Predictors of Clinical Outcomes in Sexually Abused Adolescents

ABSTRACT

This cross-sectional, case control study examines the association between child sexual abuse and interpersonal and intrapersonal outcomes among 54 adolescents, examining specific clinical measures (depression, anxiety, dissociation, and posttraumatic stress disorder, attachment patterns, self-esteem, self-disclosure, and family environment characteristics). The research results point to a correlation between sexual abuse and higher levels of the clinical measures. In addition, a correlation was found between sexual abuse and level of avoidant attachment, self-esteem, and family environment characteristics. Stepwise hierarchical regressions were conducted to examine how adolescent attributes predicted depression, anxiety, and dissociation beyond the prediction based on sexual abuse. A combination of self-esteem, anxiety attachment, and family cohesiveness made sexual abuse insignificant when predicting levels of depression, anxiety, and dissociation. This study contributes to characterizing the emotional, personal, and family attributes of adolescents who experienced sexual abuse. It also raises questions about the clinical outcomes usually associated with sexual abuse.     

Career Salience of Institutionalized Adolescent Offenders

This study investigated self-esteem and career salience of institutionalized adolescent offenders in the context of Super's (1980) lifespan career development theory. Participants were 185 male adolescents. Results indicated that participation, commitment, and values expectations in home-family roles contribute significantly to self-esteem in adolescent offenders. Additionally, adolescent offenders differ from adolescent non-offenders on home-family and work roles, with adolescent offenders scoring higher. Implications for career counseling of institutionalized adolescent offenders for transition into the community are discussed.     

The Effect of Negative and Positive Childhood Divorce Experiences on Professional Performers

The purpose of this study was to provide an in-depth analysis of divorce by comparing levels of depression, anxiety, self-esteem, and availability of resources between professional performers who were children from divorces considered negative, divorces considered positive or neutral, and professional performers raised in 2-parent households. The results of this study indicated that performers raised in divorced families reported more depression, more anxiety, and lower levels of self-esteem than those who were raised in intact families. Additionally, results indicated that those who were raised in neutral to positive divorced families reported less depression, less anxiety, and higher levels of self-esteem than did those stemming from negatively divorced families. Implications for treatment and directions for future research are presented.     

Indirect Over-Time Relations Between Parenting and Adolescents’ Sexual Behaviors and Emotions Through Global Self-Esteem

The present study examined indirect over-time relations between parenting and adolescent sexuality through global self-esteem. Three waves of online questionnaire data were collected among a community sample of 1,116 Dutch adolescents (M = 13.9 years at baseline). Participants rated the quality of their relationship with parents, their global self-esteem, and their experience with various sexual behaviors. Sexually experienced adolescents (n = 168) evaluated their sexual experiences using six emotions. Path model results showed that a higher-quality relationship with parents at T1 predicted higher levels of self-esteem at T2, which in turn predicted less experience with sexual behaviors and more positive sexual emotions at T3. The indirect over-time path from relationship quality through self-esteem to adolescents’ sexual emotions was significant; the indirect path to adolescents’ experience with sexual behaviors was not significant at the .05 level. No significant age or gender differences were found in the path models. The findings indicate that self-esteem plays an important role in adolescent sexuality and that parents can contribute to positive sexual experiences of adolescents indirectly—through the enhancement of self-esteem—by fostering a high-quality relationship with their children. Implications for theory, future research, and strategies to promote healthy and positive youth sexuality are discussed.     

Male victims of sexual abuse: An analysis of adolescent psychiatric inpatients

All too often it has been assumed that male victims of sexual abuse are simply similar to their female counterparts. The present study compares the psychological and substance use statuses of sexually abused adolescent male psychiatric inpatients with nonsexually abused adolescent male psychiatric inpatients. Data were collected from 166 male patients consecutively admitted to a 24-bed adolescent psychiatric unit. Abused adolescent males showed significant differences in several domains: they used drugs more frequently, were more depressed, had lower self-esteem, were more hopeless about the future, had more difficulty controlling sexual feelings, and were more concerned about their appearance than their nonabused counterparts. Implications for investigation, treatment, and training are discussed.     

The power of irony in an adolescent residential psychiatric program

This 1-year ethnographic study, conducted in an inpatient adolescent psychiatric unit, was guided by the research question, "What is it like for patients, families, and staff to be participants in an adolescent psychiatric program?" Verbal irony was observed to be a prominent communicative behavior among the staff and patients, suggesting a general freedom of expression and flexible boundaries. This form of expression, using nonliteral language skills encompassing a variety of humor and sarcasm, was found to promote professional solidarity and adolescent self-esteem, accelerate adolescent social skills, and offer a means of coping with the stigma of emotional and behavioral disorders.     

The Clinical Relevance of Divergence in Adolescent–Parent Reports of Adolescent Depression and Anxiety

This study examines associations between adolescent problem behaviors and adolescent–parent disagreement in ratings of adolescent depression and anxiety symptoms. Adolescent–parent dyads (N?=?463; mean age?=?12.68 years; 48.5% female; 78.2% White and 21.8% non-White) reported on adolescent depression and anxiety using parallel scales from the Youth Self Report (Achenbach et al., J Emot Behav Disord 10:194–203, 2002) and the Child Behavior Checklist (Achenbach and Rescorla, The manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2001) across four waves. Generalized estimating equations were used to examine the relationship between discrepancy scores and adolescent behavioral outcomes: incidence of adolescent past-year substance use (alcohol use, binge drinking, marijuana use, and nonmedical use of controlled medications), delinquency, self-harm behavior, and aggression. Findings showed that larger adolescent–parent divergence scores of depression were associated with higher odds of marijuana use, non-medical use of controlled medications, alcohol use, binge drinking, in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Results further revealed that larger divergence scores on anxiety were associated with higher odds of in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Adolescent–parent reporting discrepancy on adolescent’s depression and anxiety symptoms may be indicative of adolescent’s social, emotional, and behavioral problems, and the disagreement may signal further need for assessment of the adolescent.     

Sexual abuse: Effects of group therapy on pre-adolescent girls

This article describes the effectiveness of a group therapy program used at the University of Manitoba with pre-adolescent girls who have experienced sexual abuse. Thirty-five girls, ranging in age from 7 to 12, were referred to structured therapy groups of 9 to 12 weeks' duration. Issues addressed in weekly sessions included feelings about the offender, problem-solving, sex education, and prevention of further abuse. Measurements of self-esteem, anxiety, and internalizing and externalizing behaviour problems were taken for participating children prior to and following treatment at 1 and 9 to 12 month intervals. Parent- and child-reported social validity data were also collected following treatment. Comparison group data for self-esteem and anxiety were provided by a non-random sample of 35 girls with no known history of sexual abuse. Results indicated that following group therapy, self-esteem increased and anxiety and behaviour problems decreased. Comparison group data further supported the effectiveness of group treatment in improving the self-esteem of sexually abused girls. Social validity reports of children and parents also suggested that treatment was helpful and worthwhile. Implications of the findings are discussed as are difficulties encountered in conducting treatment outcome research with children who have been sexually abused.     

The Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety

Despite the efficacy of cognitive-behavioral therapy (CBT) in treating adolescent anxiety, few sufferers seek treatment. Barriers to accessing psychologists include a shortage of skilled therapists, long waiting lists, and affordability. The Internet is a medium possibly able to address issues of accessibility and affordability. This study aimed to assess the efficacy of online therapy in the treatment and prevention of adolescent anxiety and depression. Participants (N = 38) were randomly allocated to one of four conditions: online CBT, face-to-face CBT, combined face-to-face/online CBT, and control. Combined face-to-face/online CBT is more effective in treating symptoms of depression and anxiety compared to stand-alone online or face-to-face therapy. The present study suggests that for those who are unable to access face-to-face therapy, computerized therapy may be a viable option. This is an important finding, especially in light of current capacity to treat and accessibility problems faced in the treatment of adolescent depression and anxiety.     

The Relationship Between Stepdaughters' Self-Esteem and Perceived Parenting Behavior

Abstract

The purpose of this study was to examine the relationship between self-esteem of adolescent females living in stepfamilies and perceived parenting practices. Female adolescents from stepfamilies completed the Rosenberg Self-Esteem Scale and the Parent Behavior Form for each parent (mother, stepfather, and nonresidential father). Results consistent with hypotheses derived from the theory of reflected appraisal suggested that when perceived stepfathers' parenting behavior is compared to that of mothers, the former was more highly related to stepdaughters' self-esteem than is the latter. Moreover, perceived nonresidential fathers' parenting behavior was not related to self-esteem. In light of these findings, suggestions for parenting in stepfamilies were made.     

Individual differences in referral for help for severe emotional difficulties in adolescence

Adolescents with emotional distress may find help-seeking an extremely daunting endeavor. However, different adolescent population sectors relate differently to help-seeking for severe emotional difficulties. Gender and ethnic group are among the central factors influencing attitudes towards seeking emotional help. One of the possible mechanisms explaining these cross-group differences is self-esteem. The psychological price of seeking help could be admission of incompetence and feelings of failure, emotions that can be threatening, particularly to adolescents' self-esteem. In the present study, the psychological price of seeking help was manipulated by comparing the ease with which adolescents would self-refer for a severe emotional problem as opposed to referring another for the same problem, and the influence of gender, ethnic group differences and level of self esteem in both situations. The first hypothesis predicting greater ease of referral in the other-referral condition compared to self-referral was confirmed. The second hypothesis predicting general preference of informal help agents than the formal help agents was confirmed. The third hypothesis predicting gender differences such that girls would show higher ease of referral than boys from the different help agents was confirmed. The fourth hypothesis predicting that Jewish-Israeli adolescents would show greater ease of referral than Arab-Israeli adolescents was confirmed. An additional exploratory question examined the interaction between self-esteem and self versus other-referral on ease of referral for help. A significant interaction emerged only for help from the family. Adolescents with low self-esteem showed no differences in self versus other-referral, but adolescents with high self-esteem were more willing to refer others than themselves to seek help. These findings emphasize the importance of a sensitive needs assessment approach in designing mental health service delivery for youth.     

Attachment Insecurities and Women's Sexual Function and Satisfaction: The Mediating Roles of Sexual Self-Esteem,Sexual Anxiety,and Sexual Assertiveness

We examined the potential role of three mediators—sexual self-esteem, sexual anxiety, and sexual assertiveness—of the association between romantic attachment insecurities (anxiety and avoidance) and two aspects of women's sexual functioning: sexual function and sexual satisfaction. A sample of 556 women aged 18 to 30 agreed to complete an online series of validated questionnaires assessing attachment insecurities and several aspects of sexual functioning. Lower sexual self-esteem and higher sexual anxiety mediated the associations between attachment anxiety and lower sexual function and satisfaction. Lower sexual self-esteem and higher sexual anxiety also partially mediated the links between attachment-related avoidance and the two sexual functioning variables. Sexual assertiveness, however, did not mediate these associations. A significant interaction between attachment anxiety and avoidance was also found to predict sexual satisfaction, with women high in avoidance and low in anxiety being the least satisfied. Results are discussed in terms of theoretical and clinical implications.     

Discrimination,mental health,and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model

The purpose of the current study was to examine the relationships among discrimination, mental health, and body image in a national sample of transgender adults. Participants (N = 78) identified as transgender, genderqueer, or other gender-non-binary identities and were recruited via a national online survey. Harassment/rejection, work/school, and other discrimination explained 10.4% of the variance in body appreciation, while satisfaction with life, anxiety, self-esteem, and depression explained 60.7%. Within these models, harassment/rejection was inversely associated with body appreciation, while self-esteem and satisfaction with life were positively associated. A series of path models moving from a measurement model to a more parsimonious and excellent-fitting model found that the effect of harassment/rejection on body appreciation was fully mediated by self-esteem and satisfaction with life, resulting in a multiple mediation.     

Internalizing Symptoms in Adolescents: Gender Differences in Vulnerability to Parental Distress and Discord

This longitudinal study investigated gender differences in the relation between (1) internalizing symptoms of depression and anxiety reported by adolescents, and (2) emotional distress and marital discord reported by their mothers. Structural equation modeling was used to track the relationship between these variables in a community sample of 116 males and 101 females and their parents across three data intervals roughly corresponding to early adolescence (M = 11,4), mid‐adolescence (M = 13,7), and late adolescence/early adulthood (M = 19,2). For early adolescents, there were no gender differences in the relation between internalizing symptoms and parental distress and discord. Gender differences did emerge, however, by midadolescence, at which time parental disturbances were significantly associated with internalizing symptoms in adolescent females but not adolescent males. The emergence of this risk factor during this developmental phase may help account for frequent findings that place adolescent females at higher risk for anxiety and depression than adolescent males.     

Influences on Adolescent African American Females' Global Self-Esteem

Abstract

This study of 105 senior high school Southern African American adolescent females examined the relationship between global self-esteem, appearance evaluation (body image), and ethnic identity. As predicted, the relationship between global self-esteem, appearance evaluation (r = .46, p < .001), and ethnic identity (r = 40, p < .001) were significant and positive. The young women who rated their self-esteem high also scored high on the appearance evaluation (63%) and ethnic identity achievement measures. Therefore, these young women are expected to spend more time on self-enhancing behaviors and less time on self-limiting behaviors (early sexual involvement, drugs, etc.).     

A moratorium for growth: Group work with adolescent mothers

An urban child welfare agency ran a group for single, adolescent mothers based on the premise that the young mothers needed as much nurturing as their babies. Essential elements in the program were the provision of transportation to and from the weekly meetings, childcare, food for the teenagers, and a male/female co-therapy team. The group continued for over two years, allowing a psychosocial moratorium in which the adolescents could continue their developmental growth. At termination and later at a reunion of the group, the mothers were seen as young women with the capacity for both the partnerships and sacrifices of adulthood, with increased self-esteem, and confidence in their newly-developed parenting skills.     

Panel discussions

Objective.?To determine (a) the relationship between life satisfaction, anxiety, depression and ageing in the male community and (b) to identify the impact of vulnerability factors, personal and social resources on life satisfaction and distress.

Design.?A stratified random sample of the German male population (N?=?2144) was investigated by standardized questionnaires of life satisfaction (FLZ^M), depression, anxiety (PHQ), resilience (RS-11) and self-esteem (RSS).

Results.?No age-related change was found regarding overall life satisfaction. Satisfaction with health decreased in midlife (51–60 years), while the importance of health increased. Importance of and satisfaction with partnership and sexuality were only reduced in the oldest group (70+). Anxiety was highest around midlife (51–60 years), accompanied by reduced resilience and self-esteem. No clear age-related change was found regarding depression. Life satisfaction was strongly associated with resilience, lack of unemployment, the presence of a partnership, positive self-esteem, a good household income, the absence of anxiety and depression and living in the Eastern states.

Conclusions.?Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in ageing men. There is also evidence for a crisis around midlife manifested by health concerns, anxiety and reduced resilience.     

Negotiating Family

Abstract

This study sought to determine how several child-rearing behaviors within the Chinese parent-adolescent relationship were predictive of youthful self-esteem through either collectivistic or individualistic socialization approaches. Theoretically based relationships were tested with structural equation modeling to examine whether dimensions of parental behavior (i.e., support, reasoning, monitoring, and punitiveness) influenced the self-esteem of Chinese adolescents through the mediating influences of either conformity (i.e., collectivism) or autonomy (i.e., individualism) in reference to parents. The sample for this study consisted of 497 adolescents from Beijing, China, ranging in age from 12-19 years of age. Data were acquired with self-report questionnaires administered in school classrooms. Results provided support for parental behaviors as predictors of self-esteem development through individualistic patterns of socialization. Although collectivistic parent-adolescent patterns did not predict the self-esteem of Chinese adolescents, several results supported a collectivistic conception of socialization through significant relationships involving parental behaviors as predictors of adolescent conformity to parents. Some results of this study highlight the significance of parental support and dimensions of moderate parental control (e.g., reasoning and monitoring) within the Chinese parent-adolescent relationship, while identifying only a minimal role for punitive behavior.     

Natural Mentoring Relationships Among Adolescent Mothers: A Study of Resilience

This study focused on natural mentoring relationships between nonparental adults and African American adolescent mothers. Data were collected from 93 adolescent mothers over 5 time points, starting in the adolescent mothers' senior year of high school and ending 5 years after high school. We found that having a natural mentor was related to fewer depressive symptoms and fewer anxiety symptoms over time. Natural mentor presence also modified the relationship between stress and mental health problems over time. Facilitating these natural mentoring relationships between adolescent mothers and nonparental adults may be a useful strategy for promoting healthy development within this population.     

Hispanic Adolescent Girls’ Attitudes Toward School

Hispanic adolescent girls are at elevated risk for dropping out of school. The authors interviewed 54 Hispanic adolescent girls who were attending after-school programs in the New York metropolitan area. The study investigated how the multiple factors of mother–daughter and friend mutuality, coping, acculturation, self-esteem, depression and family environment influenced the way these girls felt about school. The final logistical regression analysis appeared to support our hypothesis that girls who have a higher degree of mutuality with their mothers will be more likely to like school a lot. In addition, girls who liked school a lot were significantly more likely to have higher overall grades and to be somewhat religious. Findings are discussed within the context of the empirical and theoretical literature and implications for prevention of school drop-out are considered.