depressive Symptoms

.39***

.22**

.41***

-.19*.30***

The Multiple Sequelae of Adolescent Depression

Limitations

Correlational not Causal

Very Preliminary Understanding of Mediating Processes

NOT based on diagnostic/clinical interviews

Copies of related papers are available at:

www.TeenResearch.org

Conclusions

Importance of even MILD Depressive Symptoms

Effects Beyond Simple Symptom Continuity

Interference with Relationship Formation/Maintenance – A Sensitive Period?

Intervention Implications

Copies of related papers are available at:

www.TeenResearch.org