Mediating role of depressive symptoms linking insecure attachment and disordered eating in adolescents: A multiwave longitudinal study.

Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother-child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.

Prospective Bidirectional Associations between Attachment and Depressive Symptoms from Middle Childhood to Adolescence.

Insecure attachment to parents consistently correlates with adolescent depression. However, the order of cause and effect, the impact of confounding, and gender disparities in this relationship remain unresolved. The present study therefore examined the prospective associations between attachment relationships to mothers and fathers and depressive symptoms in a community sample of Spanish children (n = 904; 49.4% females) assessed biennially from age 10-16 years, net of all unmeasured time-invariant confounding. Insecure relationships predicted depressive symptoms, and more so among girls, but depressive symptoms also forecasted worsened attachment relationships. At ages 12-14, mother-child attachment proved to be more important for the development of depressive symptoms than father-child attachment. These findings reveal a pattern of reciprocal influence between attachment relationships and depressive symptoms that appears to vary as a function of the parental and child's gender and developmental period. Thus, efforts aimed at strengthening the parent-child attachment relationship-across the transition from middle childhood to adolescence-may prevent or reduce depressive symptoms, especially by targeting mothers and female adolescents.

What do parents know about their children's comprehension of emotions? accuracy of parental estimates in a community sample of pre-schoolers.

BACKGROUND: Parents' ability to correctly perceive their child's skills has implications for how the child develops. In some studies, parents have shown to overestimate their child's abilities in areas such as IQ, memory and language. Emotion Comprehension (EC) is a skill central to children's emotion regulation, initially learned from their parents. In this cross-sectional study we first tested children's EC and then asked parents to estimate the child's performance. Thus, a measure of accuracy between child performance and parents' estimates was obtained. Subsequently, we obtained information on child and parent factors that might predict parents' accuracy in estimating their child's EC. METHODS: Child EC and parental accuracy of estimation was tested by studying a community sample of 882 4-year-olds who completed the Test of Emotion Comprehension (TEC). The parents were instructed to guess their children's responses on the TEC. Predictors of parental accuracy of estimation were child actual performance on the TEC, child language comprehension, observed parent-child interaction, the education level of the parent, and child mental health. RESULTS: Ninety-one per cent of the parents overestimated their children's EC. On average, parents estimated that their 4-year-old children would display the level of EC corresponding to a 7-year-old. Accuracy of parental estimation was predicted by child high performance on the TEC, child advanced language comprehension, and more optimal parent-child interaction. CONCLUSION: Parents' ability to estimate the level of their child's EC was characterized by a substantial overestimation. The more competent the child, and the more sensitive and structuring the parent was interacting with the child, the more accurate the parent was in the estimation of their child's EC.

The relationship between socio-economic status and antidepressant prescription: a longitudinal survey and register study of young adults.

AIMS: The current study examines the relationship between socio-economic status (SES) and antidepressant prescription among young adults and investigates mechanisms that could explain such a potential social gradient. METHODS: Longitudinal survey data from a population-based Norwegian sample (N = 2606) was collected in four waves over a 13-year period. The data were linked to register data on antidepressant prescription and several indicators of SES (education, income, social or unemployment benefits, disability or rehabilitation benefits and parents' education). RESULTS: Apart from parents' education, all indicators of low SES were related to higher rates of antidepressant prescription. A part of the relationship between SES and antidepressant prescription was due to low SES being related to higher levels of anxiety and depression. Moreover, low SES was related to more frequent use of mental health services, which again was related to higher rates of antidepressant prescription. Both contact with physicians and other mental healthcare professionals accounted for some of the relationship between SES and antidepressant prescription. CONCLUSIONS: The study provides information about mechanisms involved in the relationship between low SES and antidepressant prescription. More research is needed about whether a comparable social gradient in antidepressant prescription is also to be found outside the Nordic countries.

Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females.

BACKGROUND: There is limited information about psychological predictors of cosmetic surgery and how cosmetic surgery influences subsequent changes in mental health and overall appearance satisfaction. To date, there is a lack of studies examining this issue, whereby representative population samples are assessed at an age before cosmetic surgery is typically conducted and followed up after such surgery has commonly been performed. METHOD: We obtained data from a survey study following 1597 adolescent females from a representative Norwegian sample over a 13-year period. Participants provided information on cosmetic surgery, appearance satisfaction, mental health, risky sexual behavior, drug use and conduct problems at two time-points (overall response rate 67%). RESULTS: Of all participants, 78 (4.9%) reported having undergone cosmetic surgery, of whom 71 were operated on during the course of the study and seven before the first data collection. Symptoms of depression and anxiety [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.07-2.57] and a history of deliberate self-harm (OR 2.88, 95% CI 1.46-5.68), parasuicide (OR 3.29, 95% CI 1.53-7.08) and illicit drug use (OR 2.46, 95% CI 1.07-5.82) predicted prospective cosmetic surgery. Moreover, those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). Patients' use of alcohol also increased more than among non-patients (t=2.47, p=0.01). CONCLUSIONS: A series of mental health symptoms predict cosmetic surgery. Cosmetic surgery does not in turn seem to alleviate such mental health problems.

Conduct problems and early cannabis initiation: a longitudinal study of gender differences.

AIM: To investigate the relationship between early conduct problems and early onset of cannabis use, with special emphasis on possible gender differences. DESIGN: A prospective longitudinal study of a national sample of 2436 adolescents. The sample was followed up over a year and a half, when the adolescents were in their early teens. SETTING: Norway. MEASUREMENTS: On the basis of an earlier study, conduct problems (CP) closely related to the criteria for conduct disorder (CD) in DSM-III-R were decomposed into three dimensions, labelled serious, aggressive and covert. Further, information was collected about alcohol intoxication, daily smoking and use of cannabis. A number of questions were posed about sexual interactions and perceived puberty development. Parental socio-economic status was measured according to the ISCO-88. Separate information was collected as to whether the parents were on social welfare or unemployed. A parental bonding measure (PBI) was used to measure the emotional relationship between respondents and parents. Further, a measure of parental monitoring was used, and information was also collected on other aspects of the family milieu, and on the adolescents' peers. Statistical models. Logistic regression analysis was employed. As the sample consisted of pupils clustered within classes within schools, a three-level error structure for the logistic regression model was estimated. FINDINGS: There was a strong association between early conduct problems and subsequent cannabis initiation. Also conduct problems at a potential subclinical level seemed to have great impact. The effect was significantly stronger in girls than in boys. Serious CP was found to have a moderate effect upon cannabis initiation in boys, whereas aggressive and covert CP had strong effects in girls. Early onset of puberty and early sexual involvement had no impact, whereas early use of cigarettes proved an important precursor to cannabis use. CONCLUSIONS: Conduct problems are important precursors of early onset cannabis use, but probably represent gender-specific aetiologies. There might be an important potential for prevention of early onset drug use in the prevention of early conduct problems, in particular for girls.

Use of anabolic-androgenic steroids in adolescence: winning, looking good or being bad?

OBJECTIVE: To investigate the prevalence of anabolic-androgenic steroid (AAS) use among Norwegian adolescents and to contrast three perspectives on AAS use: performance enhancement in sports competition, body image and eating concerns, and AAS-use as belonging to a cluster of problem behaviors. METHOD: A nationally representative sample of 8,877 (53.8% female) Norwegian youths (15-22 years of age) were surveyed (response rate 78%). Sports participation included measures of participation in strength sports, participation in competitive sports, strength training and perceived athletic competence. Body image and eating concerns included measures of disordered eating, perceived physical appearance and satisfaction with body parts. Problem behavior was measured by three dimensions of conduct problems (overt destruction, overt nondestruction and covert destruction), illicit drug use and sexual involvement. RESULTS: Information about AAS was obtained from 8,508 subjects. Lifetime AAS use was 0.8% (1.2% male and 0.6% female), 12-month prevalence was 0.3% and 5.1% had been offered AAS. AAS use did not vary according to sports involvement and demographics. Logistic regression analyses showed that AAS use was associated with such problem behavior as marijuana (cannabis) involvement and overt nondestruction (e.g., aggressive-type conduct problems) and, to some extent, with involvement in power sports and disordered eating. AAS users differed little from those who had been offered but refrained from using AAS, except that they were more likely to be current marijuana users. CONCLUSIONS: Adolescent AAS use seems primarily to be another type of problem behavior and only secondarily is it associated with strength-sport participation and disordered eating.

Depressive symptoms among young Norwegian adolescents as measured by the Mood and Feelings Questionnaire (MFQ).

In a stratified random and representative sample of 2,560 13- to 14-year-old Norwegian girls and boys, depressive symptoms were assessed by means of the Mood and Feelings Questionnaire (MFQ). The MFQ showed a good internal consistency (alpha), and test-retest correlations (r) for three-week and three-month intervals were 0.84 and 0.80 respectively. Convergent and discriminative validity were also assessed. The mean total MFQ score for the whole sample was 10.6 (SD 9.5). The results showed a significant sex by age interaction effect in that girls increased their mean total MFQ sum score by age while the boys' scores decreased slightly. Reports of unattractiveness, restlessness, indecisiveness and transient feelings of low mood were common in the total sample, while unhappiness, irritability, self-dislike and concentration problems were common among high-scoring subjects. Girls experienced more often lowered mood, were more concerned with their appearance and had more self-depreciatory notions than boys, while boys more often than girls had lower school satisfaction. Girls were preponderant among the high-scoring subjects. The results of logistic regression analyses showed that concentration problems were the strongest predictor of high scores. The findings are discussed in view of similar epidemiological studies in which DSM-IV criteria have been used in the assessment of depressive symptoms and disorders among adolescents.

Young suicide attempters: a comparison between a clinical and an epidemiological sample.

OBJECTIVE: To compare risk factors for self-harm in 2 groups: hospitalized adolescents who had attempted suicide and adolescents reporting suicide attempts in a community survey. METHOD: All suicide attempters aged 13 to 19 years admitted to medical wards (n = 91) in a region of Norway were assessed and interviewed. Risk factors were identified by comparisons with a general population sample participating in a questionnaire study in the same community (n = 1,736). In this population sample, a separate analysis of risk factors for reporting deliberate self-harm (n = 141) was performed, applying bivariate and multivariate logistic regression models. RESULTS: Adjusted risk factors for suicide attempts in hospitalized adolescents were depression (odds ratio [OR] = 4.7), disruptive disorders (OR = 9.4), low self-worth (OR = 1.3), infrequent support from parents (OR = 3.3) or peers (OR = 3.3), parents' excessive drinking (OR = 4.3), and low socioeconomic status (OR = 2.4). For adolescents who self-reported self-harm, depression (OR = 3.1) and loneliness (OR = 1.13) were significant adjusted risk factors (p < .001). Low self-worth, low socioeconomic status, and little support from parents or peers characterized hospitalized suicidal adolescents compared with those who were not hospitalized. CONCLUSIONS: The risk factors were more powerful for hospitalized than for nonhospitalized adolescents. Prevention efforts should target the same factors for both groups, at a population level for nonhospitalized adolescents and at an individual level for hospitalized adolescents, with a focus on depression, low self-esteem, and family communication.

Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents.

OBJECTIVE: To investigate the risk and protective factors for previous and future suicide attempts among adolescents. METHOD: A representative sample of high school students (N = 9,679) in grades 7 through 12 (aged 12-20 years) were followed from 1992 to 1994. Response rate was 97% at initial testing and 80% at follow-up. Measures of psychiatric symptoms (depressed mood, eating problems, conduct problems), substance use, self-worth, pubertal timing, social network, and social integration were included. RESULTS: A total of 8.2% had ever attempted suicide and 2.7% reported an attempt during the 2-year study period. Logistic regression analysis showed that future attempts were predicted by previous attempt, female gender, young age, perceived early pubertal development (stronger among girls), suicidal ideation, alcohol intoxication, not living with both parents, and poor self-worth. CONCLUSIONS: The importance that the clinician ask about previous suicidal behaviors is underscored. Early pubertal timing (particularly among girls), loss of self-worth, and alcohol intoxication may serve as risk factors for future suicide attempts.

Psychological and behavioral factors unpredictive of disordered eating: a prospective study of the general adolescent population in Norway.

OBJECTIVE: To investigate if cross-sectionally identified correlates of disordered eating among adolescents could also predict disordered eating prospectively over and beyond the initial level of disordered eating. METHOD: Two-wave longitudinal questionnaire study of a representative and nationwide sample of 7,751 Norwegian adolescents aged 12-19 at initial testing (t1). A 12-item version of the Eating Attitudes Test (EAT) was included. RESULTS: Forty percent of the girls and 25% of the boys with disordered eating at t1 also scored above the cut-off point 2 years later (t2). Initial disordered eating, gender, depressed mood, body dissatisfaction, unstable self-perceptions, perceived obesity, excessive exercise, and having idols with perfect bodies all predicted change in disordered eating. However, when the initial symptom load was controlled, these variables - except gender - only contributed marginally to the prediction of disordered eating. These negative results are in line with other longitudinal studies of changes in disordered eating in unselected adolescent populations. DISCUSSION: It cannot be established that psychological factors play a major etiological role in the development of disordered eating. The results are discussed with reference to a potential discontinuity between eating problems and eating disorders.

Social network size of female patients with rheumatoid arthritis compared to healthy controls.

UNLABELLED: To estimate how rheumatoid arthritis (RA), the disease duration, and level of physical disability, influence the total size of patients' social network and the size of different subsets. Two hundred sixty four female patients (mean age 57 yrs) with RA of more than 6 yrs duration (mean 20 yrs) were compared to 61 healthy controls matched for sex, age, and residential area. Network size was measured by Social Network Delineation Questionnaire (SNDQ), physical disability by Health Assessment Questionnaire (HAQ). RA patients had a significantly smaller total network compared to the healthy controls (RA: 15.8 persons; CONTROLS: 18.1), mostly due to a significant difference in the subset of important others in favour of the controls (RA: 1.1; CONTROLS: 2.3). There were no significant differences regarding the network size of family, friends, and neighbours. The same results remained after statistical control for sociodemographic variables. Neither disease duration nor physical disability had any significant association with network size. The interaction analysis did, however, show that non-working patients with long disease duration (> 15 yrs) had fewer important others than occupationally active patients. Furthermore, a high degree of physical disability was related to a smaller number of friends for patients > 57 yrs than for equally disabled patients below this age. Most patients with RA seem to maintain contact with the family network-members, despite the challenges connected with chronic disease.

The emergence of gender difference in depressed mood during adolescence: the role of intensified gender socialization.

The prevalence of depressive mood was examined in a representative and nationwide sample of approximately 12,000 Norwegian adolescents. From the age of 14, girls scored 0.5 SD above boys in depressed mood, a difference that was stable throughout the adolescent period. At the age of 12, no gender difference was found. The gender difference was due to girls becoming more depressed from 13 to 14 years of age. An extended version of the gender intensification hypothesis (J. P. Hill & M. E. Lynch, 1983) was tested as an explanation for the gender difference in depressed mood. Structural equation modeling and regression analyses showed that the gender difference could be explained, in part, by increased developmental challenges for girls--pubertal development, dissatisfaction with weight and attainment of a mature female body, and increased importance of feminine sex role identification. Depressed mood was not associated with masculinity or school change, as had been predicted.

Sex differences in adolescent suicides in Norway, 1990-1992.

All suicides in persons under 20 years in Norway in the time period 1990-1992 (99 males, 30 females) were included in a postmortem case-control study with seven controls for each suicide, focusing on gender differences. Few sex differences between the suicide completers were evident, in spite of the difference in suicide rates (M/F rate ratio = 3.0). Females more often attempted suicide (p = .05), more often wrote farewell notes (p = .03), and used less violent suicide methods (ns). The adjusted risk for suicide related to affective disorders (Female OR = 22,1; Male OR = 24.0, both p = .000) and disruptive disorders (female OR = 14,7, ns; male OR = 5.0, p = .002) differed little, as did the effect of frequent use of alcohol or substances (female OR = 0.4, ns; male OR = 0.4, ns).

Young, wet & wild? Associations between alcohol intoxication and violent behaviour in adolescence.

AIMS: To assess gender- and age-specific associations between alcohol intoxication and engagement in violent behaviours in young people. DESIGN, PARTICIPANTS AND MEASUREMENT: Cross-sectional study comprising a national sample of 12,000 Norwegian adolescents aged 12-20 years. Data on violent behaviour, alcohol intoxication and various confounders were obtained by self-administered questionnaires in school. FINDINGS: 2.8% had been in fight with a weapon and 32.6% had been beating or threatening to beat someone during the past year. Violent behaviours were more often reported among boys, in the younger age groups, with increasing frequency of alcohol intoxication, among users of other drugs, among those engaged in criminal activities and among those in wet environments (friends drinking regularly and parents often being intoxicated). The impact of intoxication frequency on number of times engaged in violent behaviours was of modest magnitude. It was greater in the youngest age group compared to those in the middle and late teens and greater for boys than for girls. However, when criminal activities were controlled for, the adjusted effect of intoxication on violent behaviour was significantly reduced, the effect was then of the same magnitude for both genders, whereas there was no longer any significant effect in the youngest age group. Controlling also for parents' and friends' drinking and parental monitoring did not alter these findings. CONCLUSIONS: A small direct effect of alcohol intoxication on violent behaviour appears to remain after controlling for various relevant confounders in middle and late teens. However, possible indirect effects of alcohol intoxication, mediated by own deviant life-style and wetness of environment, should also be taken into consideration.

Suicide among children and younger and older adolescents in Norway: a comparative study.

OBJECTIVE: To compare characteristics and risk factors of suicide in early adolescence (younger than age 15 years) and in late adolescence. The authors examined whether differences in risk factors or resilience might explain the different suicide rates in the two age groups. METHOD: Information about all registered suicides of young people in Norway from 1990 through 1992 was gathered from several professional informants. Children younger than 15 years old who committed suicide (n = 14) were compared with late-adolescent suicides (15 through 19 years) (n = 115) and with controls (n = 889). RESULTS: Younger compared with older adolescent suicides more often hanged themselves (93% versus 35%). Suicidal ideation (7% versus 39%) and precipitating events were described less frequently (29% versus 49%). Older adolescents more often had psychiatric disorders (77% versus 43%). Compared with controls, the risk factors for suicide were affective disorders (young adolescents: odds ratio [OR] = 23.8, 95% confidence interval [CI] = 2.3 to 1,183; older adolescents: OR = 19.6, CI = 10.6 to 38.8); disruptive disorders (young adolescents: OR = 3.4, CI = 0.0 to 340; older adolescents: OR = 6.1, CI = 3.0 to 12.7); and not living with two biological parents (young adolescents: OR = 3.1, CI = 0.6 to 14.7; older adolescents: OR = 2.5, CI = 1.6 to 3.8). CONCLUSION: Children and young adolescents completing suicide were less exposed to known risk factors than older adolescents. The increased suicide risk was similar for both groups when they were compared with community controls. The low suicide incidence in childhood may be related to fewer risk factors, rather than to resilience to risk factors.

Alcohol intoxication and school dropout.

The aim of the study was to investigate if alcohol intoxications predict dropout from senior high school over and beyond the effect of alcohol consumption and to seek out potential confounding or mediating mechanisms in the form of a longitudinal cohort-sequential survey. The participants were a nationally representative sample of Norwegian junior and senior high school students (n=5308). Measures used were of alcohol consumption, number of intoxications, school dropout, conduct problems, drug use, friends' problem behaviour, truancy, attitude to school, educational aspirations, grades, homework, youth centrism, leisure time activities, religiosity, depression, academic self-concept, attachment to parents. Intoxications did override the effect of alcohol consumption and predicted dropout. This effect was confounded by parental attachment, whereas truancy and associating with peers high in problem behaviour mediated the effect of intoxications. Frequent alcohol intoxications increase the risk for school dropout by means of increased truancy and differential association with counternormative peers.

Leisure-time physical exercise: prevalence, attitudinal correlates, and behavioral correlates among young Europeans from 21 countries.

BACKGROUND: Increasing leisure time physical exercise is a major target of public health programs throughout the developed world, but few international comparisons of exercise habits among people from diverse cultures have been published. The objectives of this study were to assess the prevalence of exercise among young adults from 21 European countries, to analyze associations with health beliefs and risk awareness, and to investigate relationships among exercise, other health-related behaviors, and emotional well-being. METHODS: The European Health and Behaviour Survey, a questionnaire survey of 7,302 male and 9,181 female university students ages 18-30 years from 21 countries, was analyzed. RESULTS: Age-adjusted prevalence of physical exercise in the past 2 weeks averaged 73.2% among men and 68.3% among women, but varied markedly from more than 80% to less than 60% across country samples. Beliefs in the health benefits of exercise were consistently associated with physical exercise, as was desire to lose weight. Awareness of the influence of exercise on heart disease averaged 52% among men and 54% among women, but was not strongly associated with engagement in exercise. Associations among exercise, lack of smoking, and sleep time were observed, but results for alcohol consumption were inconsistent. Social support and depression were independently associated with physical exercise. CONCLUSIONS: Physical exercise levels are highly variable across samples of relatively privileged young Europeans from different countries. Associations with other health behaviors and with emotional well-being suggest that regular physical exercise is consistent with a healthy lifestyle. Links with health beliefs are consistent despite sociocultural differences, but deficient knowledge of the health consequences of a sedentary lifestyle remains a cause for concern.

Youth suicide in Norway, 1990-1992: a comparison between children and adolescents completing suicide and age- and gender-matched controls.

In Norway 1990-1992, the suicide rate was 18.6 per 100,000 individuals per year for boys 15-19 years old and 6.3 for girls, and for 10-14 year olds the rate was 2.7 for boys and 0.5 for girls. Comparison of all completed suicides (N = 129) with gender- and age-matched control subjects identified depression (OR = 19.9; CI = 11.2, 35.5), disruptive disorders (OR = 6.0; CI = 3.1, 11.4), and previous suicidal behavior (OR = 3.4, CI = 2.0, 5.6) as main risk factors. Of the suicide completers, 74% had mental disorders. Suicidal intent was previously expressed by 48%, but few (24%) had received treatment, despite well-developed health services. A history of disruptive disorders (17%) and substance abuse (10%) were less frequently found than in previous studies, but binge drinking may contribute to the adolescent suicide rate.

[When need is greatest--is help nearest? Help and treatment after attempted suicide among adolescents]. / Når nøden er størst--er hjelpen naermest? Hjelp og behandling etter selvmordsforsøk blant ungdom.

In a comprehensive national survey among adolescents aged 14-22 years, a total of 579 (7.6% of the net sample) stated that they had at same time taken an overdose of pills or had tried to harm themselves, in some other way. The proportion of the attempted suicides who had received help or treatment in hospital or from a medical practitioner afterwards was 6%. The proportion was higher among those who had made repeated attempts of suicide and among frequent users of drugs. A total of 16% reported having received help or treatment from a psychologist or psychiatrist, and showed a higher depression score than other attempted suicides. Thirty-two percent reported receiving help from family or friends after-wards, mostly from friends. Two thirds of the boys reported not having received any help or treatment after the suicide attempt.