Long-term Sequelae of Sub-clinical Depressive Symptoms in Early Adolescence Joe Allen Joanna Chango David Szwedo Megan Schad University of Virginia Copies.

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Long-term Sequelae of Sub-clinical Depressive Symptoms in Early Adolescence Joe Allen Joanna Chango David Szwedo Megan Schad University of Virginia Copies of related papers are available at: 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 Chango Caroline White Elie Hessel Emily 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 Links to numerous adult mental health indices Anxiety, Depression, Antisocial Personality Disorder, etc. Anxiety, Depression, Antisocial Personality Disorder, etc. Links to physical health Links to physical health Self-care Self-care Cardiovascular reactivity to Stress Cardiovascular reactivity to Stress Immune Functioning Immune Functioning Weight/obesity Weight/obesity Links to Survival 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 Development of Neural Structures Prefrontal and Parietal Cortex Prefrontal and Parietal Cortex Development of Sophisticated Social Perspective-taking Capacity Development of Sophisticated Social Perspective-taking Capacity First experience with True Adult-like Relationships First experience with True Adult-like Relationships

Early Adolescent Depressive Symptoms Concurrent Effects: Concurrent Effects: Reduced Energy for Developmental Tasks Reduced Energy for Developmental Tasks Negative Bias Regarding Relationships/Hopelessness Negative Bias Regarding Relationships/Hopelessness Self-fulfilling nature/vicious cycle Self-fulfilling nature/vicious cycle Impairment at a critical point in social development? Impairment at a critical point in social development?

Primary Question How Are Adolescent Depressive Symptoms Linked to Future Social Functioning?

Sample 184 Adolescents, their Parents, Best Friends, Other Friends, Romantic Partners 184 Adolescents, their Parents, Best Friends, Other Friends, Romantic Partners Intensive Interviews and Observations with all parties (Total N over first 13 years ~ 3200). Intensive Interviews and Observations with all parties (Total N over first 13 years ~ 3200). Equal numbers of Males and Females Equal numbers of Males and Females Socio-economically Diverse (Median Family Income= $40- $60K) Socio-economically Diverse (Median Family Income= $40- $60K) 31% African American; 69% European American 31% African American; 69% European American Very Low Attrition (98% participation rate in current phase) 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 Childhood Depression Inventory (Kovacs & Beck, 1977) 27- items based on the Beck Depression Inventory Screening Cutoffs – For possible depression Screening Cutoffs – For possible depression Clinical Cutoffs – For likely depression Clinical Cutoffs – For likely depression Aggregated Scores across 3 assessments (ages 14,15, 16) Aggregated Scores across 3 assessments (ages 14,15, 16)Adulthood: Beck Depression Inventory (Beck & Steer, 1987) 21-items assessing concurrent symptoms. Beck Depression Inventory (Beck & Steer, 1987) 21-items assessing concurrent symptoms. Aggregated Scores Across Ages 23, 24 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) 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) Aggregated from three assessments (Age 14, 15, & 16) Adulthood: UCLA Loneliness Scale (Russell et al., 1980) 20 -item inventory UCLA Loneliness Scale (Russell et al., 1980) 20 -item inventory linked to long-term mental and physical health risks linked to long-term mental and physical health risks Aggregated from two assessments (Age 23 & 24) Aggregated from two assessments (Age 23 & 24)

Depressive Symptoms Loneliness.52*** Simple Prediction of Future Loneliness (Correlations) Ages 14-16Age 23-24

Depressive Symptoms Loneliness.41*** Simple Prediction of Future Loneliness* (Correlations) Ages 14-16Age 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 Concurrent Depression.43*** Ages 14-16Age Predictions Even After Accounting for Baseline 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 8068 Above Cutoff

Depressive Symptoms Predicting Loneliness (Categorical Description) Loneliness (Age 23-24) Depressive Symptoms (Age 14-16) Below Median Above Median Below Screening Cutoff 8068 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 8068 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 All Based on Teen Self-Report Need to Begin to Explore Possible Mediators of Long- term Links 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) 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 Early adolescence: Aggregated from Age 14, 15, & 16 Late adolescence: Aggregated from Age 18, 19, & 20 Late adolescence: Aggregated from Age 18, 19, & 20 Adulthood: Maternal Report: Network of Relationships Inventory (Furman & Buhrmester, 1985) Total positivity (Six 3-item scales) Maternal Report: Network of Relationships Inventory (Furman & Buhrmester, 1985) Total positivity (Six 3-item scales) Age 23 Age 23

Depressive Symptoms Maternal Relationship Quality -.30*** Simple Continuity (Correlations) Ages 14-16Age 23

-.31*** Simple Continuity * (Correlations) Ages 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 14-16Age 23 Depressive Symptoms Maternal Relationship Quality Gender & Income

Even Mild Adolescent Depressive Symptoms Have Clear Long-term Sequelae Key Question: Mediating Pathways? 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 Adolescent Predictors (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 Adolescent Predictors (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 Adolescent Predictors (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 Maternal Relat. Quality Early Adolescent Predictors (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 Maternal Relat. Quality Early Adolescent Predictors (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 Maternal Relat. Quality Early Adolescent Predictors (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 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 Correlational not Causal Very Preliminary Understanding of Mediating Processes Very Preliminary Understanding of Mediating Processes NOT based on diagnostic/clinical interviews NOT based on diagnostic/clinical interviews Copies of related papers are available at:

Conclusions Importance of even MILD Depressive Symptoms Importance of even MILD Depressive Symptoms Effects Beyond Simple Symptom Continuity Effects Beyond Simple Symptom Continuity Interference with Relationship Formation/Maintenance – A Sensitive Period? Interference with Relationship Formation/Maintenance – A Sensitive Period? Intervention Implications Intervention Implications Copies of related papers are available at: