Social Phobia and Depression in Adolescence in General Population

197 Pages·2015·1.72 MB·English

JUHA-MATTI VÄÄNÄNEN
Social Phobia and Depression in
Adolescence in General Population
Concurrent associations
and 2 year follow up
ACADEMIC DISSERTATION
To be presented, with the permission of
the Board of the School of Medicine of the University of Tampere,
for public discussion in the Small Auditorium of Building B,
School of Medicine of the University of Tampere,
Medisiinarinkatu 3, Tampere, on April 17th, 2015, at 12 o’clock.
UNIVERSITY OF TAMPERE
JUHA-MATTI VÄÄNÄNEN
Social Phobia and Depression in
Adolescence in General Population
Concurrent associations
and 2 year follow up
Acta Universitatis Tamperensis 2040
Tampere University Press
Tampere 2015
ACADEMIC DISSERTATION
University of Tampere, School of Medicine
Tampere University Hospital, Department of Adolescent Psychiatry
Finland
Supervised by Reviewed by
Professor Riittakerttu Kaltiala-Heino Professor Pirjo Mäki
University of Tampere University of Oulu
Finland Finland
Professor Mauri Marttunen Docent Jani Penttilä
University of Helsinki University of Tampere
Finland Finland
The originality of this thesis has been checked using the Turnitin OriginalityCheck service
in accordance with the quality management system of the University of Tampere.
Copyright ©2015 Tampere University Press and the author
Cover design by
Mikko Reinikka
Distributor:
[email protected]
http://granum.uta.fi
Acta Universitatis Tamperensis 2040 Acta Electronica Universitatis Tamperensis 1529
ISBN 978-951-44-9760-5 (print) ISBN 978-951-44-9761-2 (pdf)
ISSN-L 1455-1616 ISSN 1456-954X
ISSN 1455-1616 http://tampub.uta.fi
Suomen Yliopistopaino Oy – Juvenes Print
Tampere 2015
P4a4i1n o t7u2o9te
To Maria, Mikael and Eemil

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Contents
List of original publications .................................................................................................... 11
Abbreviations ............................................................................................................................ 12
Abstract ...................................................................................................................................... 14
Tiivistelmä ................................................................................................................................. 16
1 Introduction ..................................................................................................................... 18
2 Review of the literature .................................................................................................. 21
2.1 Development in adolescence ............................................................................... 21
2.1.1 Development of identity .................................................................................. 21
2.1.2 Development of the brain ................................................................................ 22
2.1.3 Cognitive development ..................................................................................... 23
2.1.4 Developmental epidemiology and developmental psychopathology ........ 25
2.2 Psychiatric disorders in adolescence ................................................................... 32
2.2.1 Social phobia ...................................................................................................... 33
2.2.2 Depression .......................................................................................................... 35
2.3 Comorbidity and continuity of adolescent psychiatric disorders ................... 37
2.4 Concurrent and longitudinal associations between social phobia and
depression ............................................................................................................................. 39
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2.4.1 Comorbidity between social phobia and depression ................................... 39
2.4.2 Development of comorbidity between social phobia and depression ...... 40
2.4.3 Consequences of comorbidity between social phobia and depression ..... 40
2.4.4 Theories on the development of comorbidity between social phobia and
depression ......................................................................................................................... 42
2.5 Risk factors for adolescent psychiatric disorders .............................................. 43
2.5.1 Risk factors for social phobia .......................................................................... 44
2.5.2 Risk factors for depression .............................................................................. 45
2.5.3 Risk factors for comorbidity of social phobia and depression................... 46
2.5.4 Low self-esteem as a risk factor for social phobia and depression ........... 47
2.5.5 Low social support as a risk factor for social phobia and depression ...... 49
2.6 Gender differences in adolescence ...................................................................... 51
2.6.1 Gender differences in physical development ................................................ 51
2.6.2 Gender differences in the development of the brain .................................. 51
2.6.3 Gender differences in the epidemiology of psychiatric disorders and in
comorbidity ...................................................................................................................... 52
2.6.4 Gender differences in social phobia and depression ................................... 53
2.6.5 Gender differences in self-esteem .................................................................. 54
2.6.6 Gender differences in social support ............................................................. 55
2.7 Summary of the literature ..................................................................................... 57
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3 Aims of the study ............................................................................................................ 59
4 Materials and methods.................................................................................................... 60
4.1 Study design and data collection .......................................................................... 60
4.2 Ethical considerations ........................................................................................... 61
4.3 Attrition ................................................................................................................... 61
4.4 Measures .................................................................................................................. 64
4.4.1 Background......................................................................................................... 64
4.4.2 Social phobia (SP) .............................................................................................. 64
4.4.3 Depression (DEP) ............................................................................................. 65
4.4.4 Self-esteem (SE) ................................................................................................. 65
4.4.5 Perceived social support (PSS) ........................................................................ 66
4.4.6 Other measures .................................................................................................. 66
4.5 Missing values ......................................................................................................... 67
4.6 Covariates ................................................................................................................ 67
4.7 Concepts of comorbidity and heterotypic continuity ...................................... 67
4.8 Statistical methods ................................................................................................. 68
4.8.1 Methods for analysing associations between social phobia and depression
(I) 68
4.8.2 Methods for analysing associations between self-esteem and social phobia
and depression: Analyses for determining cut-points of RSES (II) ........................ 68
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4.8.3 Methods for analysing associations between self-esteem and social phobia
and depression: Self-esteem as a mediating factor (III) ............................................ 69
4.8.4 Methods for analysing associations between perceived social support and
social phobia and depression. (IV) ............................................................................... 70
4.9 Personal involvement ............................................................................................ 71
5 Results ............................................................................................................................... 72
5.1 Prevalence of social phobia, depression and comorbid social phobia and
depression (I) ........................................................................................................................ 72
5.2 Stability of social phobia, depression and comorbid social phobia and
depression (I) ........................................................................................................................ 75
5.2.1 Heterotypic continuity ...................................................................................... 75
5.2.2 Development of comorbidity .......................................................................... 75
5.2.3 Course of comorbidity ...................................................................................... 76
5.2.4 Social phobia as a risk factor for subsequent depression (I) ...................... 76
5.2.5 Depression as a risk factor for subsequent social phobia. (I) .................... 76
5.3 Associations between self-esteem and social phobia and depression ........... 77
5.3.1 The Rosenberg Self-esteem Scale discriminating adolescents with or
without DEP and SP (II) ............................................................................................... 77
5.3.2 Self-esteem according to depression and social phobia (III) ..................... 78
5.3.3 Self-esteem as a mediator of the association between earlier SP and
subsequent DEP, and vice versa. (III) ......................................................................... 82
5.4 Association between perceived social support and social phobia and
depression (IV) ..................................................................................................................... 82
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5.4.1 Perceived social support and current disorder status (IV) .......................... 82
5.4.2 Perceived social support as a risk factor for subsequent disorders (IV) .. 86
5.5 Gender differences and gender specific patterns .............................................. 88
5.5.1 Gender differences and gender specific patterns of the prevalence of
social phobia, depression and comorbid social phobia and depression. (I) .......... 88
5.5.2 Gender specific patterns in the association between social phobia and
depression (I) ................................................................................................................... 88
5.5.3 Gender specific patterns on the Rosenberg Self-esteem Scale
discriminating adolescents with or without DEP and SP (II) .................................. 88
5.5.4 Gender differences in self-esteem (III) .......................................................... 89
5.5.5 Gender specific patterns of self-esteem in the association between social
phobia and depression (III) ........................................................................................... 89
5.5.6 Gender differences in perceived social support (IV) ................................... 89
5.5.7 Gender specific patterns in longitudinal associations of low perceived
social support with social phobia and depression (IV) ............................................. 90
6 Discussion ........................................................................................................................ 91
6.1 Overview of the results ......................................................................................... 91
6.2 Symptomatology of social phobia and depression is common in middle
adolescence ........................................................................................................................... 92
6.3 Association between social phobia and depression differs by gender ........... 93
6.4 Low self-esteem as a risk indicator of social phobia and depression ............ 94
6.5 Social phobia and depression is associated with self-esteem .......................... 94
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