Search

Early adolescence is a vulnerable period for emotional distress. Both emotion regulation and social connection to peers and family adults are understood to be associated with distress. However, existing longitudinal work has not explored these constructs jointly in a way that estimates their reciprocal relationships over adolescence. We present a three-wave random-intercepts cross-lagged panel model of reciprocal relationships between emotional distress, perceived emotion regulation, and social connections during early adolescence, among 15,864 participants from education settings in disadvantaged areas of England, over three annual waves (at ages 11/12, 12/13, and 13/14 years). Findings showed that emotional distress and perceived emotion regulation share a negative relationship over time, and that higher perceived emotion regulation predicts greater family connection in the initial stages of early adolescence (from age 11–12 to 12–13 years). Findings also indicated that connection to peers is positively associated with family connection, but also positively predicts slightly greater distress in the later stages of early adolescence (from age 12–13 to 13–14 years). Findings indicate a risk of negative spiral between emotional distress and perceived emotion regulation in early adolescence, and that social connection may not necessarily play the role we might expect in reducing distress.

Purpose Self-evaluation and interpersonal factors are theoretically and empirically linked to depression in young people. An improved understanding of the multifactorial developmental pathways that explain how these factors predict depression could inform intervention strategies. Methods Using structural equation modeling, this study explored whether self-evaluation and interpersonal factors were associated with adolescent depressive symptoms in a population-based sample (n = 11,921; Avon Longitudinal Study of Parents and Children, ALSPAC), across four development stages: early and late childhood plus early and middle adolescence from 3 to 17 years old. Results Early good parenting practices predicted self-esteem, fewer peer difficulties, good friendships and fewer depressive symptoms in late childhood development outcomes. Higher self-esteem and less negative self-concept mediated the effect of early good parenting practice on reduced depressive symptoms in middle adolescence. The hypothesized erosion pathway from depressive symptoms in late childhood via higher levels of negative self-concept in early adolescence to depressive symptoms in middle adolescence was also confirmed. Additionally, peer difficulties played a mediation role in developing depressive symptoms. Contrary to the hypothesis, poor friendships predicted fewer depressive symptoms. The analysis supported a developmental pathway in which good parenting practices in early childhood led to fewer peer difficulties in late childhood and to less negative self-concept in early adolescence, which in turn predicted fewer depressive symptoms in middle adolescence. Conclusion The social-developmental origin of youth depressive symptoms was supported via the effect of peer relationships in late childhood on self-evaluation in early adolescence.

Emotional difficulties are associated with both authorized and unauthorized school absence, but there has been little longitudinal research and the temporal nature of these associations remains unclear. This study presents three-wave random-intercepts panel models of longitudinal reciprocal relationships between teacher-reported emotional difficulties and authorized and unauthorized school absence in 2,542 English children aged 6 to 9 years old at baseline, who were followed-up annually. Minor differences in the stability effects were observed between genders but only for the authorized absence model. Across all time points, children with greater emotional difficulties had more absences, and vice versa (authorized: ρ = .23–.29, p < .01; unauthorized: ρ = .28, p < .01). At the within-person level, concurrent associations showed that emotional difficulties were associated with greater authorized (β = .15–.17, p < .01) absence at Time 3 only, but with less unauthorized (β = −.08–.13, p < .05) absence at Times 1 and 2. In cross-lagged pathways, neither authorized nor unauthorized absence predicted later emotional difficulties, and emotional difficulties did not predict later authorized absence at any time point. However, greater emotional difficulties were associated with fewer unauthorized absences across time (β = −13–.22, p < .001). The implications of these findings are discussed.

Funding: JI was supported by the Medical Research Council (MC_UU_00022/1) and the Scottish Government Chief Scientist Office (SPHSU16). The HBSC 2013/14 study in Scotland was funded by NHS Health Scotland (now Public Health Scotland). The current study investigated how adolescents' loneliness relates to school connectedness, classmate support, teacher support, and offline and online communication with friends. We also examined the association between loneliness, physical health, and sleep. Data came from the Scottish Health Behavior in School-aged Children (HBSC). The total sample was 2983 adolescents (F = 1479 [49.6%]) aged 14-17 years (M = 15.66, SD = 0.39) from 117 secondary schools in Scotland. Results showed that (1) higher teacher support, classmate support, and offline contact with friends predicted lower levels of loneliness, (2) online friendship engagement predicted higher levels of loneliness, and (3) poor health and sleep were positively associated with loneliness. The study offers new findings, highlighting the role played by classmates/peers and teachers in reducing loneliness. Supporting previous research, we also found associations between loneliness, poor sleep, and worse physical health. Publisher PDF

There is growing concern about the role of social media use in the documented increase of adolescent mental health difficulties. However, the current evidence remains complex and inconclusive. While increasing research on this area of work has allowed for significant progress, the impact of social media use within the complex systems of adolescent mental health and development is yet to be examined. The current study addresses this conceptual and methodological oversight by applying a panel network analysis to explore the role of social media on the interacting systems of mental health, wellbeing, and social life of 12,041 UK adolescents. We find that across time, social media is one of the least influential factors of adolescent mental health with other factors (e.g. bullying, lack of family support) deserving greater attention. Our findings suggest that the current depiction of social media use as the culprit of adolescent mental health difficulties is unwarranted and highlight the need for social policy initiatives that focus on the home and school environment to foster resilience.

Adolescence is a period of increased vulnerability for low well-being and mental health problems, particularly for girls and older adolescents. Accurate measurement via brief self-report is therefore vital to understanding prevalence, group trends, screening efforts, and response to intervention. We drew on data from the #BeeWell study ( N = 37,149, aged 12–15) to consider whether sum-scoring, mean comparisons, and deployment for screening were likely to show bias for eight such measures. Evidence for unidimensionality, considering dynamic fit confirmatory factor models, exploratory graph analysis, and bifactor modeling, was found for five measures. Of these five, most showed a degree of non-invariance across sex and age likely incompatible with mean comparison. Effects on selection were minimal, except sensitivity was substantially lower in boys for the internalizing symptoms measure. Measure-specific insights are discussed, as are general issues highlighted by our analysis, such as item reversals and measurement invariance.

The current study examines the relationship between prolonged loneliness, physical health, and sleep among young adolescents (10–13 years; N = 1214; 53% girls). Loneliness was measured at 10, 12 and 13 years of age along with parent-reported health and sleep outcomes. Using growth mixture modelling, 6 distinct trajectories were identified: ‘low increasing to high loneliness’ (n = 23, 2%), ‘high reducing loneliness’ (n = 28, 3%), ‘medium stable loneliness’ (n = 60, 5%), ‘medium reducing loneliness’ (n = 185, 15%), ‘low increasing to medium loneliness’ (n = 165, 14%), and ‘low stable loneliness’ (n = 743, 61%). Further analyses found non-significant differences between the loneliness trajectories and parent-report health and sleep outcomes including visits to health professionals, perceived general health, and sleep quality. The current study offers an important contribution to the literature on loneliness and health. Results show that the relationship may not be evident in early adolescence when parent reports of children’s health are used. The current study highlights the importance of informant choice when reporting health. The implications of the findings for future empirical work are discussed.

This cluster randomized trial evaluated the impact of the Promoting Alternative Thinking Strategies (PATHS) curriculum on children’s psychological wellbeing, peer social support, and school connectedness. Forty-five schools in England were randomly assigned to implement PATHS or continue their usual provision for 2 years. The trial sample was 5,218 students, aged 7–9 at baseline (M = 8.12, SD = .87). Teachers in PATHS schools received initial training and ongoing implementation support and assistance from trained coaches. Multilevel intent-to-treat (ITT) analysis of outcome data indicated that PATHS led to a small, statistically significantly improvement in children’s psychological wellbeing but had no discernible impact on their peer social support or school connectedness. Multilevel complier average causal effect estimation using dosage as a compliance marker increased the intervention effect size for psychological wellbeing and revealed significant medium to large effects for peer social support and school connectedness. The implications of these findings are discussed, and study limitations are noted. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

Age differences in the prevalence of loneliness have been a key focus among researchers, practitioners, and policy makers. However, the degree to which those reflect genuine differences in the experience of loneliness or the way individuals understand and respond to loneliness measures is yet to be examined. The current study explored the age measurement invariance of the 20-item Revised University of California Los Angeles, Loneliness Scale (UCLA-LSR) and its shorter forms in a U.K. sample of adults aged 18 to 99 years ( M = 50.6, SD = 19.7). The fit of different structures/versions was explored through multigroup confirmatory factor analysis (CFA; N = 4,375) and local structural equation modeling ( N = 19,521). Results indicated a poor and/or inconsistent structure for the 20-item UCLA-LSR and many of its shorter forms. Of the structures considered, 12 showed acceptable model fit and received age measurement invariance testing through multigroup CFA and alignment; 10 of these achieved full, partial, or approximate measurement invariance. Our findings suggest that the age measurement invariance of loneliness measures should not be assumed, and crucially, this must be explored before accurate and meaningful age comparisons can be made. Implications for measurement research, and clinical and community practice, are discussed.

There is general agreement about the benefits of school-based social and emotional learning (SEL) interventions in relation to children and young people’s social-emotional competence, mental health, and academic achievement. However, we know little about the theorized mechanisms through which SEL leads to improved academic outcomes. The current study is the first to present an integrative model (derived from the SEL logic model) using a 3-wave (annual assessment, T1, T2, T3) longitudinal sample of 1626 (51% boys, n = 832) 9–12-year-old students (M = 9.17, SD = .31 at baseline) attending 45 elementary schools in England, drawn from a major randomized trial of a universal SEL intervention (the Promoting Alternative Thinking Strategies curriculum; PATHS). Using structural equation modeling that accounted for within-time covariance, data clustering, gender and prior academic attainment, we examined the temporal relations between social-emotional competence (T1), school connectedness (T2), mental health difficulties (T2), and academic attainment (T3). It was hypothesized that social-emotional competence would directly and indirectly influence academic attainment through school connectedness and mental health difficulties. Our analyses also examined whether these hypothesized relations varied as a function of intervention exposure (PATHS versus usual provision). The theorized model was partially supported. Social-emotional competence at T1 exerted a significant influence on school connectedness and mental health difficulties at T2. However, the latter was the only significant predictor and mediator of academic attainment at T3 after controlling for gender and prior academic performance. Students with greater social-emotional competence at T1 were reported to experience fewer mental health difficulties at T2, and this in turn predicted higher academic attainment at T3. Intervention exposure did not markedly influence the magnitude or statistical significance of these identified pathways. Collectively, these findings indicate some possible revisions to our current understanding regarding the role of social-emotional competence in promoting academic attainment, as its contribution appears to lay primarily in buffering the adverse effects of mental health difficulties.

Since its development over a decade ago, the Social Skills Improvement System (SSIS) has been one of the most widely used measures of social skills in children. However, evidence of its structural validity has been scant. The current study examined the original seven-factor and more recent five-factor structure (SSIS-SEL) of the self-report SSIS in a sample of English elementary school students ( N = 3,331) aged 8 to 10 years ( M = 8.66, SD = 0.59). A problematic fit was found for both structures with poor discriminant validity. Using exploratory graph analysis and bifactor-( S − 1) modeling, we found support for a four-factor structure, the variation of which was captured by a general factor defined by “empathy and prosocial skills.” Future researchers, particularly those interested in using specific domains of the SSIS, are urged to assess its structure in their studies, if their findings are to be theoretically meaningful.

Internalizing symptoms are the most prevalent mental health problem in adolescents, with sharp increases seen, particularly for girls, and evidence that young people today report more problems than previous generations. It is therefore critical to measure and monitor these states on a large scale and consider correlates. We used novel panel network methodology to explore relationships between internalizing symptoms, well-being, and inter/intrapersonal indicators. A multiverse design was used with 32 conditions to consider the stability of results across arbitrary researcher decisions in a large community sample over three years (N = 15,843, aged 11–12 at Time 1). Networks were consistently similar for girls and boys. Stable trait-like effects within anxiety, attentional, and social indicators were found. Within-person networks were densely connected and suggested mental health and inter/intrapersonal correlates related to one another in similar complex ways. The multiverse design suggested the particular operationalization of items can substantially influence conclusions. Nevertheless, indicators such as thinking clearly, unhappiness, dealing with stress, and worry showed more consistent centrality, suggesting these indicators may play particularly important roles in the development of mental health in adolescence.

Dual-factor models of mental health have emphasized the importance of considering both mental health difficulties and wellbeing in young people. However, studies to date have failed to consider the conceptual and statistical similarity between wellbeing and internalizing indicators. Drawing on network methods, we present exploratory and confirmatory models of indicator-level interactions for internalizing symptoms and wellbeing in two large independent samples (sample 1, N = 14,805, sample 2, N = 14,066). A densely connected network was found which showed good stability across samples. The most and strongest relationships were observed within the two domains. Nevertheless, direct associations similar to some within-domain relationships were also observed between internalizing and wellbeing indicators. Worry was the most central indicator in both samples, and was meaningfully related to the wellbeing indicator “feeling relaxed”. Evidence of known-groups validity was demonstrated since indicator-level interactions in the networks were sensitive to known differences between girls and boys. Findings suggest the covariance between internalizing symptom and wellbeing indicators in adolescent datasets should be more closely attended to, and controlled for in intervention and epidemiological research.Key words: internalizing symptoms, wellbeing, adolescence, network analysis

The self-report version of the Strengths and Difficulties Questionnaire is widely used in clinical and research settings. However, the measure’s suitability for younger adolescents has recently been called into question by readability analysis. To provide further insight into the age-appropriateness of the self-report Strengths and Difficulties Questionnaire, readability was assessed at the item level alongside consideration of item quality criteria, its factor structure was analyzed, and measurement invariance between adolescents in Year 7 (age 11-12 years) versus Year 9 (age 13-15 years) was tested. The measure showed a wide range of reading ages, and the theorized factor structure was unacceptable. Measurement invariance was therefore considered for a flexible exploratory structural equation model, and no evidence of differences between age groups was found. Suggestions are made for the measure’s revision based on these findings.

Abstract. This study investigated the factor structure, internal consistency, and known-groups validity of the 4-item Perceived Stress Scale in a large sample of 29,388 English adolescents. Results indicated that the original unidimensional structure was not viable and instead provided support for a two-factor structure. Examination of a bifactor-( S − 1) model indicated that this multidimensionality can be attributed to reverse-worded items; however, beyond method effects, these factors appear to capture distinct, though inter-related, constructs. As this multidimensional structure relies on 2-item factors, we advise use of longer versions of this measure where possible.

BackgroundUniversal social and emotional learning interventions can produce significant practical improvements in children’s social skills and other outcomes. However, the UK evidence base remains limited.ObjectivesTo investigate the implementation, impact and cost-effectiveness of the Promoting Alternative THinking Strategies (PATHS) curriculum.DesignCluster randomised controlled trial. Primary schools (n = 45) were randomly assigned to implement PATHS or to continue with their usual provision for 2 years.SettingPrimary schools in seven local authorities in Greater Manchester.ParticipantsChildren (n = 5218) in Years 3–5 (aged 7–9 years) attending participating schools.InterventionPATHS aims to promote children’s social skills via a taught curriculum, which is delivered by the class teacher, generalisation activities and techniques, and supplementary materials for parents. Schools in the usual provision group delivered the Social and Emotional Aspects of Learning programme and related interventions.Main outcome measuresChildren’s social skills (primary outcome, assessed by the Social Skills Improvement System); pro-social behaviour and mental health difficulties (Strengths and Difficulties Questionnaire); psychological well-being, perceptions of peer and social support, and school environment (Kidscreen-27); exclusions, attendance and attainment (National Pupil Database records); and quality-adjusted life-years (QALYs) (Child Health Utility 9 Dimensions). A comprehensive implementation and process evaluation was undertaken, involving usual provision surveys, structured observations of PATHS lessons, interviews with school staff and parents, and focus groups with children.ResultsThere was tentative evidence (at ap-value of d = 0.12, 95% confidence interval (CI) –0.02 to 0.25;p p LimitationsModerate attrition through the course of the main trial, and significant attrition thereafter (although this was mitigated by the use of multiple imputation of missing data); suboptimal frequency of delivery of PATHS lessons.ConclusionsThe impact of PATHS was modest and limited, although that which was observed may still represent value for money. Future work should examine the possibility of further modifications to the intervention to improve goodness of fit with the English school context without compromising its efficacy, and identify whether or not particular subgroups benefit differentially from PATHS.Trial registrationCurrent Controlled Trials ISRCTN85087674 (the study protocol can be found at:www.journalslibrary.nihr.ac.uk/programmes/phr/10300601/#/).FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol 6, No. 10. See the NIHR Journals Library website for further project information.

We present a developmental cascade model of the longitudinal relationships between internalizing symptoms, externalizing problems, and academic performance in middle childhood, utilizing a large sample (N = 1,771) from the United Kingdom in a 3-year, cross-lag design. Three hypotheses were tested: adjustment erosion, academic incompetence, and (cumulative) shared risk. In addition, we sought to examine whether developmental cascade pathways varied across gender, while also statistically exploring indirect, mediation pathways. Structural equation models that accounted for within-time covariance, data nesting, and temporal stability provided evidence of gender-specific effects as follows: externalizing-attainment adjustment erosion pathways were found only in boys, while attainment-internalizing/externalizing academic incompetence pathways were found only in girls. Analysis of mediation pathways provided further support for these gender-specific longitudinal profiles. Protective longitudinal internalizing-externalizing and externalizing-internalizing pathways were found for both boys and girls. Finally, while it improved model fit for both genders, the influence of cumulative shared risk on the aforementioned pathways was relatively meager, substantively affecting only one (externalizing-attainment adjustment erosion pathway in boys). The implications of these findings are discussed, and study limitations noted.

BackgroundIn the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.AimsTo examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.MethodWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.ResultsWe identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs;g= 0.30, 95% CI 0.09–0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI 0.35–1.02), with a number needed to treat of approximately 10 (95% CI 5–∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.ConclusionsFor people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.

Objective: Two key treatment effect modifiers—implementation variability and participant cumulative risk status—are examined as predictors of disruptive behavior outcomes in the context of a large cluster randomized controlled trial of a universal, school-based behavior management intervention. The core components of the Good Behavior Game (GBG) are classroom rules, team membership, monitoring behavior, and positive reinforcement. Children work in teams to win the game, which is played alongside a normal classroom activity, during which their teacher monitors infractions to classroom rules. Teams with four or fewer infractions at the end of the game win and are rewarded.\ud Method: Seventy-seven English primary schools (N = 3,084 children, aged 6–7) were randomly assigned to deliver the GBG or continue their usual practice over 2 years.\ud Results: Intent-to-treat analysis found no discernible impact of the intervention on children’s disruptive behavior. Additionally, subgroup analyses revealed no differential gains among children at low, moderate or high levels of cumulative risk exposure (CRE). However, complier average causal effect estimation (CACE) using dosage as a compliance marker identified a large, statistically significant intervention effect (d = −1.35) among compliers (>1,030 min of cumulative intervention exposure). Furthermore, this compliance effect varied by participant CRE, such that children at high and low levels of exposure experienced significantly greater and lesser reductions in disruptive behavior, respectively.\ud Conclusions: These findings highlight the importance of optimizing implementation and demonstrate the utility of CRE as a theoretically informed approach to subgroup moderator analysis. Implications are discussed and study strengths and limitations are noted.

The adverse consequences of posttraumatic stress on quality of life have been well documented. It is, however, possible that it is not the intrusive re-experiencing and hyperarousal posttraumatic stress symptoms that have an impact on quality of life per se, but the inflexible efforts to avoid internal experiences and emotions related to the traumatic event, and the way these emotions are expressed and experienced. Previous research shows that both experiential avoidance and emotion regulation have been found to be etiologically central to the development and maintenance of psychological problems in trauma survivors. The degree to which experiential avoidance and emotion regulation act together as toxic underlying mechanisms to explain the relationship between posttraumatic stress and quality of life is, however, yet to be examined. Quality of life is now regarded as an important outcome variable across a broad range of conditions and problem areas. The quality of life concept has generated a large body of research and yet its assessment has been a challenge for researchers. The WHOQOL-BREF is considered to be one of the few genuine quality of life measures but it has received much criticism, especially regarding the poor psychometric performance of its social relationships domain. The aim of the current thesis was twofold. The first aim involved the revision of the WHOQOL-BREF through the enhancement of the social relationships domain. In Study I 986 ill and healthy individuals from five countries worldwide completed the Pilot Revised WHOQOL-BREF (WHOQOL-BREF-R) along with measures of life satisfaction, anxiety, and depression for the detailed psychometric analysis of the scale. Study I confirmed the limitations of the social relationships domain, and despite its improvement, the performance of the overall scale was found to be poor. In fact, findings from modern and robust techniques challenged the 4-factor structure of the WHOQOL-BREF. Instead, results supported the performance of a 3-factor solution, which led to the development of a psychometrically sound measure. Study II is preceded by a systematic review of the literature investigating experiential avoidance as a mediator in trauma survivors with posttraumatic stress. Ten studies were identified and organised in two categories assessing experiential avoidance as a mediator between: 1) trauma exposure and posttraumatic stress, and 2) posttraumatic stress and maladaptive behaviours. Findings suggest that the development and maintenance of posttraumatic stress symptoms and maladaptive behaviours in the aftermath of trauma can be explained through the use of experiential avoidance. Methodological limitations and future directions for research are discussed. The WHOQOL-BREF-R was then used in Study II, which explored an integrative mediation model whereby experiential avoidance and emotion regulation were tested as mediators in the relationship between posttraumatic stress symptomatology and quality of life in trauma exposed adults. The two mediators were also explored for their overlapping relationship. A total of 360 participants from the community completed self-report measures of posttraumatic stress, experiential avoidance, emotion regulation, and quality of life. With the use of path analysis Study II found experiential avoidance and emotion regulation to be two distinct constructs that together act as an underlying mechanism explaining the impact of posttraumatic stress on quality of life. Alternative mediating models were explored. The current study makes an important contribution in the area of trauma and in the conceptualisation and assessment of quality of life. Findings can be considered as a first step towards an integrative mediation model of toxic mechanisms in trauma and quality of life. Additionally, the favourable psychometric properties of the WHOQOL-BREF-R make it a powerful tool for use in quality of life research.