Anxiety symptoms in African-American and Caucasian youth: relations to negative life events, social support, and coping

Understanding Signs and Sources of Anxiety in Urban Elementary Schools Serving Predominately Ethnically/Racially Minoritized Children

OBJECTIVE

This mixed-methods study examined teachers' perceptions of student anxiety in urban elementary schools serving predominantly low-income and ethnically/racially minoritized youth.

METHOD

Most participating teachers were female (87.7%) and from minoritized backgrounds themselves (89.2%), teaching in schools serving predominantly Black/African American (40%) or Hispanic (60%) students, and in which > 70% of students are eligible for free meals. Teachers were asked in surveys (N = 82) and interviews (n = 12) about the nature of student anxiety, and cultural/contextual considerations that influence anxiety.

RESULTS

Overall, teachers reported prevalence and signs of student anxiety that were consistent with the literature, but they reported higher levels of impairment than in previous community samples. Regressions revealed that greater levels of student exposure to community violence and higher proportions of Black students were associated with higher teacher-perceived prevalence and concern about student anxiety, respectively. Moreover, greater emotional exhaustion in teachers was associated with higher reports of anxiety-related impairment in students. Thematic coding of interviews emphasized how teachers perceived 1) most student anxieties to be proportional responses to realistic threats and stress in students' lives (e.g. resource insecurity), 2) systems-level problems (e.g. pressure to perform on standardized tests) contribute to student anxiety, and 3) school-based anxiety sources often interact with traumas and stressors students experience outside of school (e.g. immigration experiences).

CONCLUSIONS

Relative to the predominant literature that has focused on biological, cognitive, and other intraindividual factors as sources of anxiety, the present work underscores the importance of considering how broader economic and systems-level influences exacerbate anxiety in marginalized youth.

COVID-19 stressful life events and mental health: Personality and coping styles as moderators

OBJECTIVE

To examine the role of COVID-19-specific stressful life events (SLE) in predicting depression, anxiety, and life satisfaction, and if personality traits (extraversion and neuroticism), and coping styles (problem-focused coping and avoidance coping) moderated these relations.

PARTICIPANTS

Data were collected from 371 college students (Mage = 20.59; SDage = 2.58) from one large university of the Mid-Atlantic region in the U.S.

METHODS

Participants completed an online survey measuring COVID-19 related stressful life events (adapted from a tool developed to measure stressful life events during the SARS pandemic; Costa et al., 2001; Main et al., 2011), personality (the Mini-Markers; Saucier, 1994), coping styles (by using a measure developed by Aldrige-Gerry et al., 2011), depression (PHQ-9; Kroenke et al., 2011), anxiety (GAD-7; Spitzer et al., 2006), and life satisfaction (Student's Life Satisfaction Scale, Huebner, 1996) between March 27th and April 27th, 2020.

RESULTS

Path analysis results showed that extraversion and avoidance coping style moderated the effects of SLE on depression and anxiety symptoms; neuroticism and avoidance coping style moderated the relation between SLE and life satisfaction. The moderation results also differed by gender.

CONCLUSIONS

These findings indicated that the COVID-19 pandemic had deleterious effects on college students' mental health, where extraversion emerged as a protective factor, while neuroticism and avoidance coping style were risk factors. These findings underscore the importance of paying special attention to college students' mental health needs and promoting appropriate coping strategies in the light of the current pandemic.

The effect of event impact on fear of missing out: the chain mediation effect of coping styles and anxiety

The fear of missing out is a generalized anxiety stemming from the possibility of not being present at new events or advantageous situations of others. To explore potential mechanisms, a survey measuring the impact of event, coping style, anxiety, and fear of missing out was conducted with 1,014 college students (367 males and 647 females, aged 19-24 years). In addition, the study delved deeper into the dimensions of intrusion, avoidance, and hyperarousal concerning the impact of event, examining their roles in coping style, anxiety, and fear of missing out. Results showed that: (1) The impact of event could predict the fear of missing out positively. (2) A more positive coping style is negatively associated with anxiety. (3) A chain mediation effect of coping style and anxiety is observed in the path from hyperarousal and avoidance to the fear of missing out. (4) In contrast to the hyperarousal or avoidance, the path from intrusion to the fear of missing out is mediated by anxiety but not coping style. These findings motivate us to implement different intervention tactics for varying impacts of events.

Adolescent coping and social media use moderated anxiety change during the COVID-19 pandemic

INTRODUCTION

Adolescence is a sensitive period during which stressors and social disruptions uniquely contribute to anxiety symptoms. Adolescent's coping strategies (i.e., avoidance and approach) during the coronavirus disease 2019 (COVID-19) pandemic may be differentially related to anxiety symptom changes. Further, social media use (SMU) is ubiquitous and may serve as an avenue to deploy avoidant and/or approach coping.

METHOD

Participants included 265 adolescents (ages 12-20 years; 55.8% female, 43.8% male) and one parent per adolescent. At two time points separated by ~6 months, adolescents reported on SMU and coping strategies, and parents and adolescents reported demographic information and adolescents' anxiety symptoms. Data were collected online in the United States, from summer 2020 through spring 2021.

RESULTS

Increases in avoidant coping predicted increasing anxiety, particularly when approach coping decreased. Decreases in both avoidant coping and SMU coincided with decreasing anxiety. Older adolescents showed decreasing anxiety when avoidant coping declined and SMU increased.

CONCLUSION

Coping strategies and SMU predicted patterns of adolescent anxiety symptom change across 6 months during the COVID-19 pandemic. Results highlight that coping and SMU should be contextualized within the time course of stressors.

Young people's happiness in the context of negative life events and coping strategies: a latent profile and latent class analysis

Young people have to cope with many negative life events and stress factors to maintain their happiness. Although there are studies on how they benefit from different coping strategies and their results, there is no study that profiles/groups young people according to negative life events and coping styles. From this point of view, the study aims to determine different life events classes and stress coping profiles in young people, and to examine the differences in happiness among the new groups created according to the discovered classes and profiles. Participants consisted of 1093 young people (M = 21.08) from different state universities in Turkey. Latent profile analysis (LPA) was conducted, resulting in a 3 profile solution characterizing coping strategies: Positive-oriented (26.8%), slightly positive-oriented (50%), and negative-oriented (23.2%) coping strategy profiles. Latent class analysis (LCA) was conducted, resulting in a 2 class solution characterizing negative life events: More negative (40.1%) and less negative (59.9%) life events classes. For the purpose of the study, the profiles created with the latent profile analysis and the latent class analysis were considered together and the participants were divided into 6 groups. These groups differed significantly in terms of happiness. The group with the highest level of happiness is the group with positive-oriented coping strategies and less negative life conditions (μ = 4.35, p < .001), and the group with the lowest level of happiness is the group with negative-oriented coping strategies and more negative life conditions (μ = 3.48, p < .001). However, the findings indicated that a positive-oriented coping strategy profile (the profile that scored high on positive coping strategies and low on negative coping strategies) offers the most promising route to happiness whether experienced negative life events are less or more.

Family and Parent Correlates to Anxiety in a National Sample of 12 to 17 Year Olds

Anxiety is a common mental health issue among adolescents. Family is one influence on adolescent anxiety that warrants attention. We investigated the relationship between adolescent anxiety, demographic, and familial and parental factors using data from the 2017 National Child Health Survey. We found an estimated one adolescent in seven reported anxiety, and nearly one in five reported anxiety related to witnessing family violence. Our study's findings may aid in the creation of family level programs aimed at preventing and reducing anxiety among adolescents.

Self-reported mental health symptoms, quality of life and coping strategies in French health sciences students during the early stage of the COVID-19 pandemic: An online survey

Introduction

Health sciences students usually report high rates of mental health problems. The COVID-19 pandemic context may have serious psychological impacts in this at-risk population. We aimed to assess the self-reported mental health status, health-related quality of life and coping strategies of health sciences students during the early stage of the pandemic.

Method

An online 128-item questionnaire sent to 17,673 health sciences students from the Claude Bernard University Lyon 1 in April 2020 assessed: a) sociodemographic characteristics, b) conditions of lockdown, c) depressive (Beck Depression Inventory- Short Form, BDI-SF), anxiety (State-Trait Anxiety Inventory-A, STAI-A) and traumatic symptoms (Impact of Event Scale -Revised, IES-R), d) health-related quality of life (SF12) and e) coping strategies (Brief Coping Orientation to Problems Experienced, Brief COPE).

Results

The participation rate was 9.9% (n = 1,765). A total of 19.5% of participants reported an IES-R > 33, 11.6% depressive symptoms, 58.1% anxiety symptoms, and 4.4% suicidal ideation. Their mental health-related quality of life was significantly poorer than for physical health. Female gender, COVID-like symptoms, social isolation due to the lockdown, pandemic-related financial restraint and exams-related stress were significantly associated with poorer self-reported mental health conditions. Volunteering in the healthcare system was significantly associated with lower mental health scores. Coping strategies were mostly oriented toward avoidance and positive appraisal.

Conclusion

French health sciences students exhibited high levels of self-reported mental health problems and a poor mental health-related quality of life during the early stage of the COVID-19 pandemic. Specific risk factors related to the pandemic partly explain the observed prevalence.

Negative Life Events as Predictors of Anxiety Outcomes: An Examination of Event Type

Long-term follow-up studies of anxiety treatment have found that greater exposure to negative life events (NLEs) predicts poorer anxiety outcomes, but none have examined whether specific types of NLEs are differentially associated with child outcomes. This study examined the frequency of NLEs and whether specific types of NLEs were associated with increased risk of having an anxiety disorder 6.5 years post randomization. Participants were 319 adolescents and adults, ages 11 to 26 (M = 17), enrolled in Child/Adolescent Anxiety Multimodal Extended Long-term Study. At their first follow-up visit, participants completed a diagnostic interview and a 40-item Life Events Scale that reflected whether specific events occurred since their last post treatment assessment. Life events were categorized into domains (i.e., family, academic, health, and social) via researcher consensus. Participants reported having experienced an average of four NLEs. Participants with an anxiety disorder at follow-up were significantly more likely to have failed a grade in school (OR = 5.9) and experienced a negative change in acceptance by peers (OR = 4.9; ps < 0.001). After controlling for gender, age, race, and SES, a greater number of NLEs in the academic domain increased the odds of having an anxiety disorder at follow-up (OR = 2.4, p < 0.001). No other domains were predictive of disorder status at follow-up. Findings highlight the value of examining specific NLEs in relation to the long-term child anxiety outcomes.

Interaction Effects of Life Events and Hair Cortisol on Perceived Stress, Anxiety, and Depressive Symptoms Among Chinese Adolescents: Testing the Differential Susceptibility and Diathesis-Stress Models

The differential susceptibility model and the diathesis-stress model on the interaction effect between the individuals’ traits and environmental factors will be conducive to understand in depth whether the psychophysiological traits are the risk factors of child development. However, there is no study focusing on the activity of the hypothalamic-pituitary-adrenal (HPA) axis. We examined whether the HPA activity serves as a physiological marker of the differential susceptibility model or the diathesis-stress model by exploring the interactive effect of life events and hair cortisol on perceived stress, anxiety, and depressive symptoms among Chinese adolescents. The participants were 324 students in senior high school. They reported their psychological states with questionnaires in their first semester after a 3-month adaptation period; 2 weeks later, they provided 1-cm hair segments closest to the scalp. We measured hair cortisol concentration as a biomarker of HPA activity using high-performance liquid chromatography–tandem mass spectrometry. There was a significant interaction effect of academic events and hair cortisol on adolescents’ perceived stress, anxiety, and depression symptoms. We also observed a significant interaction between interpersonal events and hair cortisol on adolescents’ anxiety symptoms. Looking at the region of significance, proportion of interaction index, and proportion affected index, we found that adolescents with higher cortisol levels had a tendency to experience higher perceived stress and anxiety symptoms when they had high academic events scores, but lower perceived stress and anxiety symptoms when they had lower academic events scores. By contrast, adolescents with higher cortisol levels had a greater risk of experiencing high depressive symptoms only when they had higher academic events scores. Adolescents with higher cortisol levels also tended to have lower anxiety symptoms when they had higher interpersonal events scores, but greater anxiety symptoms when they had lower interpersonal events scores. These results suggested that HPA activity might serve as a biomarker of the differential susceptibility model for perceived stress and anxiety symptoms, while for depressive symptoms, it might serve as a marker of the diathesis-stress model.

The effects of childhood maltreatment and anxiety proneness on neuropsychological test performance in non-clinical older adolescents

BACKGROUND

The effect of childhood maltreatment (CM) on neuropsychological performance is well established, but the effect of anxiety proneness (AP) on such performance has been underexplored. We assessed the predictive ability of CM and AP, and their interaction, in non-clinical adolescents, for a range of previously documented neuropsychological deficits.

METHODS

Multiple linear regression models were used to assess the unique and combined influences of CM and AP on neuropsychological performance in 104 non-clinical adolescents, who underwent both neuropsychiatric and neuropsychological assessment.

RESULTS

The interaction of CM and AP was associated with poorer performance in executive functioning skills, processing speed, and estimated IQ. CM and AP were uniquely associated with verbal working memory performance, while verbal and visual memory performance and learning, and visuo-spatial ability, were not associated with either CM, AP or the interaction of CM and AP.

LIMITATIONS

The use of self-report measures to determine participants' levels of CM, AP, and depression. The CTQ-SF, a retrospective self-report measure, may have introduced recall bias. The neuropsychological evaluation was not conducted in the Xhosa language, the first language of most African participants. Most instruments utilized have not been validated in a South African adolescent sample. The impact of important moderator variables (e.g., age of onset of maltreatment) was not assessed.

CONCLUSIONS

Increased levels of CM and AP may be risk markers for poor performance in several key neuropsychological domains. Our findings underscore the importance of assessing the impact of both CM and anxiety-related temperamental traits on neuropsychological performance.

"I think that's all a lie…I think It's genocide": Applying a Critical Race Praxis to Youth Perceptions of Flint Water Contamination

Background

In April 2014, the emergency manager of Flint, Michigan switched the city's water supplier from Detroit's water department to the Flint River. The change in water source resulted in the Flint Water Crisis (FWC) in which lead (Pb) from the city's network of old pipes leached into residents' tap water. Residents of Flint reported concerns about the water to officials; however, the concerns were ignored for more than a year.

Objective

This study sought to understand how Black youth in Flint conceptualize, interpret, and respond to racism they perceive as part of the normal bureaucracy contributing to the FWC.

Methods

In 2016, we conducted four community forums with Flint youth aged 13 to 17 years. Sixty-eight youth participated with 93% self-identifying as Black. Participants completed a brief survey. We audio-recorded the forums and transcribed them verbatim. Critical Race Theory (CRT) guided the development of the interview protocol and Public Health Critical Race Praxis (PHCRP) served as an interpretive framework during qualitative data analysis. Content analyses were completed using software.

Results

Many youth viewed the FWC through a racially conscious frame. They described Flint as a Black city where historical and contemporary forms of racial stratification persist. Some described the contamination of the city's water as a form of genocide targeting Blacks.

Conclusions

The findings from this exploratory study suggest some Black youth in Flint have difficulty coping with the FWC. Those who perceive it through a racial frame attribute the crisis to racism. They feel distressed about this and other traumas (eg, failure to address high rates of crime) they perceived as racism-related. Future research should examine the implications for specific mental health outcomes among youth.

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research. (PsycINFO Database Record

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

Moderating Effects of Gender on Outcomes Associated with Stressful Life Events Among Elementary School-Age Youth

Stressful life events have been associated with child and adolescent maladjustment, including elevated levels of aggression and anxiety (Attar et al. in J Clin Child Psychol 23:391-400, 1994; Fox et al. in J Adolesc 33:43-54, 2010). However, gender specific outcomes associated with stressful life events among elementary school-age youth are less known. Accordingly, the current study examined the role of gender in the associations between stressful life events and anxiety and proactive and reactive aggression. Participants included 294 elementary school-age children (M = 8.71, SD = 1.17, 50.7 % male). Regression analyses indicated that stressful life events were positively associated with anxiety and reactive, but not proactive, aggression. There were no gender differences with regard to the associations with anxiety symptoms or proactive aggression. However, gender moderated the association between stressful life events and reactive aggression, such that stressful life events were only positively associated with reactive aggression for boys. Future directions and implications of this research are presented.

The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children

The aim of this study was to explore the change and associated risk and protective factors of social anxiety symptoms among Chinese children. A 2-year longitudinal study was performed in a general primary and secondary school population in Anhui Province, China including 816 children in grades 3, 4, and 7. Children's social anxiety symptoms were assessed using the Social Anxiety Scales for Children (SASC) at three assessments. The overall prevalence of children's elevated social anxiety symptoms ranged from 15.2% to 16.4% across three assessments. Children's overall mean SASC scores were 5.6 (SD =3.7), 5.3 (SD =3.8), and 5.3 (SD =4.1) at three assessments, respectively, but the difference was not statistically significant. However, children's social anxiety symptom levels and change among different subgroups was not stable across 2-year follow-up. Multivariable logistic regression analysis indicated that age, severe family dysfunction, quality of life, positive coping, negative coping, depressive symptoms and self-esteem were predictive factors for childhood elevated social anxiety symptoms. The findings suggested that the overall social anxiety symptoms showed a relatively stable pattern over time. The identified risk and protective factors may provide scientific evidence for school, family, and health authorities to conduct necessary intervention.

Testing direct and moderating effects of coping styles on the relationship between perceived stress and antenatal anxiety symptoms

OBJECTIVE

The objective of this study was to test the direct and moderating effects of different coping styles in mitigating perceived stress associated with antenatal anxiety symptoms among 755 pregnant women in Chengdu.

METHODS

A cross-sectional study using a questionnaire survey was carried out. The Perceived Stress Scale, the Trait Coping Style Questionnaire and the Zung Self-rating Anxiety Scale were used to measure stress, coping and anxiety symptoms, respectively. Hierarchical regression analysis was used to test the direct and moderating effects of coping styles in the relationship between perceived stress and antenatal anxiety symptoms.

RESULTS

Direct effects of negative coping (NC) styles were found. Women with higher NC scores were more likely to have anxiety symptoms. Positive coping (PC) styles had moderating effects on perceived stress, whereas NC styles did not.

CONCLUSION

The findings of this study highlight the direct and moderating effects of coping styles. This knowledge is important to healthcare professionals in planning health service provision. Health services should dedicate resources to teaching pregnant women how to enhance PC styles, alter NC styles and cultivate optimistic thinking to alleviate anxiety symptoms.

Coping Mediates the Association Between Gender and Depressive Symptomatology in Adolescence

Previous studies have found evidence for gender and racial/ethnic differences in depressive symptoms in adolescence; however, the mechanisms driving this relationship are poorly understood. The goal of this study was to examine the role of individual differences in dispositional coping in the relationships between gender and depressive symptomatology, and race/ethnicity and depressive symptomatology. Surveys were administered to 905 15-17 year old adolescents (mean age 16.10, SD = .67; 54% girls, n = 485) in the spring of 2007, 2008, and 2009. Girls reported more depressive symptomatology than boys and endorsed a greater disposition for the following coping strategies in comparison to boys: emotional social support, instrumental social support, and venting emotions. When race/ethnicity was examined, African-American adolescents reported a greater tendency toward using religious coping than Caucasian and Hispanic adolescents. Dispositional coping preferences also were found to mediate the relationships between gender and depressive symptomatology. These findings indicated that a preference for venting emotions may be particularly problematic when endorsed by girls, whereas instrumental social support may be particularly helpful for girls.

Adolescent coping profiles differentiate reports of depression and anxiety symptoms

The purpose of the study was to identify groups of adolescents based on their reported use of different coping strategies and compare levels of depression and anxiety symptoms across the groups. Tenth and eleventh grade public school students (N=982; 51% girls; 66% Caucasian; M age=16.04, SD=0.73) completed a battery of self-report measures that assessed their use of different coping strategies, depressive symptoms, and anxiety symptoms. Latent profile analysis (LPA) classified the participants into four distinct groups based on their responses on subscales of the COPE inventory (Carver et al., 1989). Groups differed in amount of coping with participants in each group showing relative preference for engaging in certain strategies over others. Disengaged copers reported the lowest amounts of coping with a preference for avoidance strategies. Independent copers reported moderate levels of coping with relatively less use of support-seeking. Social support-seeking copers and active copers reported the highest levels of coping with a particular preference for support-seeking strategies. The independent copers reported the lowest levels of depressive symptoms compared to the three other groups. The Social Support Seeking and Active Coping Groups reported the highest levels of anxiety. Although distinct coping profiles were observed, findings showed that adolescents between the ages of 14 and 16 engage in multiple coping strategies and are more likely to vary in their amount of coping than in their use of specific strategies.

The roles of social support in helping chinese women with antenatal depressive and anxiety symptoms cope with perceived stress

A community-based sample of 755 pregnant Chinese women were recruited to test the direct and moderating effects of social support in mitigating perceived stress associated with antenatal depressive or anxiety symptoms. The Social Support Rating Scale, the Perceived Stress Scale, the Edinburgh Depressive Postnatal Scale and the Zung Self-Rating Anxiety Scale were used. Social support was found to have direct effects and moderating effects on the women's perceived stress on antenatal depressive and anxiety symptoms in multiple linear regression models. This knowledge of the separate effects of social support on behavioral health is important to psychiatric nurse in planning preventive interventions.

Negative life events and migraine: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data

Background

Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

Methods

ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity.

Results

We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19 – 1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47 – 1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25 – 1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09 – 1.75) in full-adjusted model.

Conclusions

The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.

Why are anxiety and depressive symptoms comorbid in youth? A multi-wave, longitudinal examination of competing etiological models

BACKGROUND

The present study sought to clarify the development of comorbid emotional distress by comparing different explanations for how youth develop anxiety and depressive symptoms. Specifically, we introduced the diathesis-anxiety approach (whether cognitive vulnerabilities interact with anxiety symptoms), and compared it to a causal model (anxiety symptoms predicting depressive symptoms), and a correlated liabilities model (whether cognitive vulnerabilities interacted with stressors to predict both anxiety and depressive symptoms) to examine which model best explained the relation between depressive and anxiety symptoms in youth.

METHODS

678 3rd (n=208), 6th (n=245), and 9th (n=225) grade girls (n=380) and boys (n=298) completed self-report measures at baseline assessing cognitive vulnerabilities (rumination and self-criticism), stressors, depressive and anxiety symptoms. Every 3 months over the next 18 months, youth completed follow-up measures of symptoms and stressors.

RESULTS

While limited support was found for a causal (p>0.10) or correlated-liability model (p>0.05) for comorbidity, findings did support a diathesis-anxiety approach for both self-criticism (t(2494)=3.36, p<0.001) and rumination (t(2505)=2.40, p<0.05).

LIMITATIONS

The present study׳s findings are based on self-report measure and makes inferences concerning comorbidity with a community sample.

CONCLUSIONS

These results may help clarify past research concerning comorbidity by introducing a diathesis-anxiety approach as a viable model to understand which youth are most at-risk for developing comorbid emotional distress.

Perceived social support mediates anxiety and depressive symptom changes following primary care intervention

BACKGROUND

The current study tested whether perceived social support serves as a mediator of anxiety and depressive symptom change following evidence-based anxiety treatment in the primary care setting. Gender, age, and race were tested as moderators.

METHODS

Data were obtained from 1004 adult patients (age M = 43, SD = 13; 71% female; 56% White, 20% Hispanic, 12% Black) who participated in a randomized effectiveness trial (coordinated anxiety learning and management [CALM] study) comparing evidence-based intervention (cognitive-behavioral therapy and/or psychopharmacology) to usual care in the primary care setting. Patients were assessed with a battery of questionnaires at baseline, as well as at 6, 12, and 18 months following baseline. Measures utilized in the mediation analyses included the Abbreviated Medical Outcomes (MOS) Social Support Survey, the Brief Symptom Index (BSI)-Somatic and Anxiety subscales, and the Patient Health Questionnaire (PHQ-9).

RESULTS

There was a mediating effect over time of perceived social support on symptom change following treatment, with stronger effects for 18-month depression than anxiety. None of the mediating pathways were moderated by gender, age, or race.

CONCLUSIONS

Perceived social support may be central to anxiety and depressive symptom changes over time with evidence-based intervention in the primary care setting. These findings possibly have important implications for development of anxiety interventions.

Adverse life events and emotional and behavioural problems in adolescence: the role of coping and emotion regulation

We tested whether emotion regulation (cognitive reappraisal and expressive suppression) and coping (distraction, avoidance, support seeking and active coping) mediate or moderate the association between change in life stress (change in number of adverse life events) and change in adolescent problem behaviour. We used prospective and retrospective longitudinal data from a community sample. We measured change in problem behaviour as emotional and behavioural problems at Time 2 controlling for emotional and behavioural problems at Time 1, a year earlier. We measured change in life stress as life stress between Times 1 and 2, controlling for total previous life stress (before Time 1). Neither coping nor emotion regulation mediated the association between change in life stress and change in problem behaviour. Avoidance and expressive suppression were related to an increase in problem behaviour. Only cognitive reappraisal moderated the effect of increase in life stress on worsening of problem behaviour, suggesting that, as expected, cognitive reappraisal was a protective factor. In adolescents who reported they habitually reappraise, the association between change in life stress and change in emotional and behavioural problems was non-significant.

The role of gender and race in the relation between adolescent distress tolerance and externalizing and internalizing psychopathology

Distress tolerance (DT) is an established construct contributing to the onset and maintenance of psychopathology in adulthood; however, few studies have examined the role of DT in older adolescent psychopathology. Emerging data suggest that gender and race may influence this relation. Therefore, the current study examined the relation between gender, race, and DT on parent-reported internalizing and externalizing DSM-oriented symptoms among a community sample of 128, 14-18 year old adolescents. Results indicated a moderating effect of gender on affective problems, such that females with low DT, but not males, displayed significantly greater affective problems. Findings also indicated a significant moderating effect of race, such that Caucasians with low DT, but not African Americans, displayed significantly higher somatic, oppositional defiant, and conduct problems. These findings suggest that DT is an important clinical variable in older adolescence, particularly among Caucasians and females.

Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.