The long-term effects of being bullied or a bully in adolescence on externalizing and internalizing mental health problems in adulthood.

BACKGROUND: The aim is to examine associations between bullying involvement in adolescence and mental health problems in adulthood. METHODS: Information on bullying-involvement (being bullied, bully-victim, aggressive toward others) and non-involved was collected from 2464 adolescents in Mid-Norway at mean age 13.7 and again at mean age 14.9. Information about mental health problems and psychosocial functioning was collected about 12 years later at mean age 27.2 (n = 1266). RESULTS: All groups involved in bullying in young adolescence had adverse mental health outcomes in adulthood compared to non-involved. Those being bullied were affected especially regarding increased total sum of depressive symptoms and high levels of total, internalizing and critical symptoms, increased risk of having received help for mental health problems, and reduced functioning because of a psychiatric problem in adulthood. While those being aggressive toward others showed high levels of total and internalizing symptoms. Both those being bullied and bully-victims showed an increased risk of high levels of critical symptoms. Lastly, all groups involved in bullying on adolescence had increased risk of psychiatric hospitalization because of mental health problems. CONCLUSION: Involvement in bullying in adolescence is associated with later mental health problems, possibly hindering development into independent adulthood.

Is obesity associated with reduced health-related quality of life in Latino, Black and White children in the community?

OBJECTIVE: Few studies have examined the impact of obesity on health-related quality of life (HRQOL) in non-clinical community samples of children, and methodological limitations have hindered drawing firm conclusions, especially whether the impact is similar across racial/ethnic groups. The present aims were to examine at what levels of non-normal weight, school-aged children experience lower HRQOL and whether this differs among racial/ethnic groups, when controlling for socioeconomic status (SES) differences. DESIGN: Cross-sectional community cohort survey. SUBJECTS AND METHODS: Data are from the Healthy Passages, reporting on 4824 Latino, black and white 5th graders in a population-based survey conducted in three United States metropolitan areas. Children's weight status was classified from measured weight and height into underweight (1%), normal weight (52%), overweight (19%), obese (13%) and extremely obese (14%). Children reported their own HRQOL using the Pediatric Quality of Life Inventory and additional scales addressing global self-worth, physical appearance and body satisfaction. Parents reported children's overall health status. RESULTS: Each increment in higher non-healthy weight class-overweight to obese to extremely obese-was associated with significantly lower scores in more domains of psychosocial HRQOL compared with that in normal weight. However, only extremely obese children reported significantly lower physical HRQOL. Differences among weight classes remained when adjusting for SES and were independent of race/ethnicity. Underweight children generally reported HRQOL that was not significantly different from normal weight children. CONCLUSIONS: Overweight, obese and extremely obese 5th graders on average experience worse HRQOL than normal weight children, especially in psychosocial domains including self-worth and peer relationships, regardless of race/ethnicity. If messages can be conveyed in a sensitive and supportive manner, the desire to improve HRQOL could provide additional motivation for children and their parents in addressing unhealthy weight.

Risk factors for psychopathology in children with intellectual disability: a prospective longitudinal population-based study.

BACKGROUND: This study examined risk factors for the development of psychopathology in children with intellectual disability (ID) in the developmental, biological, family and social-ecological domains. METHODS: A population sample of 968 children, aged 6-18, enrolled in special schools in The Netherlands for educable and trainable ID were assessed at Time 1. A random 58% were re-contacted about 1 year later, resulting in a sample of 474 at Time 2. RESULTS: Psychopathology was highly consistent over 1 year. Risk factors jointly accounted for significant, but small, portions of the variance in development of psychopathology. Child physical symptoms, family dysfunction and previous parental mental health treatment reported at Time 1 were uniquely associated with new psychopathology at Time 2. CONCLUSIONS: Prevention and early intervention research to find ways to reduce the incidence of psychopathology, possibly targeting family functioning, appear important.

Quality of life measurement in children and adolescents: issues, instruments, and applications.

There is increasing interest in measuring quality of life (QL) in children and adolescents, but this interest has developed without careful attention given numerous important issues. Consequently, there is much diversity and confusion in this measurement area. We discuss at a conceptual level herein how to construe and define QL, approach its measurement, and the implications of for whom this is done. Methodological issues pertaining to validation, proxy report, and child development are also discussed. Guidelines for selecting QL measures are provided and a set of generic QL measures is recommended for further consideration. Finally, applications of the QL concept in the policy, service and care, and science areas are delineated.

Growing or just getting along? Technical and adaptive competence in coping among adolescents.

This study examined coping among African American adolescents with learning disabilities. Ninety-seven African American adolescents and their mother or primary caregiver participated in the study. The study centered on a new conceptual distinction between technical competence in coping and adaptive competence in coping. Technical competence referred to short-term, reactive attempts at coping based on individuals' abilities to find techniques for reducing their feelings of distress. Adaptive competence referred to longer-term, developmental processes of adaptive change that resulted in more global benefits for the individual. Past literature was reassessed on the basis of this conceptual distinction, and a new model of technical and adaptive competence in coping was proposed based on developmental theory. Perceptions of coping efficacy and the incidence of behavioral problems were regressed on measures of technical and adaptive competence in coping. Results were explored first as a general test of the model on the total sample, and second as a comparative analysis between gender subsamples. Total sample findings were consistent with hypothesized results. Technical competence was a better predictor of feelings of efficacy and adaptive competence was a better predictor of behavioral problems. Gender subsample differences were significant and supported a picture of gender-typed approaches to coping.

Cultural factors enhancing resilience and protecting against maladjustment in African American adolescents with mild mental retardation.

Researchers have found elevated risk for maladjustment associated with being an African American adolescent in an urban environment as well as being an individual with mental retardation. The culturally relevant factors of ethnic identification, intergenerational support, and church support were investigated in relation to high risk exposure on maladjustment in 147 urban African American adolescents enrolled in EMR special education classes. Maladjustment was measured with both self- and parent-report. Risk exposure was measured in the personal, social, and community domains. Results indicate that presence of cultural factors were associated with better adjustment generally. Furthermore, ethnic identification appeared to protect adolescents exposed to high-risk conditions against experiencing significantly elevated maladjustment. Implications of culture on intervention and prevention were discussed.

Effects of pediatric chronic physical disorders on child and family adjustment.

Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

Health risk behaviors of African American adolescents with mild mental retardation: prevalence depends on measurement method.

Health risk behaviors (e.g., substance use, violence, suicide, and car safety) of 194 14- to 17-year-old African American urban adolescents with mild mental retardation from special education classes were measured. One group was assessed using a confidential individual interview method, and an individually matched group was assessed with an anonymous group survey method. Participants completing the anonymous survey reported engaging more frequently in risk behaviors that respondents typically consider sensitive. In comparison to national and state populations of African American adolescents, urban African American adolescents with mild mental retardation appear to be at substantial elevated risk for engaging in alcohol binge drinking and weapon and gun carrying. Findings were discussed relative to cognitive and social deficits inherent in mild mental retardation.

Daily activity level buffers stress-glycemia associations in older sedentary NIDDM patients.

Examined glycemic associations with medical variables, activity, daily stress, and mood state in 72 older patients with non-insulin-dependent diabetes mellitus (NIDDM). On three occasions over a 2-week observation period, subjects provided measures of everyday life stress, negative mood state, and daily activities. At the end of this period, fructosamine was assayed to measure glycemic control throughout the assessment period. After controlling for medical variables (age, illness duration, body mass index, caloric intake, and activity) and the main effects of psychological factors (stress; anxious, angry, and depressed mood states), stress interacted with activity such that glycemic elevation was positively associated with stress for subjects below the activity median but not for those above the median. This was unattributable to any overall activity-related differences in fructosamine, stress, or mood. None of the mood states interacted with activity. The findings suggest that extremely low levels of activity may strengthen life stress-glycemia associations in NIDDM.

Handicap-related problems in mothers of children with physical impairments.

An inventory was developed for the measurement of handicap-related problems experienced by mothers of children with chronic physical conditions and an initial evaluation of its psychometric properties was completed in a sample of 119 mothers of children with physical or sensory impairments. Principal component analysis of the Handicap-related Problems for Parents Inventory (HPPI) yielded three subscales, which accounted for 54% of the total variance. The HPPI demonstrated excellent internal consistency for each scale and total score. It also generally had good test-retest reliability over 6-, 12-, and 18-month periods. There was minimal covariation between HPPI scores and demographic status. Concurrent validity was demonstrated by significant correlations between appropriate HPPI scales and measures of daily stress and the child's physical condition or disability status. Support for its construct validity was obtained when expected convergent and discriminant relationships were confirmed between HPPI scales and measures of maternal adaptation, maternal social support, and child behavior problems. Among other results, HPPI scores predicted maternal adaptation 18 months later. The potential uses of the HPPI in research and intervention with mothers of children with chronic physical conditions were discussed.

Perceived problem-solving ability, stress, and coping in mothers of children with physical disabilities: potential cognitive influences on adjustment.

Examined the contribution of perceived problem-solving ability to the adjustment of mothers of children with a physical disability, in conjunction with appraised disability-related stress and approach and avoidance coping, as a further evaluation of Wallander and Varni's Disability-Stress-Coping model emphasizing cognitive processes. One hundred sixteen mothers of children, ages 2 to 20, with spina bifida or cerebral palsy completed measures of relevant constructs. Results show that the mother's appraisal of disability-related stress is strongly associated with her reported maladjustment. However, perceptions of competence in problem solving are associated with better overall adjustment. A portion of this relation appears mediated by coping styLe, as confidence in one's problem-solving ability increases so does the likelihood of selecting more adaptive coping strategies when faced with disability-related stress. Overall, consideration of perceived problem-solving ability appears to make a valuable contribution to the Disability-Stress-Coping model and to current understanding of the experience of coping with raising a child with a disability. Perceived problem-solving ability can also be linked to clinical intervention, as discussed.

Development and evaluation of a measure of concerns related to raising a child with a physical disability.

Developed a measure of perceived disability-related stress, the Parents of Children with Disabilities Inventory (PCDI). A content analysis of concerns expressed by mothers identified four primary domains: Medical and Legal Concerns, Concerns for the Child, Concerns for the Family, and Concerns for the Self. Item analysis performed on an initial item pool administered to 48 mothers recruited from area spina bifida and cerebral palsy clinics identified 40 items for further investigation. Psychometric evaluation of this final version was, performed based on additional data collected from 63 mothers from the same clinics. The organization and reliability of the PCDI were confirmed through traditional measures of internal consistency and test-retest reliability over a 2-month interval. Preliminary support for the construct validity of the PCDI was provided through the confirmation of several hypothesized relationships. Scores on the PCDI were significantly related to maternal mental and physical health. Concerns for the Self scale made a significant unique contribution to these prediction models. Findings provide preliminary support for the PCDI being an appropriate and informative measure of perceived disability-related stress to be used with mothers of children with physical disabilities.

Perceived role restriction and adjustment of mothers of children with chronic physical disability.

Examined the relationship between maternal perceived role restriction, the extent to which a mother feels unable to pursue her own interests due to responsibilities with raising a child with a chronic physical condition, and psychosocial adjustment in 50 mothers with children 6-11 years old who had a chronic physical disability. Perceived role restriction accounted for a significant increment in the variation in adjustment beyond that contributed by objective indices of the child's disability. Neither these objective parameters of the child's disability nor his or her level of problem behaviors predicted perceptions of role restriction. However, perception of social support did. The potential role of intrapersonal processes was discussed as a neglected component of a multidimensional model of adjustment in mothers of children with a chronic physical condition.

A nomothetic-idiographic study of daily psychological stress and blood glucose in women with type I diabetes mellitus.

Although there has been some study of the extralaboratory generality of stress effects on diabetic metabolism, analysis of the diabetic response to everyday life stress is needed. The secondary objective of this study was to investigate whether personal characteristics moderate the daily stress-glucose relationship. Twenty-five women with Type I diabetes completed measures of internality and self-esteem and subsequently monitored daily stress and blood glucose for 30 consecutive days. Data were analyzed by both time-series and conventional correlational analyses. Glucose was higher on high-stress days than on low-stress days, with one-third of the sample showing significant positive associations between stress and same-day glucose. However, stress showed little relation to next-day glucose. Personal characteristics failed to explain differences in stress-glucose associations. Implications for practice and future research are presented.

Theory-driven research in pediatric psychology: a little bit on why and how.

Introduces a Special Issue, covering two published issues (5 and 6) of this journal, on theory-driven research in pediatric psychology. A rationale for conducting research from a conceptual basis is presented. It is emphasized that science is primarily an intellectual activity, demonstrated in the form of theory building, testing, and reformulation. Furthermore, it is argued theory serves as a planning and communication aide for scientific pursuit. The process and components of theory-driven research are then highlighted. Theoretical constructs, theoretical and empirical definitions of constructs, and the use of variables are discussed. A definition of scientific theory is offered. Theory testing is distinguished from post hoc theorizing. Differences in the scope of theories are noted. Connections between theory and hypothesis testing and research design are addressed, especially for nonexperimental or correlational research.

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type I diabetes mellitus: evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Child functional independence and maternal psychosocial stress as risk factors threatening adaptation in mothers of physically or sensorially handicapped children.

This study investigated the contribution of child functional independence and maternal psychosocial stress to the adaptation of 119 mothers. Each mother had a child, aged 2-18 years, with a physical or sensory disability. Multiple dimensions of each construct were measured through self-report. Child functional independence did not uniquely explain variation in mothers' adaptation. However, maternal stress was uniquely associated with maternal mental health, but not physical health or social functioning, even when controlling for demographic status, disability type, and functional independence. Daily hassles and handicap-related psychosocial stress in particular put mothers at risk for reporting mental health problems.

The social environment and the adaptation of mothers of physically handicapped children.

Evaluated relationships between social environmental characteristics and adaptation in 50 mothers of congenitally physically handicapped 6- to 11-year-old children. Mothers reported on utilitarian resources, child adjustment, psychosocial family resources, service utilization, and three dimensions of adaptation. Analyses of the concurrent correlational design indicated significant proportions of the variance in mental and social functioning were explained by features of the social environment. Mother's physical health could not be significantly predicted. Consistently strong contributions were made by psychosocial family resources in all adaptation domains.

Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children.

The hypothesis that their psychological adjustment is related in part to resources present in their families was investigated in 153 children, age 4-16, who had one of five chronic physical disorders: juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy. Their mothers completed standardized psychometric instruments to measure specific dimensions of family psychological and utilitarian resources and of child adjustment. Variation in children's psychological adjustment was related both to their psychological and utilitarian family resources. Psychological family resources contributed uniquely to the prediction of adjustment beyond that provided by utilitarian family resources. These results are discussed as having implications for the identification of chronically ill and handicapped children at risk for adjustment difficulties.