Jessica L. Schleider

Implicit theories and youth mental health problems: a random-effects meta-analysis.

Compared to youths who believe that personal traits are malleable, those who believe that personal traits are fixed experience more academic and self-regulatory distress. Recently, studies have begun to explore relations between beliefs about the malleability of personal traits, or implicit theories, and youth mental health problems. We synthesized this emerging body of research in youths (ages 4-19) across 45 effect sizes from 17 research reports. Studies were included if they assessed youth mental health and implicit theories and did not manipulate implicit theory or affective/behavioral states prior to measuring these variables. Our random-effects meta-analysis using clustered data analysis techniques (i.e., effect sizes nested within samples) revealed that youths holding entity theories-the belief that personal traits are fixed-showed more pronounced mental health problems. This association between entity theories and mental health problems was evident across methodological factors and problem types (internalizing versus externalizing; psychopathology versus general distress). Limitations include the small number of eligible studies, insufficient data to test further demographic moderators, and few longitudinal studies on this topic. Overall, findings support the value of parsing the implicit theory-mental health link in youths. Implicit theories may prove to be promising targets for treatment and prevention of youth mental health problems.

Family process and youth internalizing problems: A triadic model of etiology and intervention

Despite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic model of family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the models implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.

Sequential Comorbidity of Anxiety and Depression in Youth: Present Knowledge and Future Directions

Research suggests that a history of childhood anxiety correlates with and predicts adolescent depression. The present review synthesizes current knowledge of relations between childhood anxiety and adolescent depression, focusing on the possibility that primary anxiety in childhood may cause secondary depression in adolescents. Across existing studies, evidence strongly supports childhood anxiety as a risk factor for adolescent depression, and long-term follow-up studies of cognitive-behavioral childhood anxiety treatments may suggest a causal anxiety-depression link. However, mechanisms underlying this relationship remain unexplored. Future directions include careful assessment of comorbidity between anxiety and depressive disorders, longitudinal evaluations of anxiety and depression following interventions for childhood anxiety, and investigations of mediators and moderators of the anxiety-depression link. Finally, mechanisms by which the treatment of childhood anxiety might prevent depression in adolescents are proposed.

Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Internalizing and Externalizing Problems

Child internalizing and externalizing problems have been identified as high priority intervention targets by the World Health Organization. Parental depression is a risk factor for development of these childhood problems and may negatively influence intervention outcomes; however, studies have rarely assessed its influence on these outcomes. The present study assessed whether baseline parental depressive symptoms predicted psychotherapy outcomes among children treated for clinically significant internalizing and externalizing problems. The sample included 142 children (79 with primary internalizing problems, 63 with primary externalizing problems). Children were aged 7–13, 67.6% boys, and race included Caucasian (46.5%), African-American (9.9%), Latino (5.6%), Asian (1.4%), and multi-racial (32.4%). Analyses focused on child- and parent-reported weekly trajectories of change and post-treatment symptoms among children treated for internalizing and externalizing problems whose parents did (N = 28 and 25) and did not (N = 51 and 38) have elevated depressive symptoms. For children with internalizing problems, growth curve analyses showed markedly different trajectories, by child- and parent-report: children with less depressed parents showed significantly steeper symptom declines than did children with more depressed parents, who showed an increase in symptoms. ANCOVAs showed marginally lower post-treatment symptoms for children of less depressed versus more depressed parents (p = 0.064 by child-report). For children with externalizing problems, growth curve analyses showed trajectories in the opposite direction, by child- and parent-report; however, ANCOVAs showed no group differences at post-treatment. These findings suggest that it may be important to consider the impact of parental depressive symptoms when treating child internalizing and externalizing problems.

Anxiety Sensitivity Moderates the Relation Between Family Accommodation and Anxiety Symptom Severity in Clinically Anxious Children

High levels of family accommodation (FA), or parental involvement in child symptoms, are associated with child anxiety symptom severity. The strength of associations has varied across studies, however, highlighting the need to identify moderating variables. We investigated whether anxiety sensitivity (AS) moderated the FA-anxiety symptom severity association in clinically anxious children (N = 103, ages 6–17; mean age 11.07 years). We collected child and mother ratings of FA, child anxiety symptom severity, and child AS ratings. AS significantly moderated the FA-child anxiety severity link. Specifically, this link was significant for low-AS but not high-AS children. Findings suggest that FA may operate in the typically observed fashion for low-AS children—alleviating immediate distress while inadvertently exacerbating longer-term anxiety—whereas high-AS children may experience distress following anxiety-provoking stimuli regardless of FA. Assessing AS in research and clinical settings may help identify subsets of children for whom FA is more closely tied to anxiety severity.

Perceived Peer Victimization Predicts Anxiety Outcomes in a Prevention Program for Offspring of Anxious Parents

Offspring of anxious parents are at heightened risk for developing anxiety disorders. Preventive interventions for these youths are promising but not universally effective, creating a need to identify outcome predictors. Peer experiences (e.g., peer victimization, social support) are associated with youth anxiety trajectories but have been relatively unexplored in this context. Thus, this study tested whether peer experiences predicted anxiety-related outcomes in families participating in a randomized controlled trial of a child anxiety prevention program for families with a clinically anxious parent. Parental anxiety severity was also examined as a moderator of relations between peer experiences and subsequent child anxiety. Participants were 121 families (child M age = 8.69, 55.90% girls). Hierarchical logistic and linear regressions were used to test whether baseline peer-related factors predicted increased anxiety symptom severity and anxiety disorder onset over 12 months. Youths reporting greater perceived peer victimization at baseline were more likely to develop an anxiety disorder and had more severe anxiety symptoms 12 months later. Lower social support from classmates also predicted increased anxiety severity, but this effect became nonsignificant after accounting for peer victimization. Further, parental anxiety severity moderated the peer victimization–child anxiety severity link: Higher child-reported peer victimization predicted increased anxiety in offspring of highly and moderately anxious but not low anxious parents. Children’s reports of peer victimization appear important for understanding which youth may not respond to preventive interventions in high-risk families—especially for children with more severely anxious parents. Implications for the focus of selective anxiety prevention programs are discussed.

Parent Expectancies and Preferences for Mental Health Treatment: The Roles of Emotion Mind-Sets and Views of Failure

Because parents are primary gatekeepers to mental health care for their children, parental expectations that mental health treatment is ineffective may undermine treatment seeking, retention, and response. Thus, a need exists to understand parents’ expectations about treatment and to develop scalable interventions that can instill more favorable views. We examined parents’ treatment expectancies and preferences for their offspring and themselves in relation to two global beliefs: mind-sets (malleability beliefs) of emotions and anxiety, and views of failure as enhancing versus debilitating. Study 1 (N = 200; 49.5% fathers; 70.4% Caucasian) examined associations among parents’ emotion mind-sets, anxiety mind-sets, failure beliefs, and treatment expectancies and preferences. Study 2 (N = 430; 44.70% fathers; 75.80% Caucasian) tested whether online inductions teaching “growth emotion mind-sets” (viewing emotions as malleable), adaptive failure beliefs, or both improved parents’ treatment expectancies and hypothetical preferences for treatment (vs. no-treatment). Participants received one of three 8- to 15-min inductions or a psychoeducation control, rating treatment expectancies. and preferences pre- and postinduction. In Study 1, fixed emotion mind-sets and failure-is-debilitating beliefs were associated with lower parent psychotherapy expectancies for offspring and themselves and stronger “no-treatment” preferences for offspring. In Study 2, inductions teaching (a) growth emotion mind-sets only and (b) growth emotion mind-sets and failure-is-enhancing beliefs improved parents’ psychotherapy expectancies for themselves (ds = .38, .51) and offspring (ds = .30, .43). No induction increased parents’ hypothetical preferences for treatment (vs. no-treatment). Findings suggest scalable strategies for strengthening parents’ psychotherapy effectiveness beliefs for themselves and their children.