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Internalizing Symptoms in Adolescence: Familial Aggregation and Other Psychosocial Factors

Ranøyen, Ingunn
Doctoral thesis
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URI
http://hdl.handle.net/11250/284982
Date
2015
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  • Regionalt kunnskapssenter for barn og unge - Psykisk helse og barnevern [338]
Abstract
In this thesis, several psychosocial factors associated with internalizing symptoms in

adolescence were addressed, with a focus on familial aggregation. Having a parent with mental

health problems is one of the most important risk factors for developing psychiatric symptoms,

but existing research is limited by the fact that paternal mental health seldom has been

examined. In addition, the development and maintenance of internalizing symptoms may rely on

individual characteristics of the child, peer factors, socioeconomic status, and other psychosocial

factors. Psychosocial correlates can have important implications for both prevention and

treatment of internalizing symptoms because such variables can often be modified, in contrast to

biological correlates, and may also serve to increase identification of symptoms. Previous

research indicates that especially social anxiety is understudied and not easily recognized by

adults, even mental health professionals working with youth.

The main objectives in this thesis were to examine several psychosocial correlates of

internalizing symptoms. In study 1, associations between several mental health symptoms in

both parents and internalizing symptoms in adolescent offspring were investigated. In addition,

we examined whether parental and offspring sex moderated these associations. In study 2, the

associations between recurrent internalizing symptoms in parents over a ten-year time span

and internalizing symptoms in adolescent offspring were examined. In addition, we investigated

whether associations between parental and offspring internalizing symptoms were mediated by

offspring self-esteem and moderated by physical activity. In study 3, we focused solely on

internalizing symptoms related to social anxiety and their correlates.

All three studies were based on data from the adolescent portion of The Nord-Trøndelag

Health Study (Young-HUNT3). The sample in studies 1 and 2 consisted of 5732 adolescents in

Young-HUNT3 (ages 13-18) who had one (N=2503) or both parents (N=3229) participating in

the adult HUNT3. In study 2, the sample moreover included data from those parents who also

participated in the adult HUNT2 when offspring were of a preschool age. This constituted 3198 of the mothers (78%) and 2488 of the fathers (77%). In study 3, the study sample consisted of

7669 adolescents from Young-HUNT3, in addition to comparable data from a clinical sample

consisting of 694 participants (ages 13-18) in The Health Survey in the Department of Child and

Adolescent Psychiatry, St. Olav’s University Hospital in Sør-Trøndelag, Norway (the CAP Survey).

All participants responded to questionnaires reporting on their own mental health.

The findings showed that parental symptoms of anxiety and depression, but not alcohol

abuse and eating problems, were associated with low subjective well-being, low self-esteem, and

more symptoms of depression, general anxiety, and social anxiety in adolescent offspring. None

of the associations were dependent on parental or offspring sex, suggesting that internalizing

symptoms in fathers and mothers were equally important for offspring symptoms. Parental

symptoms of anxiety and depression when offspring were of a preschool age were associated

with such symptoms in offspring ten years later, but these associations were fully mediated by

current parental symptoms. These findings suggest that the children of parents with

internalizing symptoms are at a sustained risk for such symptoms themselves due to the

apparent 10-year stability of both maternal and paternal symptoms. The associations between

parental and adolescent internalizing symptoms were partly mediated by low adolescent selfesteem,

which may be an important precursor of symptoms and amenable to interventions.

Adolescent physical activity moderated the association between maternal and offspring

internalizing symptoms, and may reduce familial aggregation of such symptoms. This suggests

encouraging physical activity in the offspring of parents with such symptoms could be useful.

Social anxiety symptoms were frequently reported by adolescents, and the most prominent

correlates were academic school problems, bullying, eating problems, and acne problems. These

correlates may be easier to detect than social anxiety symptoms, and prevention programs

targeting these factors may also be useful for reducing such symptoms. Based on the combined

findings, routine screening of a broad range of problems among children, adolescents, and

parents may be vital to reduce the burden of internalizing problems in adolescence.
Has parts
Paper 1: Ranøyen, Ingunn; Kløckner, Christian; Wallander, Jan Lance; Jozefiak, Thomas. Associations between internalizing problems in adolescent daughters versus sons and mental health problems in mothers versus fathers (The HUNT Study). Journal of Child and Family Studies 2014 Is not included due to copyright. Available at : http://dx.doi.org/10.1007/s10826-014-0001-x

Paper 2: Ranøyen, Ingunn; Stenseng, Frode; Kløckner, Christian; Wallander, Jan Lance; Jozefiak, Thomas. Familial aggregation of anxiety and depression in the community: the role of adolescents’ self-esteem and physical activity level (the HUNT Study). BMC Public Health 2015 ;Volum 15. http://dx.doi.org/10.1186/s12889-015-1431-0 © 2015 Ranøyen et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

Paper 3: Ranøyen, Ingunn; Jozefiak, Thomas; Wallander, Jan Lance; Lydersen, Stian; Indredavik, Marit Sæbø. Self-reported social anxiety symptoms and correlates in a clinical (CAP) and a community (Young-HUNT) adolescent sample. Social Psychiatry and Psychiatric Epidemiology 2014 ;Volum 49.(12) s. 1937-1949 - Is not included due to copyright. Available at : http://dx.doi.org/10.1007/s00127-014-0888-y
Publisher
NTNU
Series
Doctoral thesis at NTNU;2015:90

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