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Weight Status, Bullying Involvement, and Internalizing Symptomology in Adolescents: Examining a Diathesis-Stress Model
Abstract
Bullying is a pervasive societal issue that is consistently linked to negative outcomes that are emotionally, socially, behaviorally, and medically related. Most youth will encounter this negative life event in their childhood. The purpose of this dissertation was to use a diathesis-stress model perspective to assess the relations between the negative life event of bullying involvement, youths’ mental health, and youth weight status. Youth who have an unhealthy weight status are more likely to be involved in bullying than those with a healthy weight status (Browne, 2012; Puhl). Additionally, bullying and having an unhealthy weight status are related internalizing symptomology (i.e., anxiety, depression; Fox & Farrow, 2009; Puhl & Latner, 2007). Having an unhealthy weight status does not inherently cause individuals to have mental health concerns; rather, it was hypothesized that bullying involvement (i.e., a negative life event) serves as a catalyst for developing internalizing symptomology for youth with unhealthy weight statuses (i.e., individual vulnerability). The current study found a statistically significant association between bullying involvement and weight status. Additionally, weight status and bullying involvement predicted depressive and anxious symptomology. The diathesis-stress model was partially supported within a specific weight and gender group. The study found that experiences may differ by gender and that involvement in the bullying dynamic may moderate the experience between weight status and internalizing symptomology. This study provides empirical support of the complex relationship between weight status, bullying involvement, and internalizing symptomology. Implications for research and clinical practices as well as study limitations are discussed. Advisor: Susan M. Swearer
... The social-ecological diathesis-stress model was developed by Swearer and Hymel (2015) based on the social-ecological model and the diathesis-stress model. The social-ecological model highlights how contextual systems (e.g., microsystems, mesosystems, macrosystems, and chronosystems) strongly influence an individual's development, especially during adolescence when the prevalence of depressive symptoms increases (Damme, 2019;Holfeld and Baitz, 2020;Pössel et al., 2018). The diathesis-stress model suggests that stressful life events may activate cognitive vulnerabilities in individuals, leading to more severe, negative outcomes in adolescents (Hamlat et al., 2015;Mac Giollabhui et al., 2018). ...
... In particular, mood dysregulation, a widely supported psychosocial risk factor for depressive symptoms (Marganska et al., 2013), may serve as a significant mediator in the relationship. Furthermore, according to the social-ecological model, since parents, teachers, and peers are proximal factors that contribute to the development of children's physical and mental health (Damme, 2019;Holfeld and Baitz, 2020;Pössel et al., 2018), the 'teacher factor' may be important in moderating in the relationship. ...
Background
Family violence as an inducing factor of depressive symptoms has been confirmed in previous studies. However, the mechanisms underlying this association are not well understood, particularly in Chinese adolescents. Guided by the social-ecological diathesis-stress model, this three-wave longitudinal study aimed to examine the effects of an individual's cognitive vulnerabilities (rejection-sensitivity anxiety and negative cognitive error) and positive societal contexts (peer support) on the link between family violence and depressive symptoms in Chinese society.
Methods
A total of 859 Chinese adolescents (44.35 % female; Mage = 12.73, SD = 0.43 at baseline) completed self-reporting surveys that assessed variables associated with study and peer-nominated peer support.
Results
The results showed that family violence increased the incidence of depressive symptoms in adolescents after two years, resulting in rejection-sensitivity anxiety and negative cognitive error. Surprisingly, higher self-reported peer support, although not peer-nominated support, exacerbated rather than mitigated this indirect effect, supporting the reverse stress-buffering model and extending the healthy context paradox.
Limitations
Most of the measures were based on participants' self-reports.
Conclusions
These results emphasize the importance of individual cognition and societal contexts in adolescents with traumatic experiences and provide empirical evidence for the intervention and clinical treatment of depressive symptoms.
Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.
Unfortunately, the original version of this article (Zsila et al. 2018) contained an error. The first moderation model relating to the second hypothesis.
Experiences of depression, anxiety, and peer victimization have each been found to predict one another, and to predict negative outcomes in the domains of school connectedness, social functioning, quality of life, and physical health. However, the common co-occurrence of depression, anxiety, and peer victimization experiences has made it difficult to disentangle their unique roles in these associations. The present study thus sought to characterize the precise nature of the bidirectional relationships between depressive symptoms, anxiety, and victimization over time, and to examine their unique sequelae during the transition from childhood to early adolescence. Longitudinal multi-informant (child-reported, parent-reported, and teacher-reported) data from a nationally representative sample were analyzed using path analysis when the study child was aged 10–11 (n = 4169; Mage = 10.3; 48.8% female) and aged 12–13 (n = 3956; Mage = 12.4; 48.2% female). Depressive symptoms, anxiety, and peer victimization had small but significant unique bidirectional relationships. All three constructs also uniquely and prospectively predicted poorer life functioning across all domains examined. These results demonstrate that current interventions should broaden their scope to simultaneously target depression, anxiety, and peer victimization, as each of these experiences independently act as additive risk factors for subsequent negative outcomes.
Background:
In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.
Discussion:
In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.
Conclusion:
Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
Childhood bullying is a well-known public health problem world-wide. Research has described numerous health and mental health effects on victims, bullies, and bystanders. While there are studies of contemporaneous consequences, there is still much to be discovered in terms of the impact of childhood bullying lasting into adult life. This qualitative inquiry investigated the aftermath of childhood bullying for young adults in terms of their health, mental health, and relationship issues. Further, it asked participants for their definitions of bullying. The study was part of a mixed-methods inquiry. For the qualitative portion, 72 graduate and undergraduate students in the U.S., ages 18 to 29, participated as a purposive sample. The majority of participants were Caucasian and female, though 28% percent represented minority groups. Semi-structured interviews were conducted lasting approximately 1 h each. A participatory action research approach was taken to understand the lived experiences and perceptions of the young adults. Grounded theory was utilized in reviewing the data for thematic responses. Member checks and triangulation were employed to substantiate credibility, authenticity, and coherence of the data. Content analysis revealed lasting consequences in (a) mental and psychological well-being (b) eating disorders, weight, and body image, and (c) relationship and trust issues. Results are indicative of the need for further research on childhood bullying as it affects later adolescent and young adult development. Understanding the aftermath of childhood bullying is important in informing bullying interventions and maintaining a focus on early prevention efforts.
The aim of this chapter is to review the literature on the associations
between family violence and abuse as it relates to bullying, sexual violence,
and dating violence among children and adolescents. First, we define bullying,
sexual violence/harassment, and teen dating violence and present prevalence
rates among children and adolescents. Second, we review the
association between family violence and other forms of violence/abuse children
experience and their association with bullying and later interpersonal
violence. Finally, we provide directions for future research and implications
for prevention.
Bullying is the most common form of school violence and is associated with a range of negative outcomes, including traumatic responses. This study used hierarchical linear modeling to examine the multilevel moderating effects of school climate and school level (i.e., elementary, middle, and high schools) on the association between bullying victimization and student engagement. Participants included 25,896 students in 4th to 12th grades from 114 schools. Results indicated that, after controlling for student and school demographic factors, positive school climate was associated with higher behavioral/cognitive and emotional engagement of students across all grades. This highlights the critical and fundamental role of positive school climate in bullying prevention and intervention, among students across all grade levels, including those with frequent bullying victimization experience. Results also showed that negative associations between student-level bullying victimization and engagement were intensified in more positive school climates. This finding suggests that, in comparison with students in schools with less positive school climates, the engagement of bullying victims in schools with a more positive school climate might be more negatively influenced by their victimization experience. Additionally, the relation between student-level bullying victimization and emotional engagement was significantly different across middle and high schools.
Being bullied at school is strongly related to psychological health complaints at the same time point. Studies have also found long-term associations, but few have combined a prospective design with children’s own reports on bullying, and conducted gender-specific analyses. The present study assess health consequences in young adulthood of self-reported victimization in adolescence using data from Child-LNU in 2000 and the follow-up in 2010 (including 63% of the original sample, n = 813). At ages 10–18 a clear cross-sectional association was found for both girls and boys. Among girls, exposure to bullying also predicted psychological complaints 10 years later, at ages 20–28 (OR 2.86). This association was not explained by socio-economic circumstances, neither in adolescence nor in young adulthood. Instead, it can partly be understood as victimization, among adolescent girls, being associated with negative self-image and psychological health as well as with deficits in social resources more generally (e.g., relations with teachers, parents and peers).
Objective
Weight‐related teasing (WT) is associated with poor mental health. This study examined whether weight status moderates the relationship between WT and psychosomatic symptoms within a representative sample of school‐aged youth.
Methods
Data are from the Canadian 2013/2014 Health Behaviour in School‐aged Children Survey, a nationally representative sample of youth in Grades 6–10. WT, psychosomatic symptoms and body mass index (BMI) were self‐reported.
Results
The final sample consisted of 20,277 youth (mean age = 14.2 years; 50.2% female). The prevalence who reported being WT at least once a week was 4.6%, 8.1% and 17.3% among youth with normal weight, overweight, and obesity, respectively (p < 0.001). There was a gradient relationship between the frequency of WT and psychosomatic symptoms (p < 0.001). By comparison to youth that were not WT, psychosomatic symptom z‐scores were significantly (p < 0.05) higher in youth that were WT one to two times in the past few months (0.47, 95% CI: 0.41–0.53), two to three times per month (0.65, 0.52–0.77), about once a week (0.82, 0.71–0.93) and several times a week (0.98, 0.84–1.12). However, the WT * BMI category interaction term was not significant (p = 0.86).
Conclusions
Victims of WT experienced more psychosomatic symptoms independent of BMI category; however, BMI category did not moderate the association between WT and psychosomatic symptoms.
We examined middle school students' attitudes and perceptions of bullying during their middle school years. Participants were categorized along the bully/victim continuum as bullies, victims, bully-victims, and no-status students based on their self-nomination from a survey that queries students about their experiences with bullying (either as a bully, victim, or both), their observations of bullying, and their attitudes toward bullying. The majority of participants were classified as bullies, victims, and bully-victims as 70% of the participants reported involvement with bullying and/or victimization during their middle school years. Participants' perceptions about bullying and attitudes toward bullying were examined at three points in time. Participants' attitudes toward bullying became more supportive of bullying as students
This commentary reviews the four articles included in a special issue of the School Psychology Review that address factors related to the bullying and discrimination among youth. The articles explore rather diverse topics within the broader literature on youth interpersonal violence, but each adds to our understanding of the very complex nature of bullying involvement. In an attempt to understand this complexity, we view these studies through the lens of a socialecological diathesis-stress model (Swearer & Hymel, 2015), considering the individual, family, peer, school community, and societal contexts in which youth interpersonal violence occurs, and how biological and cognitive vulnerabilities interact with stressors like peer victimization to understanding the mechanisms at play in any particular incident of interpersonal violence. Together, the studies presented in this special issue contribute to our understanding of this complexity, reminding us that peers matter; educational placement matters; individual differences in race, sexual orientation, and disabilities matter; and measurement matters. It is perhaps this complexity that limits the effectiveness of current universal strategies for addressing such behaviors in school, but paves the way for more effective, multidimensional prevention and intervention efforts.
Background:
Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship.
Aims:
The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk.
Method:
The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide.
Results:
All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk.
Conclusion:
The study's limitations include the use of cross-sectional and self-data reports. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.
The relationship between obesity and suicide risk is still unclear with controversial research results. The aim of this study is to investigate the relationship between obesity and suicide risk for men and women in a population-based study of young adults. This is a cross-sectional population-based study that identified young adults between 18 and 35 years of age. Suicide risk was investigated through the structured clinical interview Mini. Weight and height were assessed, and participants were classified as normal-weight body mass index (BMI < 30) or obese (BMI > 30). The prevalence of obesity was of 19.9% of the total sample (n = 1953). Obesity was more prevalent among women and participants between 27 and 35 years of age. Suicide risk was present in 13.0% of the sample and more prevalent among women. In our study we found an association between obesity and suicide risk for women, but not for men. Obesity was associated with a higher prevalence of suicide risk in women. Given the strength of the relationship between BMI and suicide, identifying the mechanisms associated with obesity, especially for women, can lead to new insights into the prevention of suicide risk.
Although several studies have addressed developmental trajectories from childhood to adolescence of internalizing/externalizing problems, limited attention has been given to underweight children. Two groups were recruited for this study from a community sample: underweight (Ug, N = 80, 50% female) and normal weight (NWg, N = 80, 50% female) to examine the developmental trajectories of body mass index and emotional-behavioral functioning of underweight children from the age two years, and their risk of eating disorder at early adolescence. The study was organized over four waves, each of three years. Pediatricians measured BMI, parents completed the Child Behavior Checklist (CBCL) and the Eating Disorders Inventory-Referral Form (EDI-3-RF). Our results showed that children in the two groups recorded different BMI trajectories over time. In NWg, male and female subjects started from a higher BMI at T1 than their peers. In Ug, internalizing and externalizing problems in males and females remained higher than their peers at all points of assessment. Males and females in Ug scored higher than those in NWg on EDI-3-RF total score. Our results indicate a need for effective physical and psychological assessment of underweight children in community samples to prevent psychological difficulties and eating disorders in adolescence.
The first aim of the present study was to examine in a single model how moral disengagement and moral emotions were related to bullying and defending behavior among schoolchildren. The second aim was to test whether the two moral dimensions interacted with each other to explain behavior in bullying situations. Data were collected from 561 Swedish students. Moral disengagement was positively associated with bullying and negatively associated with defending, whereas moral emotions score was negatively associated with bullying and positively associated with defending. Moreover, students who scored high in moral emotions did not tend to bully other students, irrespective of their levels of moral disengagement, whereas when the moral emotions score was low bullying behavior increased with increasing levels of moral disengagement. In contrast, moral disengagement was negatively related to defending behavior at low levels of moral emotions, but not when moral emotions were high.
Many studies have reported on gender differences in bully and victim rates, but with the majority of reports from a small number of countries. Here we report on such gender differences from five large cross-national data bases. We report on overall male:female (M:F) ratios, and variations in these by age (or grade), by survey time point, and by offline/online bullying. We also compare consistency of M:F ratios across countries, over the five surveys. The preponderance of male perpetrators of bullying is found consistently across surveys, and survey time point. It is also consistent by age, but HBSC data suggest a curvilinear trend in early adolescence. Males also tend to more frequently be victims of bullying, consistent across age and survey time point, but with variations by survey. There is some indication of a decrease in M:F ratio recently in mid-adolescence, possibly related to online bullying. At least relatively, females are more involved as victims of online than offline bullying. Comparing recent findings on M:F ratio across countries for the five surveys, correlations vary from high to near zero. Implications for the explanation of gender differences in different countries, the comparability of data from different surveys, and for gender-specific interventions, are discussed.
Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children’s body image attitudes, but extensive evaluation is needed.
This study identified profiles of internalizing (anxiety and depression) and externalizing (delinquency and violence against peers) symptoms among bullying victims and examined associations between bullying victimization characteristics and profile membership. The sample consisted of 1196 bullying victims in grades 8-10 (Mage = 14.4, SD = 1.01) who participated in The Context Study in three North Carolina counties in Fall 2003. Five profiles were identified using latent profile analysis: an asymptomatic profile and four profiles capturing combinations of internalizing and externalizing symptoms. Associations between bullying characteristics and membership in symptom profiles were tested using multinomial logistic regression. More frequent victimization increased odds of membership in the two high internalizing profiles compared to the asymptomatic profile. Across all multinomial logistic regression models, when the high internalizing, high externalizing profile was the reference category, adolescents who received any type of bullying (direct, indirect, or dual) were more likely to be in this category than any others.
Introduction
Traditional (offline) bullying and cyberbullying involvement are associated with severe psychosocial problems. Non-heterosexual (LGBQ) youth are more often victimized by traditional bullying than heterosexual (non-LGBQ) youth, but little research is available on LGBQ youth's cyberbullying victimization and perpetration rates. Moreover, rates may differ by youth's age and gender, and victimization may be higher for sexual forms of cyberbullying.
Method
A cross-sectional, school-based survey was conducted in Flanders, Belgium among 1037 adolescents aged 12–18 years. Traditional and cyberbullying involvement were measured using validated single items for each type of involvement (victimization, perpetration), and complemented with items on specific types of cyberbullying victimization (by messaging and posts; by sexual images; by personally embarrassing images). Sexual orientation was determined based on sexual attraction. Logistic regression analyses were conducted, corrected for age and gender.
Results
LGBQ youth were more often victimized by traditional victimization than non-LGBQ youth and more often perpetrator of cyberbullying. No gender differences were found, and no increased rates of traditional bullying perpetration were noted once interaction effects with age and gender were taken into account. A significant interaction effect was found with age for traditional victimization, cyberbullying victimization, and cyberbullying victimization by messaging/posts and by sexual images: these prevalence rates were higher among older LGBQ youth but decreased or remained stable among non-LGBQ youth with age.
Conclusion
This study highlights the need for tailored prevention and intervention programs specific for LGBQ youth in late adolescence, whereas most current programs are targeted at early adolescence when there is a peak in victimization for the general population.
Background:
Although the current obesity epidemic has been well documented in children and adults, less is known about long-term risks of adult obesity for a given child at his or her present age and weight. We developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States.
Methods:
We pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults. We simulated growth trajectories across the life course and adjusted for secular trends. We created 1000 virtual populations of 1 million children through the age of 19 years that were representative of the 2016 population of the United States and projected their trajectories in height and weight up to the age of 35 years. Severe obesity was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or higher in adults and 120% or more of the 95th percentile in children.
Results:
Given the current level of childhood obesity, the models predicted that a majority of today's children (57.3%; 95% uncertainly interval [UI], 55.2 to 60.0) will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood. Our simulations indicated that the relative risk of adult obesity increased with age and BMI, from 1.17 (95% UI, 1.09 to 1.29) for overweight 2-year-olds to 3.10 (95% UI, 2.43 to 3.65) for 19-year-olds with severe obesity. For children with severe obesity, the chance they will no longer be obese at the age of 35 years fell from 21.0% (95% UI, 7.3 to 47.3) at the age of 2 years to 6.1% (95% UI, 2.1 to 9.9) at the age of 19 years.
Conclusions:
On the basis of our simulation models, childhood obesity and overweight will continue to be a major health problem in the United States. Early development of obesity predicted obesity in adulthood, especially for children who were severely obese. (Funded by the JPB Foundation and others.).
Purpose
The purpose of this study was to compare intervening mechanisms proposed by general strain theory and the control model of criminal lifestyle theory as explanations for the strain–behavior relationship.
Methods
In this study strain was defined as bullying victimization, behavior was operationalized as delinquency, and the two mediators were anger and cognitive impulsivity. Analyses were completed on a group of 572 early adolescent schoolchildren from the Illinois Study of Bullying and Sexual Victimization (ISBSV). A causal mediation analysis was performed with prospective data from the ISBSV, with six months between the independent and mediator variables and six months between the mediator and dependent variables.
Results
The outcome of the analyses indicated that cognitive impulsivity but not anger mediated the victimization–delinquency relationship, although the two pathways did not differ significantly from one another.
Conclusions
These findings provide preliminary support for the mediating mechanism proposed by the control model of criminal lifestyle theory (i.e., cognitive impulsivity).
Importance
Between 1980 and 2000, the prevalence of obesity increased significantly among adult men and women in the United States; further significant increases were observed through 2003-2004 for men but not women. Subsequent comparisons of data from 2003-2004 with data through 2011-2012 showed no significant increases for men or women.
Objective
To examine obesity prevalence for 2013-2014 and trends over the decade from 2005 through 2014 adjusting for sex, age, race/Hispanic origin, smoking status, and education.
Design, Setting, and Participants
Analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population that includes measured weight and height.
Exposures
Survey period.
Main Outcomes and Measures
Prevalence of obesity (body mass index ≥30) and class 3 obesity (body mass index ≥40).
Results
This report is based on data from 2638 adult men (mean age, 46.8 years) and 2817 women (mean age, 48.4 years) from the most recent 2 years (2013-2014) of NHANES and data from 21 013 participants in previous NHANES surveys from 2005 through 2012. For the years 2013-2014, the overall age-adjusted prevalence of obesity was 37.7% (95% CI, 35.8%-39.7%); among men, it was 35.0% (95% CI, 32.8%-37.3%); and among women, it was 40.4% (95% CI, 37.6%-43.3%). The corresponding prevalence of class 3 obesity overall was 7.7% (95% CI, 6.2%-9.3%); among men, it was 5.5% (95% CI, 4.0%-7.2%); and among women, it was 9.9% (95% CI, 7.5%-12.3%). Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity (P = .004) and for class 3 obesity (P = .01) but not among men (P = .30 for overall obesity; P = .14 for class 3 obesity).
Conclusions and Relevance
In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends.
Importance
Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years.
Objectives
To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014.
Design, Setting, and Participants
Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys.
Exposures
Survey period.
Main Outcomes and Measures
Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted.
Results
Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87).
Conclusions and Relevance
In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.
The present study examined associations among anxiety symptoms, anxiety disorder diagnoses, perceptions of family support and conflict, and suicidal ideation (SI) in a clinical sample of psychiatrically hospitalized adolescents. Participants were 185 adolescents (72% female; 84% white, mean age = 15.02 years, SD = 1.33) hospitalized on an acute psychiatric inpatient unit. Results indicated that anxiety disorders and symptoms were positively associated with SI, even after controlling for mood disorder diagnoses and sex. Moreover, this relationship was stronger among youth who reported lower (versus higher) levels of family support. Family conflict was positively associated with SI but did not moderate the relationship between anxiety and SI. Results suggest that family support may represent an important intervention target to decrease suicide risk among anxious youth. Integrating positive parenting techniques (e.g., attending to positive behaviors, providing praise, emotion coaching) and effective parent-child communication into treatment with anxious youth may help achieve this aim.
The present study sought to examine a diathesis-stress model involving hope and trauma history as predictors of depressive and anxious symptoms in a sample of 575 college students. Results from regression analyses indicated that hope and trauma were important and unique predictors of both depressive and anxious symptoms in students. Moreover, we found support for a significant Hope × Trauma interaction in predicting both depressive and anxious symptoms. Some implications of the present findings are discussed.
Background and objectives:
Stress is well known as a trigger of depressive reactions, fear, anxiety, and behavioral disorders. However, there are many gaps in the conceptualization and measurement of environmental stress.
Results:
Exciting developments in the neuroscience of stress have increasingly expanded our knowledge of mechanisms by which stress may affect emotional and behavioral adjustment. Ironically, environmental stress has often been a silent player in human studies of stress processes. There is significant need for increased efforts to include environmental stress variables in models of internalizing and other disorders. Measurement and conceptualization issues are prominent, and this article makes the case for improved methods of measuring acute, chronic, and early life stress, and for additional conceptualization of the dynamically changing and bidirectional effects of stress on disorder over time.
Conclusions:
There is a critical need for greater focus on and better measurement of the environment and its impact on emotional and other disorders, with emphasis on developmentally informed hypotheses. Empirical findings and new perspectives may contribute enormously to our understanding of normal and abnormal outcomes, and also to the challenge of effective interventions to promote mental health and optimal functioning.
This chapter defines relevant terms and reviews available literature on classification of childhood anxiety disorders. Specifically, it examines data regarding commonalities and differences among the anxiety disorders as they present in juveniles and in adults. The chapter further reviews the data on one specific childhood anxiety disorder: Social Phobia or Social Anxiety Disorder due to the fact that research on this disorder has increased recently from clinical psychopathology, cognitive neuroscience, and developmental psychology perspectives. Social Anxiety Disorder provides an excellent model for integrating these viewpoints, especially insofar as they have each grappled with the constructs of emotion and emotion regulation. The chapter summarizes recent advances in basic neuroscience that relate to Social Anxiety Disorder and emotion regulation. These advances in neuroscience suggest that fear states might be best conceptualized as a family of distinct but related entities.
It is argued that studies of early adolescent peer victimization and bullying should be longitudinal because of the dynamism of this developmental period. Traditional methods for analyzing longitudinal data are inadequate because of the strict data requirements and inflexibility of models. A better alternative is linear mixed models (LMMs) for repeated measures. LMMs have less restrictive data requirements and much flexibility in the type of models that may be specified. Using empirical data from middle school students, it is shown how LMMs can be used to examine three major aspects of change in dominance and bullying. The first is unconditional change, which involves treating the sample as an entire group and modeling the mean trajectories of dominance and bullying over time. The second is conditional change, which involves examining gender differences in mean change of dominance and bullying over time. The third is dynamic change, which involves examining the longitudinal covariation between bullying and dominance controlling for trajectory effects. The algebra of the LMMs is presented from a multilevel perspective assuming a random effects model. The results are discussed in terms of dominance theory and highlight the advantages of the LMM approach to data analysis in the study of adolescent peer victimization and bullying.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
When the first edition of this book was published in 2004, we argued that bullying had to be studied across individual, peer, family, school, community, and cultural contexts. Like discrimination, bullying is a complex phenomenon, with multiple causal factors and multiple outcomes. We and other authors have continued to frame bullying among school-aged youth from this social ecological perspective. Drawing a parallel to discriminatory behavior, research on bullying has established that bully perpetration includes physical and verbal behavior within an affective framework (i.e., the intent to harm). Bullying comprises a complex set of antecedents, behaviors, and consequences. The reasons why children and adolescents bully one another are complex, multiply-determined, and differentially reinforced. We explicate these factors and frame the content for the second edition of Bullying in North American Schools.
In this chapter, we will review the literature on internalizing problems in youth who are involved in bullying. Involvement in bullying occurs along a continuum (i.e., the bully- victim continuum), meaning that students can participate in multiple roles, including bullying others, being bullied, both bullying others and being bullied, witnessing bullying, and no involvement in bullying. It is clear that involvement in bullying is not defined by static and fixed roles in individuals. It is also evident that students involved in the bully-victim continuum experience greater levels of internalizing problems compared to students who are not involved in bullying. The goal of this chapter is to examine the relation between internalizing problems and the bully-victim continuum, to present longitudinal data on this dynamic, and to provide suggestions for effective mental health interventions for youth involved in bullying. It is our contention that parents, students, teachers, and mental health professionals must work in tandem in order to derail the destructive cycle of bullying and mental health problems.