Internalizing Symptoms in Adolescence: Familial Aggregation and Other Psychosocial Factors
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-xPaper 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