The influence of familial factors on anxiety and depression in childhood and early adolescence

Adolescence, Winter, 1997 by Kjell R. Nilzon, Kerstin Palmerus

Early adolescence is a period of transition involving changes in physical development, cognitive abilities, emotional adjustment, and self-esteem (Freud, 1958; Sullivan, 1953; Erikson, 1968). In addition, there are changes in family relationships, and these, along with family life events and family dynamics, have been found to play a significant role in the development of adjustment problems during this period. Relationships have been found between major life changes, daily hassles, and mood dysfunction (Delongis, Folkman, & Lazarus, 1988). Thus, it is not surprising that early adolescence may be the period when emotional problems, negative self-evaluations, and depression increase (Alsaker, Dundas, & Olweus, 1991; Rutter & Garmezy, 1983). Several studies indicate that depressive feelings become more prevalent in adolescence (Rutter, 1986; Knorring & Kristiansson, 1994). Assessments of depressive symptoms in normal populations of children and adolescents have revealed rates ranging from 5.2% (Lefkowitz & Tesiny, 1982) to 17.4% (Kashani & Simonds, 1979).

Research has focused on depression in children of parents with affective disorders (Downey & Coyne, 1990; Gottlib, 1982; Kowalik & Gottlib, 1987; Kahn, Coyne & Margolin, 1985). Much less work has examined other family factors, such as discord and dysfunctional family dynamics, in relation to depression and anxiety in children and adolescents. One common approach in investigations of psychosomatic disease and depression has been to focus on enmeshment, rigidity, conflict avoidance, and overcontrol in family interactions (Minuchin, 1984; Asarnow, 1987). The underlying processes involved in family functioning as it relates to life events (such as separation, divorce, and death of a close family member) are only beginning to be explored. Initially researchers focused on associations between the frequency of major life events and negative health outcomes (Holmes & Rahe, 1967). Yet, exposure to interparental conflict is a common source of stress for children and has been shown to be predictive of problems in emotional adjustment during adolescence. Other major life events, such as death of a loved one and sickness have also been found to be potent factors in child stress (Holmes & Rahe, 1967; Kanner, Coyne, Schefer, & Lazarus, 1981).

Other family antecedents of depression in children, according to the theory of learned helplessness (Seligman, 1975), include a hard work load and restrictive parental methods of conflict resolution, which increase the risk of anxious reactions. Daily stressors have been found to affect youngsters' mood (DeLongis, Folkman, & Lazarus, 1988). Further, daily hassles correlate with life events, because life events influence the pattern of daily hassles (Kanner et al., 1981). Monroe (1983), however, argues that daily hassles are independent predictors of stress and anxiety.

Some studies have found only moderate correlations between parental variables and depressive tendencies in early adolescents (Alsaker et al., 1991). Other research, however, has shown that the level of depressive tendencies in preadolescents is significantly associated with problems in parent-child interactions (Armsden & Grennberg, 1987).

Adolescents raised in an environment of conflict and rejection will generally be more vulnerable to feelings of depression. This points to the importance of studying and treating depression in the context of adolescent-parent relations (Kashani et al., 1981). Kashani and colleagues have suggested that more emphasis should be placed on factors related to family interaction.

The aim of this study was to determine the influence of family factors on the onset and maintenance of depression and anxiety in children and early adolescents. On the basis of previous findings, the first hypothesis was that depressive tendencies in children and young adolescents will be associated with less positive relationships between parents, major life events, and patterns of strict control and lack of monitoring. The hypothesis that positive relationships between parents, as well as between parents and children, may have a protective effect with respect to anxiety, as opposed to family disharmony leading to depression in adolescents, should ideally be tested in a longitudinal study. Two long-term studies have addressed the issue of family relationships in the prediction of depressive symptematology (Lefkowitz & Tesiny, 1982; Alsaker, Dundas, & Olweus, 1991), but neither examined the combined impact of parent symptomatology, life events, and family dynamics on the lives of depressed children and adolescents. It was also hypothesized that there will be a higher degree of anxious symptoms in children and adolescents from families that are less adaptive to change and less capable of solving conflicts.

METHOD

Subjects

Thirty-two children and their parents took part in the study. Participants included 16 early adolescents (11 males and 5 females, 12-14 years old) from a group of 23 (12 males and 11 females, 9-11 years old) who fulfilled the criteria for childhood depression in 1991 and were still depressed according to Child Depression Inventory (CDI) self-ratings three years later. All sixteen had received treatment for depression. They came from six schools in three different cities in Sweden,and were matched for age, sex, and school with a nondepressed comparison sample.