Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.     

Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders.

Eighty-two women, presenting as normal-weight bulimics, obese binge eaters, social phobics, and individuals with panic disorder, were compared on anxiety, depression, and substance abuse. All were administered the Anxiety Disorder Interview Schedule-Revised and completed the Michigan Alcohol Screening Test, Drug Abuse Screening Test, and Self-Consciousness Scale. A striking proportion of eating disorder subjects were comorbid for one or more anxiety disorders, the most frequent diagnoses being generalized anxiety disorder and social phobia. The results suggest that the place of anxiety in bulimia nervosa goes beyond that discussed within the context of the anxiety reduction model. Conflicting comorbidity findings among this and prior investigations are noted, however, and discussed in terms of the issue of differential diagnosis between eating and anxiety disorders.     

Resilient Adolescent Adjustment Among Girls: Buffers of Childhood Peer Rejection and Attention-Deficit/Hyperactivity Disorder

Examined a risk-resilience model of peer rejection and attention-deficit/hyperactivity disorder (ADHD) in a 5-year longitudinal study of 209 ethnically and socioeconomically diverse girls aged 6-13 at baseline and 11-18 at follow-up. Risk factors were childhood ADHD diagnosis and peer rejection; hypothesized protective factors were childhood measures of self-perceived scholastic competence, engagement in goal-directed play when alone, and popularity with adults. Adolescent criterion measures were multi-informant composites of externalizing and internalizing behavior plus indicators of academic achievement, eating pathology, and substance use. ADHD and peer rejection predicted risk for all criterion measures except for substance use, which was predicted by ADHD only. ADHD and peer rejection predicted lower adolescent academic achievement controlling for childhood achievement, but they did not predict adolescent externalizing and internalizing behavior after controlling for baseline levels of these constructs. Regarding buffers, self-perceived scholastic competence in childhood (with control of academic achievement) predicted resilient adolescent functioning. Contrary to hypothesis, goal-directed play in childhood was associated with poor adolescent outcomes. Buffers were not found to have differential effectiveness among girls with ADHD relative to comparison girls.     

Examining the impact of psychiatric diagnosis and comorbidity on the medical lethality of adolescent suicide attempts

Specific psychiatric diagnoses and comorbidity patterns were examined to determine if they were related to the medical lethality of suicide attempts among adolescents presenting to an urban general hospital (N=375). Bivariate analysis showed that attempters with substance abuse disorders had higher levels of lethality than attempters without substance abuse. Regression results indicated having depression comorbid with any other diagnosis was not associated with medical lethality. However, having a substance abuse disorder was associated with higher suicide attempt lethality, highlighting the importance of substance abuse as a risk factor for lethal suicide attempts in adolescents. This finding stimulates critical thinking around the understanding of suicidal behavior in youth and the development and implementation of treatment strategies for suicidal adolescents with substance abuse disorders.     

Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder-combined type (ADHD-C; n=93), ADHD-inattentive type (ADHD-I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD-C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD-I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology.     

Pathways to Adolescent Substance Use Among Sexually Abused Girls

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.     

The Relationship Between Parental Alcoholism and Adolescent Psychopathology: A Systematic Examination of Parental Comorbid Psychopathology

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 13-17 year-old adolescents and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment.     

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.     

Testing a Gender Additive Model: The Role of Body Image in Adolescent Depression

Despite consistent evidence that adolescent girls are at greater risk of developing depression than adolescent boys, risk factor models that account for this difference have been elusive. The objective of this research was to examine risk factors proposed by the gender additive model of depression that attempts to partially explain the increased prevalence of depression in adolescent girls. The theory suggests that body image and eating related variables predict depression for girls, but not for boys, above and beyond the variance accounted for by other well-known risk factors, some of which were examined in the current study. The sample was 247 adolescent girls and 181 adolescent boys studied over a 24-month duration. Results suggest that body dissatisfaction is a potent predictor of depression for girls, but not for boys, above and beyond the predictive effects of other established risk factors. Results provide insight into the etiology of adolescent depression and the disparate rate of depression among adolescent girls and provide direction for identifying high-risk individuals and developing effective prevention programs.     

Prospective Relations Between Organized Activity Participation and Psychopathology During Adolescence

This longitudinal study examined psychopathology as a predictor and outcome of organized activity involvement during high school among 198 adolescents who varied in risk for psychopathology as a function of their mother's depression history. Higher levels of internalizing and externalizing symptoms in eighth grade significantly predicted lower levels of involvement in academic clubs during high school, over and above risk and SES. Tobacco use prior to high school predicted lower levels of involvement overall and in academic clubs and performance arts. Controlling for psychopathology prior to high school, higher levels of activity involvement were associated with lower levels of externalizing symptoms, less tobacco use, and fewer diagnoses of behavior disorders and substance abuse in 12th grade. The positive association between risk and adolescent psychopathology was not buffered by adolescent activity involvement. Overall, these findings suggest that involvement in organized activities may contribute to lower levels of externalizing psychopathology during high school even when controlling for prior psychopathology.     

Risk Factors for Disordered Eating During Early and Middle Adolescence: A Two Year Longitudinal Study of Mainland Chinese Boys and Girls

Even though reliable eating disorder risk factors have been identified among adolescent girls, little is known about predictors of increased vulnerability within specific phases of adolescence or among adolescent boys, particularly in highly populated non-Western contexts. In this study, early and middle adolescent boys (n?=?1,271) and girls (n?=?1,415) from Chongqing, China completed validated measures of eating disorder pathology and putative risk factors at baseline and 2 years follow-up. Multivariate models for boys of each age group indicated increases in disordered eating at follow-up were predicted by higher initial body mass index, negative affect and body dissatisfaction levels as well as attendant increases in perceived appearance pressure from mass media, body dissatisfaction, negative affect between assessments. High baseline levels of reported appearance pressure from parents and dating partners contributed, respectively, to prediction models of younger and older boys. More distinct constellations of significant predictors emerged in multivariate models of early versus middle adolescent girls. Together, findings indicated body dissatisfaction and negative affect were fairly robust risk factors for exacerbations in disturbances across samples while risk factors such as perceived pressure from desired/prospective dating partners were salient only during particular phases of adolescence.     

Reciprocal Associations Between Depressive Symptoms and Disordered Eating Among Adolescent Girls and Boys: A Multiwave,Prospective Study

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N?=?942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.     

Risk factors for disordered eating during early and middle adolescence: prospective evidence from mainland Chinese boys and girls

Despite evidence that sociocultural and psychological factors contribute to disordered eating, researchers have yet to examine the extent to which putative risk factors influence vulnerability for girls versus boys within and across phases of adolescence, particularly in non-Western cultures. In this study, early and middle adolescent samples from China (N = 2,909) completed measures of eating disorder pathology and putative risk factors at baseline and were reassessed 12 months later. Among both younger and older girls, elevations in appearance-focused interactions with friends, negative affect, and body dissatisfaction predicted increases in symptomatology at follow-up. In contrast, there was more discontinuity in risk factors relevant to samples of boys. Although media and friendship influences contributed to later disturbances among early adolescent boys, psychological factors, including body dissatisfaction and negative affect, had stronger effects in the multivariate model for older boys. Implications of finding are discussed in relation to adolescent development and a Chinese cultural context.     

Relationships between health behaviors,posttraumatic stress disorder,and comorbid general anxiety and depression

Poor health outcomes associated with posttraumatic stress disorder (PTSD) may reflect engagement in unhealthy behaviors that increase morbidity risk and disengagement in healthy behaviors that decrease morbidity risk. Although research supports this pattern, findings are not definitive, particularly for healthy behaviors. Many studies have not controlled for effects of concurrent generalized anxiety and depression, which might explain conflicting findings. To address this limitation, we used an online cross-sectional research design and multivariate multilevel modelling to evaluate associations between a multitude of health behaviors (i.e. sedentary behavior, sleep quality, physical activity, eating habits, alcohol use and substance use) and PTSD, while adjusting for comorbid generalized anxiety and depression, in a sample of trauma-exposed individuals (N = 246). Our results indicate that PTSD and comorbid generalized anxiety and depression symptoms were differentially associated with specific health constructs. Specifically, sedentary behavior and poor sleep quality were associated with PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with depression. Both increased alcohol and substance use were associated with generalized anxiety. Results from our study highlight the need to conceptualize associations between health behaviors and specific psychological symptoms in a comprehensive manner as part of clinical presentations of PTSD.     

Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation

Because few prospective studies have examined predictors of body dissatisfaction--an established risk factor for eating disorders--the authors tested whether a set of sociocultural, biological, interpersonal, and affective factors predicted increases in body dissatisfaction using longitudinal data from adolescent girls (N = 496). Elevated adiposity, perceived pressure to be thin, thin-ideal internalization, and social support deficits predicted increases in body dissatisfaction, but early menarche, weight-related teasing, and depression did not. There was evidence of 2 distinct pathways to body dissatisfaction--1 involving pressure to be thin and 1 involving adiposity. Results support the contention that certain sociocultural, biological, and interpersonal factors increase the risk for body dissatisfaction, but suggest that other accepted risk factors are not related to this outcome.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.     

Early Adolescent Growth in Depression and Conduct Problem Symptoms as Predictors of Later Substance Use Impairment

Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.     

A prospective test of cognitive vulnerability models of depression with adolescent girls

This study sought to provide a more rigorous prospective test of two cognitive vulnerability models of depression with longitudinal data from 496 adolescent girls. Results supported the cognitive vulnerability model in that stressors predicted future increases in depressive symptoms and onset of clinically significant major depression for individuals with a negative attributional style, but not for those with a positive attributional style, although these effects were small. This model appeared to be specific to depression, in that it did not predict future increases in bulimia nervosa or substance abuse symptoms. In contrast, results did not support the integrated cognitive vulnerability self-esteem model that asserts stressors should only predict increased depression for individuals with a confluence of negative attributional style and low self-esteem, and this model did not appear to be specific to depression.