A multisystemic perspective on the temporal interplay between adolescent depression and resilience-supporting individual and social resources

Multisystemic resilience and its impact on youth mental health: reflections on co-designing a multi-disciplinary, participatory study

Youth depression is a global emergency. Redressing this emergency requires a sophisticated understanding of the multisystemic risks and biopsychosocial, economic, and environmental resources associated with young people's experiences of no/limited versus severe depression. Too often, however, personal risks and a focus on individual-level protective resources dominate accounts of young people's trajectories towards depression. Further, studies of depression in high-income countries (i.e., "western") typically inform these accounts. This article corrects these oversights. It reports on the methodology of the Wellcome-funded R-NEET study: a multidisciplinary, multisystemic, mixed method longitudinal study of resilience among African youth whose status as "not in education, employment or training" (NEET) makes them disproportionately vulnerable to depression. Co-designed by academics, community-based service providers and youth in South Africa and Nigeria, with partnerships in the United Kingdom, Canada and the United States, the R-NEET study is identifying the physiological, psychological, social, economic, institutional, and environmental risks and resources associated with distinct trajectories of depression. Using the methodology of the R-NEET study as exemplar, this article advances an argument for understanding resilience as a contextually and culturally rooted capacity that draws on the multiple, co-occurring systems that young people depend upon to support their wellbeing. Acknowledging and harnessing the multiple systems implicated in resilience is critical to researchers and mental health providers who seek to support young people to thrive, and to young people themselves when protecting or promoting their mental wellbeing.

The Relationship Between Social Anxiety and Depression Among Rural High School Adolescents: The Mediating Role of Social Comparison and Social Support

Objective: This study aimed to explore the impact of social anxiety on depression among high school students and examine the parallel mediating roles of social comparison and social support. Methods: A total of 806 rural high school students were surveyed using the Short Mood and Feelings Questionnaire, the Social Phobia Inventory, the Chinese version of the Social Comparison Orientation Scale, and the Multidimensional Scale of Perceived Social Support. Results: Social anxiety and social comparison were significantly and positively correlated with depression, while social support exhibited a significant negative correlation with depression. The direct effect of social anxiety on depression was also found to be significant. Moreover, social comparison and social support both played significant parallel mediating roles in the relationship between social anxiety and depression. Conclusions: Social anxiety has a direct positive predictive effect on depression, and this effect can be indirectly mediated through the parallel roles of social comparison and social support.

The relationship between social support and depression among older adults with hypertension in urban communities: mediating effects of coping styles

Background

Older adults with hypertension are at an increased risk of depression. Social support and coping style significantly influence this risk, with social cognitive theory suggesting that social support can affect an individual's coping style, and coping style can affect the effective use of social support. However, the mediating role of coping style in the relationship between social support and depression in older hypertensive patients remains unclear. This study aimed to explore the inter-relationships between social support, coping style and depression in older hypertensive patients within a community setting, and to investigate the mediating effects of coping style.

Methods

A cross-sectional questionnaire survey was conducted with 4211 older hypertensive patients from Fuzhou, Fujian Province, China. Participants were assessed for depression, social support, coping styles, and general demographic information. Pearson correlation analysis was employed to test the correlation between variables. Mediation effect test was conducted using SPSS macro program PROCESS with Bootstrap based Model 4, after controlling for confounding factors.

Results

A total of 4211 valid questionnaires were collected, yielding an effective response rate of 98.6%. The average depression score among participants was 7.99 ± 4.92 points, with 29.5% of respondents experiencing varying degrees of depression. Both social support and coping style were associated with depression in older hypertensive patients. Specifically, objective support, subjective support, support utilization, and positive coping style were negatively correlated with depression, with correlation coefficients of -0.159, -0.160, -0.145, and -0.163, respectively. Conversely, negative coping style was positively correlated with depression, with a correlation coefficient of 0.170. Mediating effect analysis showed that coping style played a mediating role between social support and depression. Social support negatively moderated depression through positive coping style (moderating effect =-0.020, Bootstrap 95%CI [-0.027, -0.138], mediating effect value was 15.87%), while it positively influenced depression through negative coping style (moderating effect =0.012, Bootstrap 95%CI [0.008,0.017], intermediate effect value =9.52%).

Conclusion

Social support exerts a direct negative effect on depression, while coping styles mediate the relationship between social support and depression. Interventions to reduce depression in this population should focus on enhancing social support (across objective, subjective, and utilization aspects) and promoting positive coping strategies, thus strengthening psychological resilience and improving overall health and quality of life for older adults with hypertension.

A network comparison analysis of socio-ecological protective and risk factors of depression between Chinese urban and rural adolescents

BACKGROUND

Anchoring in the socio-ecological framework and the differential impact theory, the present study pioneered to explore the differential network structures of multilevel risk and protective factors that influence depression among Chinese urban and rural adolescents.

METHOD

A sample of 684 urban adolescents and 1123 rural adolescents completed a battery of self-report questionnaires measuring their depressive symptoms, as well as risk and protective factors at intrapersonal (psychological flexibility, emotion regulation), interpersonal (social support, parental control), and social levels (social capital, stressful life events).

RESULTS

Central risk and protective factors in both groups included psychological flexibility, which bridged intrapersonal, interpersonal and social resources, along with social support, social capital, rumination, catastrophizing, and self-blame. Network comparison tests revealed significant differences in the global strength and network structures between the two groups. Rural adolescents showed denser connections between positive refocusing - rumination, positive refocusing - other-blame, refocusing on planning - self-blame, and family support - self-blame, while urban adolescents showed a stronger relationship between rumination - blaming others - depression. Rural adolescents uniquely benefited from a protective loop of reappraisal - social satisfaction - depression.

CONCLUSION

The findings suggest both beneficial and trade-off effects of a denser psychosocial network in adolescents growing up in a high-risk environment. Such results imply that only increasing the number of protective factors (e.g., social resources) may not be sufficient; instead, practical strategies that can neutralize the drawbacks of protective mechanisms may serve as critical strategies in promoting the socio-ecological well-being of adolescents in China and elsewhere.

Unraveling the complexities of adolescent depression: A call for action

The adolescent years are a period of profound change, both physically and psychologically. For many, these years are marked by excitement and exploration, but for others, they are fraught with challenges that can lead to significant mental health issues. Depression, in particular, has become an increasingly prevalent concern among adolescents worldwide, and its multifaceted etiology requires a comprehensive approach to understanding and intervention. A recent study on the relationships among negative life events, dysfunctional attitudes, social support, and depressive symptoms in Chinese adolescents offers valuable insights into the complex interplay between various factors contributing to adolescent depression. The authors explore a moderated mediation model to better understand how these factors interact with and contribute to the onset of depression. This article aims to delve into the key findings of the study, highlight its implications for clinical practice, and encourage further research in this critical area.

Promotive factors associated with reduced anxiety and depression across three years in a prospective clinical cohort of adolescents: Examining compensatory and protective models of resilience

The rates of anxiety and depression increase across adolescence, many experience recurrence after treatment, yet longitudinal studies examining promotive factors are scarce. We prospectively examined the role of the promotive factors structured style, personal and social competencies, family functioning, and social resources in homotypic and heterotypic continuity and discontinuity of anxiety and depression across three years in a clinical sample. Participants were adolescents with anxiety or depressive disorders aged 13-18 years at T1 (N = 717, 44% initial participation rate) and aged 16-21 years at T2 (N = 549, 80% follow-up participation rate). At T1, diagnoses were collected from medical records and participants responded to questionnaires. At T2, semi-structured diagnostic interviews were conducted. Higher levels of all promotive factors were associated with reduced probability of anxiety or depression three years later. The promotive factors were not associated with homotypic continuity of anxiety, whereas personal competence beliefs, social competence, and, less strongly, family functioning were associated with reduced homotypic continuity of depression and heterotypic continuity from depression to anxiety. Analyses with interaction terms did not indicate moderation by the promotive factors. Our findings suggest that bolstering promotive factors may be vital for increasing treatment success and preventing recurrence of anxiety and depression in the transition toward adulthood.

Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study

Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords' WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0-120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18-24), late young (25-34), middle (35-49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

Multisystemic approaches to researching young people's resilience: Discovering culturally and contextually sensitive accounts of thriving under adversity

As our understanding of the process of resilience has become more culturally and contextually grounded, researchers have had to seek innovative ways to account for the complex, reciprocal relationship between the many systems that influence young people's capacity to thrive. This paper briefly traces the history of a more contextualized understanding of resilience and then reviews a social-ecological model to explain multisystemic resilience. A case study is then used to show how a multisystemic understanding of resilience can influence the design and implementation of resilience research. The Resilient Youth in Stressed Environments study is a longitudinal mixed methods investigation of adolescents and emerging adults in communities that depend on oil and gas industries in Canada and South Africa. These communities routinely experience stress at individual, family, and institutional levels from macroeconomic factors related to boom-and-bust economic cycles. Building on the project's methods and findings, we discuss how to create better studies of resilience which are able to capture both emic and etic accounts of positive developmental processes in ways that avoid the tendency to homogenize children's experience. Limitations to doing multisystemic resilience research are also highlighted, with special attention to the need for further innovation.

Drinking motives, personality traits and life stressors-identifying pathways to harmful alcohol use in adolescence using a panel network approach

BACKGROUND AND AIMS

Models of alcohol use risk suggest that drinking motives represent the most proximal risk factors on which more distal factors converge. However, little is known about how distinct risk factors influence each other and alcohol use on different temporal scales (within a given moment versus over time). We aimed to estimate the dynamic associations of distal (personality and life stressors) and proximal (drinking motives) risk factors, and their relationship to alcohol use in adolescence and early adulthood using a novel graphical vector autoregressive (GVAR) panel network approach.

DESIGN, SETTING AND CASES

We estimated panel networks on data from the IMAGEN study, a longitudinal European cohort study following adolescents across three waves (aged 16, 19 and 22 years). Our sample consisted of 1829 adolescents (51% females) who reported alcohol use on at least one assessment wave.

MEASUREMENTS

Risk factors included personality traits (NEO-FFI: neuroticism, extraversion, openness, agreeableness and conscientiousness; SURPS: impulsivity and sensation-seeking), stressful life events (LEQ: sum scores of stressful life events), and drinking motives [drinking motives questionnaire (DMQ): social, enhancement, conformity, coping anxiety and coping depression]. We assessed alcohol use [alcohol use disorders identification test (AUDIT): quantity and frequency] and alcohol-related problems (AUDIT: related problems).

FINDINGS

Within a given moment, social [partial correlation (pcor) = 0.17] and enhancement motives (pcor = 0.15) co-occurred most strongly with drinking quantity and frequency, while coping depression motives (pcor = 0.13), openness (pcor = 0.05) and impulsivity (pcor = 0.09) were related to alcohol-related problems. The temporal network showed no predictive associations between distal risk factors and drinking motives. Social motives (beta = 0.21), previous alcohol use (beta = 0.11) and openness (beta = 0.10) predicted alcohol-related problems over time (all P < 0.01).

CONCLUSIONS

Heavy and frequent alcohol use, along with social drinking motives, appear to be key targets for preventing the development of alcohol-related problems throughout late adolescence. We found no evidence for personality traits and life stressors predisposing towards distinct drinking motives over time.

Multisystemic Resources Matter for Resilience to Depression: Learning From a Sample of Young South African Adults

This article interrogates the continuing emphasis on personal sources of resilience; it also amends the inattention to the protective factors and processes (PFPs) that support the mental health resilience of African emerging adults. To that end, we report a study that explored which PFPs distinguished risk-exposed South African 18- to 29-year-olds with negligible depression symptoms from those who reported moderate to severe symptoms. Using an arts-based approach, young people volunteered the PFPs they had personally experienced as resilience-enabling. An inductive thematic analysis of visual and narrative data, generated by young people self-reporting high exposure to family and community adversity (n = 233; mean age: 24.63, SD: 2.43), revealed patterns in the PFPs relative to the severity of self-reported depression symptoms. Specifically, young people reporting negligible depression symptoms reported a range of PFPs associated with psychological, social, and ecological systems. In contrast, the PFPs identified by those reporting more serious depression symptoms were mostly restricted to personal strengths and informal relational supports. In the interests of youth mental health, the findings direct society's attention to the criticality of facilitating young people's access to a composite of resources rooted in personal, social, and ecological systems.

Differential Pathways from Child Maltreatment Types to Insecure Adult Attachment Styles via Psychological and Social Resources: A Bayesian Network Analysis

Child maltreatment has been linked to insecure adult attachment. However, it is not yet clear how different child maltreatment types are associated with attachment-related anxiety and avoidance in adulthood; and whether resilience against these insecure attachment styles is dependent on risk-specific resources. Therefore, this study explored differential pathways from child maltreatment types to attachment-related anxiety and avoidance in adulthood and examined whether psychological resources (self-esteem) and social resources (perceived social support) show risk-specific effects. An online survey retrospectively assessed experiences of child maltreatment, the level of attachment-related anxiety and avoidance in adulthood, self-esteem, and perceived social support in N = 604 former members of fundamentalist Christian faith communities (mean age = 41.27 years, SD = 12.50; 65.90% female). Cross-sectional data was analyzed using Bayesian network analysis. Only emotional child maltreatment showed direct relationships to insecure adult attachment. Specifically, emotional abuse and emotional neglect were associated with anxious and avoidant adult attachment, respectively. The effects of other child abuse types on adult attachment were mediated through emotional abuse, which indicated patterns of complex traumatization. Self-esteem mediated the effect of emotional abuse on anxious attachment, while perceived social support mediated the effect of emotional neglect on avoidant attachment. Social support was also linked to self-esteem and was therefore also important for individuals with experiences of emotional abuse. This study showed that child maltreatment types and their interactions are meaningfully linked to attachment-related anxiety and avoidance in adulthood. Interventions for survivors of child maltreatment should focus on risk-specific resources to support their resilience.

The mediating role of specific coping styles in the relationship between perceived social support and depressive symptoms in adolescents

BACKGROUND

Depressive symptoms are one of the most common mental health problems in adolescence, and the relationship between perceived social support and depressive symptoms has been well-studied. However, little research has been conducted on the mediating role of specific coping styles in the relationship. Therefore, the primary purpose of this study was to examine the mediating role of specific coping styles in perceived social support and depressive symptoms in adolescents.

METHODS

A questionnaire was administered to 3887 Chinese junior and senior high school adolescents (mean age = 15.72 years, SD = 1.43) using a multistage stratified and cluster sampling method. The PROCESS model 4 was used to conduct a multiple mediation analysis.

RESULTS

Problem solving, seeking help, venting, fantasy and endurance mediated the relationship between internal family support or external family support and depressive symptoms. The problem solving coping style mediated the largest amount of effect, accounting for 22.32 % and 19.05 %, respectively.

LIMITATIONS

This study used a cross-sectional survey and self-reported information, which may be the main research limitation.

CONCLUSIONS

The findings suggest that higher social support not only directly reduces the likelihood of adolescent depression, but also influences depressive symptoms through specific coping styles. This may help further develop targeted prevention and interventions for at-risk adolescents for specific coping styles.

Making "Joy Pie" to Stay Joyful: Self-Care Interventions Alleviate College Students' Mental Health Challenges

As more college students are facing mental health challenges, it is imperative to explore innovative ways of improving their mental health, including developing self-care interventions that help mitigate their stressors. Based on the Response Styles Theory and self-care conceptions, this study creates the "Joy Pie" project that consists of five self-care strategies, aiming to regulate negative emotions and increase self-care efficacy. Using an experimental design and two-wave data collected from a representative sample of Beijing college students (n₁ = 316, n₂ = 127), this study assesses the effects of the five proposed interventions on the students' self-care efficacy and mental health management. The results show that self-care efficacy helped improve mental health through emotion regulation, which is mediated by age, gender, and family income. The promising results support the effectiveness of the "Joy Pie" interventions in strengthening self-care efficacy and improving mental health. This study offers insights into building back better mental health security among college students at this critical time when the world is recovering from the COVID-19 pandemic.