Mother and adolescent expressed emotion and adolescent internalizing and externalizing symptom development: a six-year longitudinal study

Development and validation of the perceived expressed emotion scale for adolescents (pees-gap)

BACKGROUND

Current assessments of expressed emotions among the psychiatric population face significant limitations in reliability and validity, particularly for non-clinical adolescent populations. Existing scales are designed for clinical settings and lack applicability to broader contexts. This study addresses these gaps by developing and validating the Perceived Expressed Emotion Scale for the General Adolescent Population (PEES-GAP). Tailored specifically for adolescents outside clinical environments, PEES-GAP enhances utility and effectiveness, offering a robust, reliable, and valid tool to assess emotional dynamics in diverse settings, representing a significant advancement in expressed emotion research.

METHODS

The study adopted a descriptive cross-sectional survey design, using accidental sampling techniques to recruit participants. One thousand seven hundred forty-one students were selected from six secondary schools and three universities from three southwestern Nigeria states to complete the questionnaires. Instruments for data collection included the Perceived Expressed Emotion Scale (PEES-GAP), Index of Family Relation (IFR), and Drug Abuse Screening Test (DAST). Ethical clearance for this study was sought and obtained from the University of Lagos Ethical Review Committee.

RESULTS

The study showed that PEES-GAP's internal consistency was 0.800, while validity analyses proved that the Index of family Relation (IFR) and Drug Abuse Screening Test (DAST) converged and diverged, respectively, with the three subdomains of expressed emotion as measured by PEES-GAP.

CONCLUSION

This study confirms the 20-item PEES-GAP as a reliable, valid tool for assessing expressed emotion in adolescents across clinical and non-clinical settings. Ensuring comparability and broad application offers a uniform measure, promotes holistic understanding, and enhances resource efficiency. Hence, it comprehensively addresses mental health issues from the client's perspective.

The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-developing Sibling Internalizing Behavior in Families with a Child with ASD

Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.

Negative parenting, epigenetic age, and psychological problems: prospective associations from adolescence to young adulthood

BACKGROUND

Epigenetic clocks are based on DNA methylation levels of several genomic loci and have been developed as indices of biological aging. Studies examining the effects of stressful environmental exposures have shown that stress is associated with differences between epigenetic age and chronological age (i.e., Epigenetic Age acceleration, EA). This pre-registered longitudinal study examined the long-term effects of negative parenting and psychological problems throughout adolescence (ages 13-17 years) on EA in late adolescence (age 17 years) and EA changes from late adolescence to young adulthood (age 25 years). Further, it examined how (change in) EA is related to changes in psychological problems from adolescence to young adulthood.

METHODS

We used data from a sample of 434 participants followed from age 13 to age 25, with saliva collected at ages 17 and 25. We estimated EA using four commonly used epigenetic clocks and analyzed the data using Structural Equation Modeling.

RESULTS

While negative parenting was not related to EA nor change in EA, (change in) EA was related to developmental indices such as externalizing problems and self-concept clarity.

CONCLUSIONS

Declining psychological well-being during young adulthood was preceded by EA.

Associations of Social Capital with Mental Disorder Prevalence, Severity, and Comorbidity among U.S. Adolescents

OBJECTIVE

To examine cross-sectional associations between social capital constructs and 1) adolescent lifetime mental disorders, 2) severity of functional impairment, and 3) psychiatric comorbidity.

METHOD

Data were from the National Comorbidity Survey Adolescent Supplement, a nationally representative mental health survey of 6,483 U.S. adolescents aged 13-18 years. Information from fully-structured diagnostic interviews, including adolescent and caregiver reports, was used to measure seven social capital constructs and lifetime DSM-IV mental disorders (mood, anxiety, behavior, substance use and eating disorder classes). Disorder severity was divided into severe vs. mild/moderate. Comorbidity was measured as the number of different classes of lifetime mental disorders.

RESULTS

Adjusted for socio-demographics and caregivers' mental health, the most consistent associations with adolescent mental disorder were for supportive friendships (any disorder OR = 0.95, 95%CI = 0.91-0.99), family cohesion (OR = 0.81, 95%CI = 0.75-0.86), school bonding (OR = 0.76, 95%CI = 0.71-0.81), and extracurricular participation (OR = 0.90, 95%CI = 0.86-0.95), although results differed by disorder class. Caregiver-reported neighborhood trust and reciprocity and caregiver community involvement were less consistently associated with mental disorder. Medium levels of adolescent-reported affiliation with neighbors was associated with lower odds of mood (OR = 0.81, 95%CI = 0.66-0.98) and anxiety (OR = 0.78, 95%CI = 0.64-0.96) disorder, while high levels were associated with higher odds of behavior disorder (OR = 1.47, 95%CI = 1.16-1.87). Several associations were stronger for severe vs. mild/moderate disorder and with increasing comorbidity.

CONCLUSION

Although we cannot infer causality, our findings support the notion that improving actual and/or perceived social capital, especially regarding friendships, family, and school, (e.g., through multimodal interventions) could aid in the prevention and treatment of both individual adolescent mental disorders and psychiatric comorbidity.

Identities: A developmental social-psychological perspective

In this contribution, we review research that uses a cross-fertilisation approach to integrate developmental and social-psychological perspectives on how identities are formed and changed over time and how identity processes are genuinely social, being embedded in social contexts and fed by social contents. First, we outline the three-factor identity model as a parsimonious approach to understanding the dynamics of identity development. Second, we review empirical studies with longitudinal approaches to shed light on how identity processes are embedded in key contexts such as family, friendships and society at large through behaviours such as civic engagement. Third, we discuss the interplay between personal and social identities. We conclude by highlighting how adopting a cross-fertilisation approach that combines social-psychological and developmental perspective can significantly advance the theoretical understanding of identity dynamics. Finally, we address similarities and differences between personal identity and social identity approaches, and we provide an agenda for future research.

A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury

BACKGROUND

Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers.

METHOD

We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS).

RESULTS

Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10).

CONCLUSION

The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.

Developmental consequences of emotional abuse and neglect in vulnerable adolescents: A multi-informant, multi-wave study

BACKGROUND

Extant research and theory posit that emotional abuse and emotional neglect-exposure is uniquely harmful during adolescence. Yet, these findings are mostly based on mono-informant, retrospective studies with unselected adults that examine emotional maltreatment in the aggregate. This prevents inferences concerning the unique, prospective risk emotional abuse and neglect, as reported by multiple informants, may confer within at-risk, adolescent samples.

OBJECTIVE

In response, the present study examined how emotional abuse and emotional neglect-exposure in adolescence uniquely related to psychological symptoms and social impairment.

PARTICIPANTS AND SETTING

Our aims were tested in a child welfare system (CWS)-involved sample of adolescents (N = 657; Age_M = 12.49 at baseline) who were participating in a longitudinal study.

METHODS

A multi-informant approach was used to assess emotional abuse/neglect and mental health. Physical abuse and lifetime CWS contact represented covariates in growth curve models.

RESULTS

Emotional abuse predicted symptoms within informant, such that youth-reported emotional abuse predicted youth-reported internalizing, β = 0.21, p = .001, and externalizing, β=0.35, p = .001, symptoms while parent-reported emotional abuse predicted parent-reported externalizing, β=0.30, p <  .001, and internalizing β=0.29, p <  .001, symptoms. Meanwhile, youth-reported emotional neglect predicted heightened self-reported internalizing symptoms, β=0.29, p <  .001, parent-reported externalizing symptoms, β=0.15, p = .002 and social impairment across youth, β=-0.17, p = .01 and parent, β=-0.24, p <  .001, report.

CONCLUSIONS

This study shows the importance of distinguishing between these maltreatment subtypes in adolescence and provides measurement recommendations for future maltreatment research. The manuscript concludes by discussing adolescent emotional abuse and neglect-exposure as a maintenance, as opposed to causal risk, factors.

Irritability and Perceived Expressed Emotion in Adolescents With Iron Deficiency and Iron Deficiency Anemia: A Case-Control Study

The objective of this study was to assess the difference in irritability and perceived expressed emotion (EE) between adolescents with iron deficiency (ID) or iron deficiency anemia (IDA) and their healthy peers. In addition, we aimed to investigate the relationship between hemogram parameters, irritability, and perceived EE in adolescents with ID and IDA. The sample of this single-center cross-sectional case-control study consisted of 89 adolescents from 12 to 17 years of age. Of the participants, 19 had been diagnosed with ID, 31 had IDA, and 39 were healthy controls. Significant differences in the self-reported and parent-reported irritability scores were observed between the ID group and the control group and between the IDA group and the control group. There was also a significant difference in the subscale of irritability between the ID group and the control group. The difference between the IDA and control groups in the intrusiveness subscale was found to be significant as well. Adolescents with IDA and ID exhibited significantly perceived irritability compared with the control group. In terms of irritability, adolescents with IDA and ID revealed greater irritability than their healthy peers. The results of this study suggest that irritability and perceived EE should be investigated in cases of ID, whether with or without anemia. As chronic diseases may benefit substantially from psychiatric consultation, psychosocial evaluation and intervention should be considered a complementary treatment option in the management of ID and IDA.

Examining the Role of Expressed Emotion in the Intergenerational Transmission of Mental Health Problems

Introduction: The aim of this study was to test a model of the intergenerational transmission of mental health problems (indicated by depression, anxiety, and loneliness) in which expressed emotion (indicated by criticism and emotional involvement) was specified as a mediator of mental health problems over multiple family generations.

Method: The sample consisted of three generations of grandmothers, mothers, and daughters (N = 242 family triads), wherein participants completed online surveys in which they self-reported on their own mental health problems and perceptions of their mothers’ expressed emotion.

Results: Results revealed only modest evidence of direct effects for the intergenerational transmission of mental health problems. However, there were a number of significant indirect effects, with all of these effects occurring through the criticism component of expressed emotion.

Discussion: This research identified expressed emotion as both a risk factor for offspring's mental health problems as well as a behavior typical of parents with mental health problems. Specifically, the results revealed that mental health problems are intergenerationally transmitted via critical parent-child interactions.

Parent Emotion Expression and Autonomic-Linked Emotion Dysregulation in Childhood ADHD

Despite evidence that ADHD is associated with disruptions in emotion regulation, few studies have examined the biological correlates of emotion dysregulation among children with this disorder. Prior work has pointed to roles of the parasympathetic and sympathetic nervous system, as indexed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Work in typically developing populations suggests that parenting behavior and parental emotion expression may shape the development of these systems. To date, a single study has examined the independent and interactive roles of autonomic nervous system functioning and parent emotion expression in youth with ADHD. This study seeks to extend that work. 86 children (42 with ADHD), aged 8-12 years, and a parent completed a parent-child interaction task, while electrocardiography and impedance cardiography data were recorded to derive RSA and PEP. Parent and child emotion word use (positive and negative valence) were coded from recordings of the task. Parents of youth with ADHD used fewer positive emotion words throughout the task. Additionally, throughout the task, children with ADHD engaged in excessive RSA withdrawal from baseline. Further, the association between RSA reactivity and ADHD diagnosis was moderated by parent positive emotion word use. Specifically, those with RSA augmentation and parents displaying high positive affect across the task conditions were least likely to have an ADHD diagnosis. If replicated and extended, these results support the use of interventions specifically designed to increase parental modeling of positive emotions, while simultaneously focusing on building emotion regulation skills in youth with ADHD.

Perceived Expressed Emotion, Emotional and Behavioral Problems and Self-Esteem in Obese Adolescents: A Case-Control Study

Objective

Obesity is a chronic disease which leads to medical and psychiatric complications. Family climate is a critical factor in the treatment of obesity and comorbid psychiatric disorders. In our study, perceived expressed emotion (EE), psychopathology, self-esteem and emotional and behavioural problems (BP) among obese adolescents were investigated and compared with their non-obese peers.

Methods

The subjects were 49 obese adolescents and 47 non-obese adolescents served as the control group. All participants were requested to fill out the Socio-demographic Data Form, Shortened Level of Expressed Emotion Scale, Rosenberg Self-Esteem Scale, Strength and Difficulties Questionnaire-Adolescent Form.

Results

In our study, obese adolescents showed a significant difference in perceived EE (p<0.001). Subscales of EE, such as Lack of Emotional Support (p<0.001), intrusiveness (p<0.001), irritability (p<0.001), self-esteem (p<0.001), emotional and BP (p<0.001), attention deficit-hyperactivity disorder (p<0.001), problems in peer relationships (p<0.001) and social skills (p<0.001) were significantly worse when compared with the control group. There was a strong relationship between EE and emotional and BP and self-esteem.

Conclusion

The higher rate of perceived EE, psychopathology and low self-esteem among obese adolescents showed that obesity prevention and treatment are also crucial for good mental health in adolescents. The important role of the family in mental health of obese adolescents was emphasized. It was shown that identification of risk factors in childhood that promote obesity should be done so that targeted intervention and prevention programs can be developed.

The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients

OBJECTIVE

Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated.

METHODS

The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels.

RESULTS

The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%.

CONCLUSION

The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.

The Interplay of Self–Certainty and Prosocial Development in the Transition from Late Adolescence to Emerging Adulthood

The transition from late adolescence to emerging adulthood is a period of the life span that offers young people the possibility to consolidate their self–certainty and prosociality. Both aspects are of core importance for increasing personal and societal well–being. The purpose of this longitudinal study was twofold: (i) to examine patterns of change and stability in self–concept clarity and prosociality; and (ii) to unravel over time associations between these constructs in the transition from late adolescence to emerging adulthood. In addressing both aims, we explored the moderating effects of gender. Participants were 244 Dutch emerging adults (46% male; mean age at T1 = 16.73 years) who completed six waves of data collection (mean age at T6 = 22.7 years). Findings highlighted that (i) self–concept clarity developed nonlinearly, with an initial decline from T1 to T2 followed by an increase thereafter, while prosociality increased linearly over time and both self–concept clarity and prosociality were characterized by high rank–order consistency; (ii) self–concept clarity and prosociality were positively related over time, with the effect of prosociality on self–concept clarity being stronger than the reciprocal effect of self–concept clarity on prosociality. Gender differences were detected in mean levels of self–concept clarity and prosociality (male participants reported higher self–concept clarity and lower prosociality than female participants) but not in their developmental pathways nor in their reciprocal associations. Copyright © 2016 European Association of Personality Psychology