Oldehinkel, A.J.

Puzzling Findings in Studying the Outcome of "Real World" Adolescent Mental Health Services: The TRAILS Study (Article)

2012-09-19T00:00:00Z

Background: The increased use and costs of specialist child and adolescent mental health services (MHS) urge us to assess the effectiveness of these services. The aim of this paper is to compare the course of emotional and behavioural problems in adolescents with and without MHS use in a naturalistic setting. Method and Findings: Participants are 2230 (pre)adolescents that enrolled in a prospective cohort study, the TRacking Adolescents' Individual Lives Survey (TRAILS). Response rate was 76%, mean age at baseline 11.09 (SD 0.56), 50.8% girls. We used data from the first three assessment waves, covering a six year period. Multiple linear regression analysis, propensity score matching, and data validation were used to compare the course of emotional and behavioural problems of adolescents with and without MHS use. The association between MHS and follow-up problem score (β 0.20, SE 0.03, p-value<0.001) was not confounded by baseline severity, markers of adolescent vulnerability or resilience nor stressful life events. The propensity score matching strategy revealed that follow-up problem scores of non-MHS-users decreased while the problem scores of MHS users remained high. When taking into account future MHS (non)use, it appeared that problem scores decreased with limited MHS use, albeit not as much as without any MHS use, and that problem scores with continuous MHS use remained high. Data validation showed that using a different outcome measure, multiple assessment waves and multiple imputation of missing values did not alter the results. A limitation of the study is that, although we know what type of MHS participants used, and during which period, we lack information on the duration of the treatment. Conclusions: The benefits of MHS are questionable. Replication studies should reveal whether a critical examination of everyday care is necessary or an artefact is responsible for these results.

Prenatal smoking exposure and the risk of behavioral problems and substance use in adolescence: The TRAILS study (Article)

2011-12-01T00:00:00Z

Aims: To study the prospective relationship between maternal smoking during pregnancy (MSP) and behavioral problems, heavy alcohol use, daily smoking, and ever use of cannabis in the offspring, and to assess the role of confounding and mediating factors in a systematic way. Methods: Population-based cohort study of 2,230 respondents, starting in 2001 when respondents were around the age of 11 years, and two follow-up measurements at intervals of about 2.5 years (response rates of 96.0 and 81.4%). Results: Almost one third of the respondents' mothers had smoked tobacco during pregnancy. These respondents were at an increased risk for all outcomes except internalizing problems (significant odds ratios ranged from 1.40 to 2.97). The successive models showed that the potential confounding factors reduced the strength of all relationships. In the full model, the strongest relationship was found for mothers who smoked more than 10 cigarettes a day during pregnancy and daily smoking in early adolescence (odds ratio: 1.56), but none of the relationships were statistically significant. Conclusions: MSP is a marker for future behavioral outcomes in the offspring, but reducing the prevalence of MSP is unlikely to make a meaningful contribution to the prevention of these problems in adolescents. Copyright

Generation of interpersonal stressful events: The role of poor social skills and early physical maturation in young adolescents-the trails study (Article)

2011-10-01T00:00:00Z

This study developed two specifications of the social skills deficit stress generation hypothesis: the "gender-incongruence" hypothesis to predict peer victimization and the "need for autonomy" hypothesis to predict conflict with authorities. These hypotheses were tested in a prospective large population cohort of 2,064 Dutch young adolescents. Social skills and pubertal timing were measured when the sample was about 11 years old, and stressful life events were measured 2.5 years later at follow-up. As predicted by the gender-incongruence hypothesis, poor assertion in boys and poor self-control in girls were associated with peer victimization. Consistent with the need for autonomy hypothesis, poor self-control was associated with conflict with authorities, in both boys and girls. Furthermore, early physical maturation exacerbated the effect of poor self-control on conflict with authorities for both genders. These specific associations provide more insights in the pathways that result in the experience of interpersonal stressors in young adolescents.

Pubertal status predicts back pain, overtiredness, and dizziness in american and dutch adolescents (Article)

2011-09-01T00:00:00Z

OBJECTIVE: Functional somatic symptoms, symptoms for which no organic pathologic basis can be found, are more prevalent in girls than in boys, and this difference tends to increase during adolescence. This might be explained, at least in part, by pubertal development. We hypothesized that pubertal maturation predicts the development of most functional somatic symptoms and that this especially is true for girls. METHOD: We used 2 longitudinal population-based studies to examine our hypotheses: the Longitudinal Study of Pain in Adolescents in Seattle (n = 1996 [49.7% girls]) and the Dutch Tracking Adolescents' Individual Lives Survey (n = 2230 [51.0% girls]). Two assessment waves of each study were used. American adolescents were younger than Dutch adolescents at the first (11.6 vs 13.6) and second (14.5 vs 16.2) assessment waves, but they were in about the same pubertal development stage. Functional somatic symptoms were measured by pain questions, the Symptom Checklist-90, and the Youth Self-report. The Pubertal Development Scale was used to assess pubertal development on a continuous scale in both cohorts. RESULTS: Ordinal logistic regression analyses revealed that American and Dutch adolescents at a later pubertal status at baseline were more likely (odds ratios ranged from 1.24 to 1.61) to report back pain, overtiredness, and dizziness but not stomach pain and headache 2 to 3 years later. Although these relationships were not equally strong for boys and girls, no significant gender differences were found. CONCLUSIONS: Pubertal status predicted the frequency of some, but not all, functional somatic symptoms at follow-up. Copyright

Self-assessed parental depressive problems are associated with blunted cortisol responses to a social stress test in daughters. The TRAILS Study (Article)

2011-07-01T00:00:00Z

Depression runs in families and is considered a stress-related disorder. Familial risk for depression may be transmitted via deregulated psychophysiological stress responses from parent to child. In this study, we examined the association between self-assessed lifetime parental depressive problems (PDP) and adolescent offspring' cortisol responses to a social stress test. Data were collected as part of the third assessment wave of TRAILS (TRacking Adolescents' Individual Lives Survey), a large prospective population study of Dutch adolescents. Data of 330 adolescents (mean age 16.04; 40.9% girls) who participated in a laboratory session, including a standardized performance-related social stress task (public speaking and mental arithmetic) were examined. Four saliva cortisol samples were collected before, during and after the social stress task which were analyzed with repeated measures Analysis of Variance. Lifetime parental depressive problems were assessed by self-reports from both biological parents. PDP was associated with daughter' cortisol responses (F(3,133) = 3.90, p= .02), but no association was found in sons (F(3,193) = 0.27, p= .78). Girls whose parents ever experienced depressive symptoms displayed a blunted cortisol response to the standardized social stress test, while girls whose parents never had such problems displayed the characteristic curvilinear response pattern. This effect was not mediated by offspring stress history (age 0-16). Analyses were corrected for smoking behaviour and adolescent depressed mood. The fact that PDP were measured by self-report questionnaires and did not reflect clinical DSM-IV diagnosis could be considered a limitation of the study.

Stressed out? Associations between perceived and physiological stress responses in adolescents: The TRAILS study (Article)

2011-04-01T00:00:00Z

Studies regarding the interrelation of perceived and physiological stress indices have shown diverging results. Using a population sample of adolescents (N=715, 50.9% girls, mean age 16.11 years, SD=0.59), we tested three hypotheses: (1) perceived responses during social stress covary with concurrent physiological stress responses; (2) high pretest levels of perceived stress predict large physiological responses; and (3) large physiological responses to social stress predict low posttest perceived stress levels. Perceived arousal, unpleasantness, and dominance were related to heart rate, respiratory sinus arrhythmia, and cortisol responses to a laboratory social stress test. Although effect sizes were small, the results suggest covariation of perceived stress and concurrent physiological stress responses in both the ANS and the HPA axis, as well as inverse associations between heart rate responsiveness and the subsequent appraisal of stress. Copyright

L-DRD4 genotype not associated with sensation seeking, gambling performance and startle reactivity in adolescents: The TRAILS study (Article)

2011-04-01T00:00:00Z

The purpose of the present study was to investigate whether a length polymorphism in the dopamine receptor D4 gene (DRD4) was associated with approach related traits in adolescents. Data were used from TRAILS (TRacking Adolescents' Individual Lives Survey), a population based cohort of Dutch adolescents. Sensation seeking, assessed with personality questionnaires from the participants themselves and their biological father and mother (n=1282) was not associated with DRD4 genotype. Gambling performance (n=591) and startle reactivity (n=432) were not associated with DRD4 genotype either. Explanations for the dissociation might be sought in differences in development of the limbic system and the prefrontal cortex, both with high dopamine receptor D4 densities and both involved in approach related behaviours.

No associations between single nucleotide polymorphisms in corticoid receptor genes and heart rate and cortisol responses to a standardized social stress test in adolescents: The TRAILS study (Article)

2011-03-01T00:00:00Z

Previously, sequence variation in the glucocorticoid (GR) and mineralocorticoid (MR) receptor genes (NR3C1 and NR3C2, respectively) have been found to be associated with physiological stress responses to social stress tests in small samples of adult men and oral contraceptives (OC) using women. Associations between single nucleotide polymorphisms (SNPs) in the GR (23EK-rs6190, 9beta-rs6198, BclI-rs4142324) and the MR gene (I180V-rs5522 and -2G/C (rs2070951) with cortisol and heart rate responses to a performance-related social stress task (public speaking and mental arithmetic) were examined in a large sample (n = 553) of adolescents (15-17 years). To make comparisons with previous findings, associations were tested in boys (n = 277), free-cycling (FC) girls (n = 183) and OC users (n = 93). None of the previously reported associations in adults could be replicated in this large adolescent sample. Explanations for non-replication are discussed.

Parental psychopathology and socioeconomic position predict adolescent offspring's mental health independently and do not interact: The TRAILS study (Article)

2011-01-01T00:00:00Z

Background Familial risk factors have been implicated in the development of mental health problems in adolescents. Whether the associations between parental loading, as assessed by lifetime psychopathology, and offspring internalising and externalising problems were moderated by family socioeconomic position (SEP) was investigated. Two hypotheses of moderation were tested: (1) the "social push" hypothesis in which parental loading effects are stronger in contexts with low environmental risks and (2) the "vulnerability" hypothesis in which parental loading effects are stronger in high-risk environments. Method In a population-based sample of 2149, familial loading and family SEP were assessed at baseline by parent reports. Offspring psychopathology was assessed by reports from multiple informants (parent, self and teachers). Multiple linear regression was used to assess the independent associations of parental loading and family SEP on offspring psychopathology and their potential interaction. Results Both family SEP and familial loading had significant independent main effects on offspring internalising and externalising problems. However, the interaction terms were not significant and did not add any explanatory power to the model. Conclusions Lower levels of family SEP appear not to confer additional risks for mental health problems in offspring of parents with high loading on psychopathology. During early adolescence, parental psychopathology and low family SEP seem independent risk factors for offspring mental health problems. Results do not support either the social push or vulnerability hypothesis as no evidence of interactions between parental loading and family SEP were found.

Reduced cardiac autonomic flexibility associated with medically unexplained somatic complaints in the context of internalizing symptoms in a preadolescent population sample: The TRAILS study (Letter To Editor)

2010-12-01T00:00:00Z

Reduced autonomic flexibility as a predictor for future anxiety in girls from the general population: The TRAILS study (Article)

2010-09-01T00:00:00Z

The present study investigated whether autonomic flexibility predicted future anxiety levels in adolescent boys and girls. This study is part of the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective cohort study of Dutch adolescents. The current study included a subsample of 965 individuals. Measures of autonomic flexibility, i.e., heart rate (HR) and respiratory sinus arrhythmia (RSA), were determined during the first assessment wave (T1: participants 10–12 years old). Self-reported anxiety was assessed at the first and second assessment wave (T2: participants 12–14 years old). Possible gender differences and cooccurring depressive problems were examined. In girls, low RSA predicted anxiety levels 2 years later. In boys, no associations between HR and RSA and future anxiety were found. We conclude that in adolescent girls from the general population, signs of reduced autonomic flexibility (i.e., low RSA) predict future anxiety levels. Since the effect size was small, at this point, RSA reactivity alone cannot be used to identify individuals at risk for anxiety, but should be regarded as one factor within a large group of risk factors. However, if the present findings are replicated in clinical studies, intervention programmes – in the future – aimed at normalising autonomic functioning may be helpful.

Reproducibility of heart rate variability and baroreflex sensitivity measurements in children (Article)

2010-09-01T00:00:00Z

Despite their extensive use, the reproducibility of cardiac autonomic measurements in children is not well-known. We investigated the reproducibility of short-term continuous measurements of heart rate (HR), heart rate variability (HRV, time and frequency domain), and spontaneous baroreflex sensitivity (BRS, frequency domain) in the supine and standing position in 57 children (11.2 ± 0.7 years, 52.6% boys). Reproducibility between two sessions within a two-week interval was evaluated by intraclass correlation coefficients (ICCs), standard error of measurement, coefficients of variation (CVs), limits of agreement, and Bland-Altman plots. HR and HRV were moderately-to-highly (ICC = 63-79; CV = 5.7%-9.7%) and BRS moderately (ICC = 49-63; CV = 11.4%-14.0%) reproducible. While the BRS measurements were slightly less reproducible than the HR and HRV measurements, all can be reliably applied in research, thus implicating sufficient capacity to detect real differences between children. Still, clinical studies focusing on individual changes in cardiac autonomic functioning need to address the considerable random variations that may occur between test-retest measurements.

Cognitive ability, parental socioeconomic position and internalising and externalising problems in adolescence: Findings from two European cohort studies (Article)

2010-08-01T00:00:00Z

We investigated whether cognitive ability (CA) may be a moderator of the relationship of parental socioeconomic position (SEP) with internalising and externalising problems in adolescents. We used data from two longitudinal cohort studies; the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Tracking Adolescents' Individual Lives Survey (TRAILS). Indicators of SEP were mother's education and household income. CA was estimated with IQ scores, derived from the Wechsler Intelligence Scale for Children. Internalising and externalising problems were measured with the Strengths and Difficulties Questionnaire in ALSPAC and with the Child Behavior Checklist in TRAILS. Logistic regression analyses were used to estimate the relative index of inequality (RII) for each outcome; the RII provides the odds ratio comparing the most to least deprived for each measure of SEP. In fully adjusted models an association of mother's education with externalising problems was observed [ALSPAC RII 1.42 (95%CI: 1.01-1.99); TRAILS RII 2.21 (95%CI: 1.37-3.54)], and of household income with internalising and externalising problems [pooled ALSPAC & TRAILS internalising RII 1.30 (95%CI: 0.99-1.71); pooled ALSPAC & TRAILS externalising RII 1.38 (95%CI: 1.03-1.84)]. No consistent associations were observed between mother's education and internalising problems. Results of stratified analyses and interaction-terms showed no evidence that CA moderated the association of SEP with internalising or externalising problems.

Peer Stressors and Gender Differences in Adolescents' Mental Health: The TRAILS Study (Article)

2010-05-01T00:00:00Z

Purpose: This study tested two hypotheses about gender-specific mental health effects of peer stressors during early adolescence: (1) boys and girls are sensitive to different types of peer stressors, and (2) peer stress is associated with different mental health problems in boys and girls. Methods: These two hypotheses were tested in a prospective large population cohort of 2,084 Dutch young adolescents. Internalizing and externalizing problems were measured at baseline and follow-up, whereas stressful life events in the period between baseline and follow-up were measured retrospectively at follow-up. We performed the analyses with two types of peer stressors; victimization at school and relationship losses. Results: Relationship losses were more strongly associated with internalizing and externalizing problems in girls than boys, supporting the first hypothesis. Peer victimization at school was also associated with both types of mental health problems, but equally strong in boys and girls. Conclusions: Peer stress is unlikely to be associated with different mental health problems in boys and girls. Instead, boys and girls are more likely to be susceptible to different types of peer stressors.

Non-right-handedness and mental health problems among adolescents from the general population: The trails study (Article)

2010-05-01T00:00:00Z

To determine whether the association between non-right-handedness and mental problems among adolescents is specific for psychotic symptoms, we included a group of 2096 adolescents with a mean age of 14 years from the general population. Mental health problems were assessed using the parent, self-report, and teacher versions of the Child Behavior Checklist. Internalising problems comprised anxious and depressed, withdrawn and depressed, and somatic complaints. Externalising problems consisted of delinquent behaviour and aggressive behaviour. The remaining problems consisted of social problems, attention problems, and thought problems. The latter were divided into psychotic and non-psychotic items. A total of 14.3% of the adolescents were non-right-handed. We observed positive associations of non-right-handedness with thought problems, social problems, and being withdrawn and depressed. Externalising problems showed no associations with handedness. Within the thought problems subscale, the effect sizes associated with non-right-handedness for psychotic and non-psychotic items were 0.18 (p.005) and 0.04 (p.459), respectively. In conclusion, non-right-handedness is predominantly associated with psychosis-related mental problems as early as in adolescence. Handedness could be taken into account when identifying adolescents at risk for psychosis.

Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: The TRAILS study (Article)

2010-03-01T00:00:00Z

Background: It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related to FSS. We hypothesized that anxiety contributes to the development of FSS and that depression is a consequence of FSS. Methods: FSS, anxiety, and depression were measured in adolescents (N = 2230, 51% women) by subscales of the Youth Self-Report during three assessment waves (adolescents successively aged: 10-12, 12-14, and 14-17) and by corresponding subscales of the Child Behavior Checklist. Using structural equation models, we combined trait and state models of FSS with those of anxiety and depression, respectively. We identified which relationships (contemporaneous and two-year lagged) significantly connected the states of FSS with the states of anxiety and depression. Results: Trait variables were all highly interrelated (r =.54-.63). Contrary to our hypothesis, both state anxiety (β =.35) and state depression (β =.45) had a strong contemporaneous effect on state FSS. In turn, state FSS had a weak two-year lagged effect on state anxiety (β =.11) and an even weaker effect on state depression (β =.06). Conclusions: While the effect of anxiety and depression on FSS is strong and immediate, FSS exert a weaker and delayed influence on anxiety and depression. Further research should be done to detect the exact ways in which anxiety and depression lead to FSS, and FSS lead to anxiety and depression.

Mental health problems during puberty: Tanner stage-related differences in specific symptoms. The TRAILS study (Article)

2010-01-01T00:00:00Z

The aim of this study was to investigate associations between specific mental health problems and pubertal stage in (pre)adolescents participating in the Dutch prospective cohort study TRAILS (first assessment: N = 2230, age 11.09 ± 0.56, 50.8% girls; second assessment: N = 2149, age 13.56 ± 0.53, 51.0% girls). Mental health was assessed by the Youth Self-Report, pubertal (Tanner) stage by parent-rated drawings of secondary sex characteristics. Overall, higher Tanner stages were related to more reported tiredness, irritability, rule-breaking behaviors, and substance use; and fewer fears and somatic complaints. Girls showed increases in social uncertainty, depressed mood, and worries; boys a decrease in self-criticism. Increasing problems during puberty were mostly related to the process of physical maturation, whereas decreasing problems were rather related to general age-related developments. Pubertal timing was associated with different symptoms than pubertal status or age. Puberty seems to affect girls more negatively than boys.

Adolescent Family Adversity and Mental Health Problems: The Role of Adaptive Self-regulation Capacities. The TRAILS Study (Article)

2010-01-01T00:00:00Z

Adolescent family adversity is a considerable adaptive challenge in an increasingly turbulent developmental period. Using data from a prospective population cohort of 2230 Dutch adolescents, we tested risk-buffering interactions between adolescent family adversity and self-regulation capacities on mental health. We used two adaptive self-regulation capacities that could allow adolescents to manage relatively well with family adversity: (1) parent-reported effortful control, and (2) an attentional flexibility (in this case, set-shifting) task. Adolescent family adversity was associated with internalizing problems and externalizing problems. The risk-buffering effects of effortful control were found for externalizing problems but not for internalizing problems. There were no risk-buffering effects of attentional flexibility on both types of mental health problems. Effortful control is likely to benefit adolescents' ability to channel their frustrations in adaptive ways in the presence of family adversity. Additionally, (attentional) set-shifting tasks might have a limited predictive value for risk-buffering research.

Hypothalamic-pituitary-adrenal axis and smoking and drinking onset among adolescents: The longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS) (Article)

2009-11-01T00:00:00Z

Aims We examined within a prospective longitudinal study whether cortisol levels were associated with smoking or drinking behaviours, taking parental substance use into account. Design The influence of parental substance use on cortisol levels of their adolescent offspring at age 10-12 years was examined. Next, cortisol levels of adolescents who initiated smoking or drinking at the first data collection (age 10-12) were compared to non-users. Finally, we examined whether cortisol levels could predict new onset and frequency of smoking and drinking 2 years later. Setting and participants First and second assessment data of the TRacking Adolescents' Individual Lives Survey (TRAILS) were used, including 1768 Dutch adolescents aged 10-12 years, who were followed-up across a period of 2 years. Measurements Cortisol was measured in saliva samples at awakening, 30 minutes later, and at 8 p.m. at age 10-12. Self-reported substance use at age 10-12 and 13-14, and parental self-reported substance use were used. Findings Only maternal substance use was related to slightly lower adolescent cortisol levels at 8 p.m. Both maternal and paternal substance use were associated with adolescent smoking and drinking at age 13-14, although fathers' use only predicted the amount used and not the chance of ever use. Finally, higher cortisol levels were related moderately to current smoking and future frequency of smoking, but not to alcohol use. Conclusions In a general population, parental heavy substance use does not seem to affect cortisol levels consistently in their offspring. We found some evidence for higher, instead of lower, hypothalamic-pituitary-adrenal axis activity as a predictor of smoking in early adolescence.

Preadolescents' somatic and cognitive-affective depressive symptoms are differentially related to cardiac autonomic function and cortisol: The TRAILS study (Article)

2009-11-01T00:00:00Z

OBJECTIVE: To examine in a nonclinical sample of preadolescents the possibility that somatic and cognitive-affective depressive symptoms are differentially related with the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. Depression is a well-known risk factor for cardiovascular disease and mortality. Dysregulation of the ANS and the HPA axis have been proposed as underlying mechanisms. Several studies suggest that only a subset of the depression symptoms account for associations with cardiovascular prognosis. METHODS: Self-reported somatic and cognitive-affective depressive symptoms were examined in relationship to heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and the cortisol awakening response (CAR) in 2049 preadolescents (mean age = 11.1 years; 50.7% = girls) from the Tracking Adolescents' Individual Lives Survey (TRAILS). RESULTS: Physiological measurements were not associated with the overall measure of depressive symptoms. Somatic depressive symptoms were negatively related to HRV and BRS, and positively to the CAR; cognitive-affective depressive symptoms were positively related to HRV and BRS, and negatively to the CAR. Associations with the CAR pertained to boys only. CONCLUSIONS: Somatic and cognitive-affective depressive symptoms differ in their association with both cardiac autonomic and HPA axis function in preadolescents. Particularly, somatic depression symptoms may mark cardiac risk. Copyright

Does HPA-axis activity mediate the relationship between obstetric complications and externalizing behavior problems? the TRAILS study (Article)

2009-09-01T00:00:00Z

To examine whether HPA-axis activity mediates the relationship between obstetric complications (OCs) and externalizing behavior problems, and to investigate whether this model is different for boys and girls. In a population-based cohort of 1,768 10- to 12-year-old early adolescents, we assessed the cortisol awakening response and evening cortisol levels. Externalizing behavior problems were assessed using the Child Behavior Checklist and the Youth Self-Report. OCs were retrospectively assessed in a parent interview. OCs significantly predicted externalizing behavior problems, but OCs did not predict HPA-axis activity. Thus, the mediation model was not supported. In addition to the relationship between HPA-axis activity and externalizing behavior problems, which is specific for girls, there is also a relationship between OCs and externalizing behavior problems. However, these two mechanisms are not related to each other indicating that HPA-axis activity is not a mediator in the relationship between OCs and externalizing behavior problems. Future research should focus on understanding the mechanism through which OCs cause externalizing behavior problems.

Baseline cortisol measures and developmental pathways of anxiety in early adolescence (Article)

2009-09-01T00:00:00Z

Objective: This study investigated whether baseline cortisol measures predicted future anxiety, and compared cortisol values of groups with different developmental pathways of anxiety. Method: Cortisol levels were assessed in 1768 individuals (10-12 years). Anxiety levels were assessed at the same age and 2 years later. Results: Cortisol measures did not predict future anxiety levels. Individuals with persistent anxiety problems did not show higher morning cortisol levels than those with persistently low, decreasing, or increasing anxiety levels. Instead, individuals with persistently high anxiety levels showed significantly lower evening cortisol levels than all other individuals. Further, participants with increasing anxiety levels showed higher morning cortisol levels (area under the curve; AUC) than individuals with persistently low anxiety levels. Conclusion: The extent to which the HPA-axis - by itself - plays a role in the aetiology of anxiety is questionable. Interactions of the HPA-axis with other biological or environmental factors may be more important.

Adolescents' cortisol responses to awakening and social stress; Effects of gender, menstrual phase and oral contraceptives. The TRAILS study (Article)

2009-07-01T00:00:00Z

Studies on the influence of sex hormones on cortisol responses to awakening and stress have mainly been conducted in adults, while reports on adolescents are scarce. We studied the effects of gender, menstrual cycle phase and oral contraceptive (OC) use on cortisol responses in a large sample of adolescents. Data come from TRAILS (TRacking Adolescents' Individual Lives Survey), a prospective population study of Dutch adolescents. This study uses data of 644 adolescents (age 15-17 years, 54.7% boys) who participated in a laboratory session including a performance-related social stress task (public speaking and mental arithmetic). Free cortisol levels were assessed by multiple saliva samples, both after awakening and during the laboratory session. No significant effects of gender and menstrual phase on cortisol responses to awakening were found, while girls using OC displayed a slightly blunted response (F(1, 244) = 5.30, p = .02). Cortisol responses to social stress were different for boys and free-cycling girls (F(3, 494) = 9.73, p < .001), and OC users and free-cycling girls (F(3, 279) = 15.12, p < .001). Unexpectedly, OC users showed no response at all but displayed linearly decreasing levels F(1, 279) = 19.03, p < .001) of cortisol during the social stress test. We found no effect of menstrual cycle phase on cortisol responses to social stress (F(3, 157) = 0.58, p = .55). The absence of a gender difference in the adolescents' cortisol awakening response found in this study is consistent with previous reports. Our results further suggest that adolescent OC users display slightly blunted cortisol responses after awakening, and that gender differences in cortisol responses to social stress during adolescence are comparable to those described for adult populations, that is, stronger responses in men than in women. Whereas previous work in adults suggested blunted stress responses in OC users compared to men and free-cycling women, adolescent OC users showed no cortisol response. Effects of type of OC could not be studied because of low numbers of OC that were only progestin based.

Parental Overprotection Predicts the Development of Functional Somatic Symptoms in Young Adolescents (Article)

2009-06-01T00:00:00Z

Objective: To examine whether parental overprotection contributes to the development of functional somatic symptoms (FSS) in young adolescents. In addition, we aimed to study whether this potential effect of parental overprotection is mediated by parenting distress and/or moderated by the adolescent's sex. Study design: FSS were measured in 2230 adolescents (ages 10 to 12 years from the Tracking Adolescents' Individual Lives Survey) by the Somatic Complaints subscale of the Youth Self Report at baseline and at follow-up 21/2 years later. Parental overprotection as perceived by the child was assessed by means of the EMBU-C (Swedish acronym for my memories of upbringing-child version). Parents completed the Parenting Stress Index. Linear regression analyses were performed adjusted for FSS at baseline and sex. Results: Parental overprotection was a predictor of the development of FSS in young adolescents (β = 0.055, P < .01). Stratified analyses revealed that maternal overprotection was a predictor of the development of FSS in girls (β = 0.085, P < .02), whereas paternal overprotection was a predictor of the development of FSS in boys (β = 0.072, P < .01). A small (5.7%) but significant mediating effect of maternal parenting stress in the relationship between parental overprotection and FSS was found. Conclusions: Parental overprotection may play a role in the development of FSS in young adolescents.

Stressful life events and depressive symptoms in young adolescents: Modulation by respiratory sinus arrhythmia? The TRAILS study (Article)

2009-04-01T00:00:00Z

Background: Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs). Methods: In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave. Results: Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs. Conclusions: In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.

Temperamental activation and inhibition associated with autonomic function in preadolescents. The TRAILS study (Article)

2009-04-01T00:00:00Z

We investigated the temperamental traits high-intensity pleasure (temperamental activation) and shyness (temperamental inhibition) in relation to autonomic function as measured by heart rate (HR), respiratory sinus arrhythmia (RSA), and baroreflex sensitivity (BRS) in 938 10-13-year-old preadolescents from a population cohort. Temperament was evaluated by parent reports on the Revised Early Adolescent Temperament Questionnaire. Autonomic measurements were obtained in supine and standing position. High-intensity pleasure was negatively associated with supine HR and positively with supine RSA and BRS in both genders. Shyness was positively related to supine BRS in girls only. Orthostatic-based autonomic reactivity (difference) scores adjusted for supine values were unrelated to temperamental measures. It appeared that higher scores on temperamental activation and inhibition are associated with higher cardiac vagal activity (RSA) and/or flexible regulation of autonomic balance (BRS), implicating healthy physiological functioning. Moreover, results suggest a physiological basis promoting the tendency towards engagement in high-intensity activities.

Income inequality, social capital and self-inflicted injury and violence-related mortality (Article)

2009-01-01T00:00:00Z

Background: The objective of the study was to investigate the relation of income inequality and indicators of social capital to self-inflicted injury mortality (suicide) and violence-related mortality, and to the share of total mortality that is due to these two causes of death in 35 developed countries. Methods: An ecological study including 30 European countries, including former communist countries, and five developed countries from other parts of the world was carried out. Countries were included if there was information available about mortality and income inequality, and if they had been included in the European/World Values Surveys of 2000. The main outcome measures were self-inflicted injury and violence-related mortality and the percentage of total mortality that was due to these two causes of death. Results: There were important variations between former communist Europe and other developed countries. In other developed countries income inequality was significantly, but negatively, correlated with self-inflicted deaths, but not with violence-related deaths. In former communist countries, it was found that income inequality was correlated with violence-related deaths, but not self-inflicted deaths. Only in former communist countries did adjusting for the level of preparedness to help others reduce the associations. Conclusions: The expectation that income inequality would have a relatively strong association with the two causes of death indicating mortality due to self-infliction and violence was only partly confirmed, that is, only for former communist countries and only for violence-related mortality. The expectation that adjusting indicators of social capital would lower associations was also only partly confirmed.

Socioeconomic position and mental health problems in pre- and early-adolescents: The trails study (Article)

2009-01-01T00:00:00Z

Background: Family socioeconomic position (SEP) is known to be associated with adolescent mental health. Whether the relationship is different for different mental health dimensions is unknown. Methods: Using a cross-sectional design, we investigated the differential effects of family SEP on multiple mental health dimensions in preadolescents (N = 2230, baseline age 10-12, 49% boys) using reports from multiple informants (parent, self, and teachers). A score equal to or higher than the 85th percentile (averaged across informants) defined mental health problems. Results: SEP was inversely associated with all dimensions. Compared to high SEP, the odds ratios (OR) for externalizing problems were 3.88 (95% confidence interval (CI): 2.56, 5.90) and 2.05 (CI: 1.34, 3.14) for low and intermediate SEP, respectively. For internalizing problems, they were 1.86 (CI: 1.28, 2.70) and 1.37 (CI: 0.94, 2.00), respectively. When adjusted for externalizing problems, SEP effects on internalizing problems materially attenuated (OR: 1.47, CI: 0.78, 1.68 and OR: 1.34, CI: 0.91, 1.96) while the converse was less pronounced (OR: 3.39, CI: 2.24, 5.15) and (OR: 1.91, CI: 1.25, 2.94). Conclusion: In early adolescence, the risk of mental health problems increases with decreasing SEP, particularly for externalizing problems. Further, the SEP-internalizing problems relationship is partly explained by shared aspects with externalizing problems.

Cohort profile: The Dutch 'TRacking Adolescents' individual lives' survey'; TRAILS (Article)

2008-12-15T00:00:00Z

Association between depressive symptoms in childhood and adolescence and overweight in later life: Review of the recent literature (Article)

2008-10-01T00:00:00Z

Objective: To present an overview of the association between depressive symptoms in childhood and adolescence and subsequent overweight in later life. Data Sources: MEDLINE, EMBASE, and Web of Science for all indexed journals from January 1, 1997, to May 30, 2007. Study Selection: Abstracts of 513 articles were reviewed manually. Studies were excluded if unrelated to depressive symptoms and overweight (n = 460), if they were conducted in an adult population (n = 10) or in a population of all age groups (n = 2), or if they were performed in clinic-based populations of overweight participants. In total, 32 articles were reviewed including 21 cross-sectional and 11 longitudinal reports. Main Exposure: Depressive symptoms in childhood and adolescence. Main Outcome Measure: Overweight. Results: Four cross-sectional studies that satisfied our quality criteria revealed an association between depressive symptoms and overweight in girls aged 8 to 15 years, reporting different effect sizes including a correlation coefficient of 0.14 and a regression coefficient of 0.27. Four longitudinal studies in accord with our quality criteria suggest that depressive symptoms in childhood or adolescence are associated with a 1.90- to 3.50-fold increased risk of subsequent overweight (95% confidence intervals varying from 1.02 to 5.80, respectively). Conclusion: These results support a positive association between depressive symptoms at age 6 to 19 years and overweight in later life, assessed after a period of 1 to 15 years.

Optimal use of multi-informant data on co-occurrence of internalizing and externalizing problems: The TRAILS study (Article)

2008-09-30T00:00:00Z

Strong between-informant discrepancies are found in ratings of (pre)adolescent problems and in co-occurrence rates between different domains of psychopathology. These discrepancies can be caused by differences in the context of measurement and the perspective of informants. The aim of this study was to develop a "Multi-Informant Co-occurrence" model (MIC), which takes into account these differences in context and perspective. In a population-based cohort of (pre)adolescents (n = 2230) from a longitudinal study in the north of the Netherlands, internalizing (INT) and externalizing (EXT) problems were rated by the (pre)adolescents themselves, their teachers, and their parents. As hypothesized Principal Component Analysis revealed four independent main components: Between-domain convergence was captured by a severity component (S), while between-domain discrepancy was captured by a direction component (D). Between-informant discrepancies were captured by a perspective (P) and a context (C) component. The use of this MIC-model will increase reliability and validity of measures of psychopathology and the four components each provide useful specific information. Copyright

Victimisation and suicide ideation in the TRAILS study: Specific vulnerabilities of victims (Article)

2008-08-01T00:00:00Z

Background: Scientific studies have provided some support for a link between being a victim of bullying and suicide ideation. We examine whether (1) parental psychopathology and (2) feelings of rejection (at home and at school) exacerbate vulnerability to suicide ideation in victims of bullying (pure victims and bully-victims). Method: Data were from a population-based cohort study of Dutch children (n = 1526, mean age = 12.29 years). Using peer nominations, three groups were established: (1) victim only; (2) bully-victims (children who are victims and who also bully others); (3) uninvolved. Self-report data on suicide ideation were obtained using two items from the Youth Self-Report (Achenbach, 1991). Parental internalising and externalising disorders were assessed, as were self-reported feelings of rejection at home and social well-being among classmates. Results: The association between victimisation and suicide ideation was moderated by parental internalising disorders (but not externalising disorders) and feelings of rejection at home. Victims (but not bully-victims) with parents with internalising disorders reported elevated levels of suicide ideation compared to children uninvolved in bullying. Victims feeling more rejected at home also reported more suicide ideation. There were no overall sex differences in suicide ideation. Surprisingly, bully-victims did not report higher levels of suicide ideation compared to children uninvolved in bullying. Conclusions: Parental internalising disorders and feelings of rejection at home confer a specific vulnerability for suicide ideation among victims of bullying.

HPA-axis activity and externalizing behavior problems in early adolescents from the general population: The role of comorbidity and gender. The TRAILS study (Article)

2008-07-01T00:00:00Z

Contradictory findings on the relationship between hypothalamus-pituitary-adrenal (HPA)-axis activity and externalizing behavior problems could be due to studies not accounting for issues of comorbidity and gender. In a population-based cohort of 1768 (10- to 12-year-old) early adolescents, we used a person-oriented approach and a variable-oriented approach to investigate whether comorbidity with internalizing behavior problems and gender moderate the relationship between HPA-axis activity (cortisol awakening response and evening cortisol levels) and externalizing behavior problems. We found that: (1) in early adolescents with pure externalizing behavior problems, there was a particularly strong effect of gender, in that girls showed significantly higher total cortisol levels after awakening (AUCGlevels) and a significantly higher cortisol awakening response (AUCIlevels) than boys. (2) Girls with pure externalizing behavior problems showed a significantly higher cortisol awakening response (AUCIlevels) than girls without behavior problems or girls with comorbid internalizing behavior problems. This effect was absent in boys. (3) Externalizing behavior problems, in contrast to internalizing behavior problems, were associated with higher evening cortisol levels. This effect might, however, result from girls with externalizing behavior problems showing the highest evening cortisol levels. Overall, we were unable to find the expected relationships between comorbidity and HPA-axis activity, and found girls with pure externalizing behavior problems to form a distinct group with regard to their HPA-axis activity. There is need for prospective longitudinal studies of externalizing behavior problems in boys and girls in relation to their HPA-axis activity. It would be useful to consider how other risk factors such as life events and family and parenting factors as well as genetic risks affect the complex relationship between externalizing behavior problems and HPA-axis activity.

Low Heart Rate: A Marker of Stress Resilience. The TRAILS Study (Article)

2008-06-15T00:00:00Z

Background: The stimulation-seeking theory posits that individuals with low habitual autonomic arousal levels will seek stimulation to increase their arousal to more optimal levels. Because of their assumed high optimal stimulation levels, persons characterized by low autonomic arousal may be better able to endure stressors than those with higher levels. In this study, we tested the hypothesis that low resting heart rate (HR) and high respiratory sinus arrhythmia (RSA) protect against the detrimental effects of stressors on mental health in early adolescents from the general population. Methods: Data were collected as part of TRacking Adolescents' Individual Lives Survey (TRAILS), a large prospective cohort of Dutch (pre)adolescents (N = 1478), with measurements at approximately age 11 (T1) and age 13.5 (T2). Internalizing and externalizing mental health problems were assessed at both waves, using multiple informants. Resting HR ands RSA were assessed at T1 and the amount of parent-reported stressors and long-term difficulties at T2. Results: Stressors predicted mental health problems in adolescents with intermediate and high HR, but not in those with low HR. These findings were consistent regardless of the measure used to assess stressors and of adjustment for T1 mental health problems. Furthermore, the stress-buffering effects of low HR pertained to both externalizing problems and internalizing problems. No stress-buffering effects were found for RSA, suggesting predominantly sympathetic influences. Conclusions: Our study, which linked physiologic measures to stress sensitivity in real life, suggests that low HR is a marker of resilience to the effects of environmental challenges in early adolescence.

Parental divorce and offspring depressive symptoms: Dutch developmental trends during early adolescence (Article)

2008-05-01T00:00:00Z

In this study, we investigated if the association between parental divorce and depressive symptoms changes during early adolescence and if developmental patterns are similar for boys and girls. Data were collected in a prospective population cohort of Dutch adolescents (N = 2,149), aged 10 - 15 years. Outcome variables were self-reported and parent-reported depressive symptoms. The effects of divorce were adjusted for parental depression. In both self-reported and parent-reported data, we found a three-way interaction of gender, age, and parental divorce, indicating that with increasing age, parental divorce became more strongly associated with depressive symptoms among girls, but not boys. These results suggest that girls with divorced parents are at particularly high risk to develop depressive symptoms during adolescence.

HPA-axis activity as a predictor of future disruptive behaviors in young adolescents (Article)

2008-05-01T00:00:00Z

Low HPA-axis activity has been proposed as a risk factor for disruptive behaviors. However longitudinal data on this topic are practically lacking. In the present study we investigated if low HPA-axis activity predicted future disruptive behaviors. We included 1,399 boys and girls from the Dutch general population, initially aged 10-12 years. At the first assessment, basal cortisol levels were assessed. At the first assessment and at follow-up 2 years later disruptive behaviors were assessed with parent and self-report questionnaires. The results suggest that the association between low cortisol levels at 8.00 p.m. and future disruptive behaviors according to the parents was only present for boys. More importantly however, the results suggest that low HPA-axis activity is not a good predictor for disruptive behaviors, but could be valuable to identify those with a poor prognosis, once disruptive behaviors are present in preadolescence. Copyright

Prosocial and antisocial behavior in preadolescence: Teachers' and parents' perceptions of the behavior of girls and boys (Article)

2008-05-01T00:00:00Z

There has been recent emphasis on the importance of investigating prosocial and antisocial behavior simultaneously owing to doubts about whether examining one automatically gives information about the other. However, there has been little empirical research into this question. The present study (based on a large population sample of preadolescents, N = 2,230) simultaneously examines prosocial and antisocial behavior, explicitly including the possibility that children might show prosocial behavior according to one informant and antisocial behavior according to another. When parents and teachers agreed in their judgments, children were distinctly profiled and differed clearly in effortful control, intelligence, academic performance, and several peer nominations and family characteristics. The correlates were more rater-specific for children that were prosocial according to one informant and antisocial according to the other informant. Teachers and parents used different context-dependent criteria for judging children to be prosocial or antisocial. Academic performance and peer relations were related to the teacher's judgment of prosocial and antisocial behavior. By contrast, children's being problematic at home (and thus causing stress for the parents) was related to the parents' judgment.

Stressful life events and depressive problems in early adolescent boys and girls: The influence of parental depression, temperament and family environment (Article)

2008-01-01T00:00:00Z

Background: Stressful life events increase the probability of depressive problems in early adolescence. Several genetic and environmental risk factors may change individual sensitivity to the depressogenic effect of these events. We examined modification by parental depression and gender, and mediation of the former by temperament and family environment. Methods: Data were collected as part of a longitudinal cohort study of (pre)adolescents (n = 2127). During the first assessment wave at approximately age 11, we assessed parental depression, family functioning, perceived parenting behaviours, and temperamental frustration and fearfulness. At the second wave, about two and a half years later, stressful life events between the first and second assessment were assessed. Depressive problems were measured at both waves. Results: Adolescents with parents who had a (lifetime) depressive episode were more sensitive to the depressogenic effect of stressful events than adolescents without depressed parents. Furthermore, girls are more sensitive to these effects than boys. The modifying effect of parental depression was not mediated by temperament, family functioning and perceived parenting. Limitations: Life events were assessed without consideration of contextual information. Depressive problems were measured by questionnaires that did not directly represent DSM-IV criteria. The measure of parental depression was unspecific regarding severity and timing of depressive episodes. Conclusion: The results suggest that gender and parental depression are associated with increased sensitivity to depression after experiencing stressful life events during adolescence.

Are the vulnerability effects of personality and psychosocial functioning on depression accounted for by subthreshold symptoms? (Article)

2007-11-16T00:00:00Z

Previous studies could not evaluate adequately the extent to which deviant levels of personality measures and psychosocial functioning found before and after a major depressive episode (MDE) should be attributed to subthreshold depressive symptoms. Our aim is to investigate whether pre- and post-MDE personality alterations and psychosocial disability truly reflect vulnerability, or whether they can be accounted for by the presence of subthreshold depressive symptoms. Data were derived from the Netherlands Mental Health and Incidence Study, a prospective general population study with three waves. Psychopathology was measured with the Composite International Diagnostic Interview (CIDI). Course of depressive symptoms was assessed with the Life Chart Instrument in a cohort of 195 respondents with a new or recurrent MDE between waves 2 and 3. Personality and psychosocial functioning were assessed with, respectively, four and two different measures. Alterations in measurements of personality and psychosocial functioning were present before onset and after remission of an MDE. Most pre- and postonset alterations occurred in the presence of subthreshold depressive symptoms. But even without these subthreshold symptoms, some alterations in measurements of personality and psychosocial functioning were found before and after an MDE. Depressive complaints between waves 2 and 3 were retrospectively assessed, and only a limited set of brief questionnaires was used to assess personality styles and psychosocial functioning. It is unlikely that the pre- and post-MDE alterations in personality and psychosocial functioning observed in earlier studies are entirely due to subthreshold depressive symptoms. This suggests that a depressive episode is interwoven in a long-standing and enduring pattern of mild personality deviance and limitations in psychosocial functioning.

Disruptive behaviors and HPA-axis activity in young adolescent boys and girls from the general population (Article)

2007-10-01T00:00:00Z

It is important to investigate associations between biological factors and disruptive behaviors in children and adolescents. Antisocial, aggressive, and criminal behaviors in adults often begin early in life. Disruptive behaviors are often thought to be associated with low activity of the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol, the end-product of this axis, can be measured to investigate HPA-axis activity. Previous studies on this topic concerned clinical or high risk samples. The aim of the present study was to investigate to which extent HPA-axis functioning plays a role in disruptive behaviors in pre-adolescents from the general population. One thousand seven hundred and sixty eight 10- to 12-year-olds from the Dutch general population were investigated. Disruptive behaviors were assessed with the Child Behavior Checklist, the Youth Self-Report, and the Antisocial Behavior Questionnaire. Baseline morning and evening salivary cortisol levels were assessed. Unexpectedly, small associations were found between disruptive behaviors, including attention problems, and higher cortisol levels. However, all effect sizes of significant effects were very small. Our study indicated that HPA-axis functioning may be more relevant in clinical or high risk samples than at the general population level. The association between HPA-axis functioning and attention problems, that has gotten less attention than that with aggressive or delinquent behaviors, requires further research. Furthermore, because effect sizes were relatively small, it can be concluded that, in pre-adolescence, the measures of baseline HPA-axis functioning that were used for the present study can not be used as biological markers for disruptive behaviors.

Preschool behavioral and social-cognitive problems as predictors of (pre)adolescent disruptive behavior (Article)

2007-10-01T00:00:00Z

This article describes preschool social understanding and difficult behaviors (hot temper, disobedience, bossiness and bullying) as predictors of oppositional defiant disorder (ODD) and aggressive conduct disorder (ACD) in a Dutch population sample of (pre)adolescents (N = 1943), measured at age 10-12 and at age 13-15. ODD and ACD were assessed by the Child Behavior Checklist and the Youth Self-Report, preschool behavior was evaluated by the parental questionnaire 'How was your child as a preschooler? (age 4-5)'. Adjusted for each other, all difficult preschool behaviors except bullying were associated with adolescent ODD, while only bullying significantly predicted adolescent ACD. Furthermore, the results suggest a qualitative difference between ODD and ACD in terms of the social component of the disorders: poor preschool social understanding was associated with the development of ACD but not of ODD; and poor social understanding interacted with difficult preschool behaviors to predict later ACD but not ODD. The associations did not differ between boys and girls, and were roughly similar for preadolescent (age 10-12) and early adolescent (age 13-15) outcomes. The finding that poor social understanding was implicated in the development of ACD but not in the development of ODD may help to demarcate the individuality of each disorder and offer leads for (differential) treatment strategies.

Testing the tripartite model in young adolescents: Is hyperarousal specific for anxiety and not depression? (Article)

2007-09-01T00:00:00Z

Background: To clarify the distinction between anxiety and depression, the tripartite model was introduced. According to this model, physiological hyperarousal (PH, i.e. autonomic hyperactivity) is specific for anxiety and not depression. Research on the relation between anxiety, depression and physiological measures representing arousal is lacking. Methods: Parent- and self-reported anxiety and depressive problems were assessed using the CBCL and RCADS. Heart rate (HR), heart rate variability in the low frequency (HRV LF) and respiratory sinus arrythmia (RSA) were used as indices for autonomic arousal. Results: Parent-reported anxiety was associated with low RSA in supine posture. This association was also found for self-reported anxiety problems, but only in boys. These findings point towards high arousal in anxiety. Self-reported depressive problems were associated with low HRV LF in standing posture and high RSA in supine posture in boys, pointing towards low arousal in depression. However, self-reported depressive problems were also associated with high HR in standing posture and with low HRV LF in supine posture in girls, suggesting high arousal in depression. Limitations: Although HRV LF in standing posture is primarily sympathetically mediated, and HRV LF in supine posture is primarily vagally mediated, the association between HRV LF and sympathetic versus vagal function is not exclusive. Thus, HRV LF measures are merely approaches of high or low arousal. Conclusions: Some evidence was found for hyperarousal in anxiety, but also for hyperarousal in depression. Apparently, the idea of hyperarousal in anxiety and not in depression is too simple to reflect the more complex reality.

Higher cortisol awakening response in young adolescents with persistent anxiety problems (Article)

2007-08-01T00:00:00Z

Objective: The aims of the present study were to test the association between current anxiety problems and basal cortisol levels in a large population sample of young preadolescents, and to test if HPA-axis activity differs between individuals with no, only current, or persistent anxiety problems. Method: Cortisol levels of 10- to 12-year olds (n = 1768) from the general population were measured on three time points during the day. A self-report questionnaire (RCADS) was used to assess current anxiety, a parent-report questionnaire (TPBQ) to assess anxiety problems at age 4. Results: Associations between cortisol levels and current anxiety problems were not found. However, individuals with persistent anxiety problems had higher morning cortisol levels and a higher cortisol awakening response. Conclusion: Apparently, only persistent, and not current, anxiety problems are associated with higher HPA-axis activity. Alterations in HPA-axis activity might underlie persistent anxiety problems, or result from the stress accompanied by persistent anxiety problems.

Being admired or being liked: Classroom social status and depressive problems in early adolescent girls and boys (Article)

2007-06-01T00:00:00Z

This study investigates associations between depressive problems and classroom social status in a large population cohort of Dutch early adolescents (N = 1046, age 13.52 ± 0.51, 52.4% girls). Depressive problems were assessed by parent and self-reports and classroom status by peer nominations. We assessed peer status with respect to both achievement-related (being a good learner, being good at sports, being good-looking) and affection-related (being liked, being disliked, being best friend) areas. In boys, depressive problems were most strongly associated with not being good at sports, while in girls the association was strongest for not being liked. The risk of a low status in one area could largely be compensated by a high status in another area.

Information processing profiles of internalizing and externalizing behavior problems: Evidence from a population-based sample of preadolescents (Article)

2007-02-01T00:00:00Z

Background: The present study explores the relationships between several information processing capacities and internalizing and externalizing behavior problems in a general population sample of 10- to 12-year olds (N = 2,037 51% girls). Methods: Parent-reported behavior problems as assessed by the Child Behavior Checklist were used to form four groups of children with 1) neither internalizing nor externalizing problems (n = 1,470), 2) only internalizing problems (n = 237), 3) only externalizing problems (n = 182), and 4) both internalizing and externalizing problems (n = 148). These groups were compared on measures of speed and accuracy from the Amsterdam Neuropsychological Tasks program reflecting the efficiency of several input-, central cognitive-, and output-related information processing capacities. Results: Children with both internalizing and externalizing problems demonstrated the least efficient performance, followed by children with only externalizing problems, whereas children with only internalizing problems did not differ from children without problems. More specifically, response variability and the ability to maintain and quickly compare information in working memory were found to be related to the severity of problem behavior. The ability to inhibit prepotent responses was related to the type of problem behavior, discriminating between the children with only internalizing problems and only externalizing problems. However, this latter capacity no longer differentiated when controlling for IQ. No differences were found between boys and girls. Conclusions: The results suggest that, in gener al, cognitive processing deficits are more strongly related to the degree than to the type of maladaptive behavior. Furthermore, response variability and working memory may serve as potential markers for identifying high-risk children and response inhibition as an indicator of the type of maladaptive behavior. & copy; 2007 The Authors Journal compilation 2007 Association for Child and Adolescent Mental Health.