31

Meaning in Life and Psychological Well-Being in Pre-Adolescents and Adolescents

Neerpal Rathi and Renu Rastogi Indian Institute of Technology, Roorkee
This study examined meaning in life and psychological well-being in male and female students of pre- adolescence and adolescence periods. A total of 104 students were randomly selected from various schools. Of these, 54 students were from class 12 and 50 students from class 9. Two questionnaires, one Personal Meaning Profile (PMP) by Wong and another Well-Being Manifestation Measure Scale (WBMMS) by Masse et al. were administered on the subjects. It was hypothesized that there will be significant differences in the perception of life as meaningful and psychological well-being of different groups of students. t-test was applied to analyze the data. Besides discussing the results, applied aspects of a meaningful life and psychological well-being are also discussed. Keywords: Meaning in Life, Psychological Well-Being, and Adolescents

Adolescence is a very critical and important stage in the development of human being. Most of the physiological, psychological, and social changes within the person take place during this period of life. The period of adolescence can be looked upon as a time of more struggle and turmoil than childhood. Adolescents have long been regarded as a group of people who are searching for themselves to find some form of identity and meaning in their lives (Erikson, 1968). They struggle to find a meaning of self. Having meaning or purpose in life can solve the identity crisis that a person normally faces during this period. Meaning in life typically involves having a goal or a sense of unified purpose (Baumeister, 1991; Ryff, 1989). Recker, Peacock and Wong (1987), defined meaning as it refers to making sense, order, or coherence out of ones existence and having a purpose and striving toward a goal or goals. More recently Wong (1998) defined meaning as an individually constructed, culturally based cognitive system that influences an individuals choice of activities and goals, and endows life with a sense of purpose, personal worth, and fulfillment. Thus the role of meaning in an adolescents life can be a central point for a successful transition into adulthood. And an adolescent may derive meaning from a variety of sources. According to Wongs (1998) Personal Meaning Profile, these sources may be achievement, relationship, religion, self-transcendence, selfacceptance, intimacy, and fair treatment. Psychological well-being is a relatively complex notion with a variety of components

that may contribute to it. Ryff (1989) extensively explored the meaning of psychological wellbeing and the definition closely paralleled with the Well-Being Manifestation Measure Scale (Masse, Poulin, Dassa, Lambert, Belair & Battaglini, 1998b) that was used in this study.
Journal of the Indian Academy of Applied Psychology, January 2007, Vol. 33, No.1, 31-38. 32

The dimensions of well-being those were focused and operationalized are: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance. All of these factors can be considered as key components that make up the definition of psychological well-being. Therefore, adolescents who exhibit strength in each and every of these areas will be in a state of good psychological well-being, while adolescents who struggle in these areas will be in a state of low psychological well-being. There are various factors that affect adolescents level of psychological well-being. Several studies have shown that the quality of relationship within families, especially with parents is a major determining factor of psychological well-being in adolescents (Shek, 1997; Sastre & Ferriere2000; Van Wel, Linssen & Abma 2000). Some other key factors that may contribute to a higher or lower level of psychological well-being in adolescents are stress (Siddique & DArcy, 1984) physical health (Mechanic & Hansell, 1987) and both popularity and intimacy in peer relationships (Townsend, McCracken & Wilton, 1988). The importance of meaning in life and commitment to personal life satisfaction and psychological health has been well established (Erikson, 1982; Ledbetter, Smith & VoslerHunter1991; Ryff, 1989; Stephen, Fraser & Marcia, 1992). Studies have shown that seeking meaning and fulfillment acts as a significant protector against emotional instability, and as a warrantor of psychological health and well-being (Lukas, 1991). Meaning in life has been found to be a strong and consistent predictor of psychological well-being (Zika & Chamberlain, 1987). Shek (1992) conducted a study on Chinese secondary students and found that students who scored highest in terms of quality of existence as well as purpose of existence also scored highest in psychological well-being.

Hypotheses Based on the review of literature and past studies, the following hypotheses have been formulated for verification of this study through empirical investigation: 1.There is a significant difference between male and female students on the subscales of Personal Meaning Profile (PMP). 2.There is a significant difference between male and female students on the subscales of Well-Being Manifestation Measure Scale (WBMMS). 3.There is a significant difference between students of pre-adolescence and adolescence periods on the subscales of PMP. 4.There is a significant difference between students of pre-adolescence and adolescence periods on the subscales of WBMMS. 5.There is a significant difference between male and female students of adolescence period on the subscales of PMP. 6.There is a significant difference between male and female students of adolescence period on the subscales of WBMMS. 7.There is a significant difference between male and female students of pre-adolescence period on the subscales of PMP. 8.There is a significant difference between male and female students of pre-adolescence period on the subscales of WBMMS. Method Sample The sample consists of total 104 students from various public schools. Out of these students, 34 boys and 20 girls were from adolescence period (class 12th) and 31 boys and 19 girls were from pre-adolescence (class 9th) period. Finally questionnaires were distributed to students and they were asked to give responses according to the instructions provided in the questionnaire. Mean age of pre-adolescents and adolescents was 13.9yrs
Meaning in Life and Psychological Well-Being 33

and 17yrs respectively. Age range was 1215yrs for pre-adolescents and 16-18yrs for adolescents. Instruments Following instruments have been used in this study: Personal Meaning Profile (PMP): This scale was developed by Wong (1998) for the purpose of measuring meaning in life. This is

a 57-item scale consisting of seven sub-scales; these are achievement, relationship, religion, self-transcendence, self-acceptance, intimacy, and fair treatment. The validity and reliability of the scale is quite high, with an overall Cronbachs alpha coefficient of 0.93 and 0.94 respectively. Well-Being Manifestation Measure Scale (WBMMS): For measuring psychological well-being, WBMMS developed by Masse et al. (1998b) was used. The scale consists of 25-items with six factors. The six factors or subscales of the WBMMS are: control Meaning in Life and Psychological Well-Being of self and events, happiness, social involvement, selfesteem, mental balance, and sociability. Masse, Poulin, Dassa, Lambert, Belair, & Battaglini (1998a) found an overall Crobachs alpha of 0.93 for the questionnaire, and a range of 0.71 to 0.85 on the subscales. Results and Discussion In order to test the postulated hypotheses, t-test was applied and t-values for different groups were obtained: Hypothesis 1 While testing the hypothesis 1 it was found that males and females differ significantly on the subscales of relationship (t-value 4.05significant at .01 level), self-acceptance (tvalue 3.00-significant at .01 level), intimacy (tvalue 2.63-significant at .01 level), and fair treatment (t-value 2.89-significant at .01 level). Results showed (table 1) higher mean scores by females than males on all of the subscales of PMP. Results showed that females have higher tendency towards relationship, selfacceptance, fair treatment, and intimacy than that of males. No significant difference was found on the subscales of achievement, religion, and self-transcendence between males and females. Hypothesis 2 In the second hypothesis results showed that female and male students differ significantly on self-esteem (t-value 2.65Table 1: Means, Standard Deviation, and tvalues of Males and Females On the Subscales of PMP and WBMMS. N = Male 65; Female 39 Subscales of PMP Mean SD t-value
Achievement M 85.815 12.511 1.87 F 90.128 9.119 Relationship M 46.569 7.875 4.05** F 52.41 5.575

Religion M 46.83 7.612 1.67 F 49.564 8.786 Self-Transcendence M 41.646 6.692 1.52 F 43.743 6.946 Self-Acceptance M 29.932 5.5 3.00** F 32.948 3.946 Intimacy M 24.969 5.536 2.63** F 27.743 4.586 Fair Treatment M 18.8 3.067 2.89** F 20.794 3.894 Subscales of WBMMS Control of Self M 13.6 3.086 0.67 and Events F 14 2.675 Happiness M 19.784 3.038 1.71 F 20.769 2.432 Social Involvement M 16.123 2.348 0.5 F 16.384 2.843 Self-Esteem M 14.2 2.469 2.65** F 15.461 2.113 Mental Balance M 14.507 2.845 2.24* F 15.743 2.499 Sociability M 16.169 2.211 0.51 F 16.41 2.424

**p< 0.01; * p< 0.05 PMP - Personal Meaning Profile, WBMMS - Well-Being Manifestation Measure Scale
Neerpal Rathi and Renu Rastogi 34

significant at .01 level) and mental balance (tvalue 2.24-significant at .05 level) subscales of WBMMS. On the other hand no significant difference was found between males and females on other subscales of WBMMS. From the results (see table 1) it is apparent that mean score of females (though very little in some cases) are higher than that of males. Femalesshowed a little higher score than male on subscales of mental health and selfesteem. Hypothesis 3 At the time of testing hypothesis 3, some differences were observed between students of pre-adolescence and adolescence periods on subscales of PMP (see table 2). Though differences were there in the mean score of male and female students, but these differences were not found to be significant at any level of significance. Hypothesis 4 Here also no significant difference was found between students of pre-adolescence and adolescence periods on any subscale of WBMMS (see table 2). Analysis of mean scores showed higher mean score (though very small in number) by adolescents than those of preadolescents on the subscales of control of self and events, mental balance and sociability.

While on the subscales of happiness, social involvement, and self-esteem pre-adolescents score higher on means than adolescents. Hypothesis 5 By analyzing the results of males and females of adolescence period, we found that mean scores of females are higher than that of males on all subscales of PMP (see table 3). Difference is significant on the subscales of relationship (t-value 2.54- significant at .05 level), self-acceptance (t-value 2.22-significant at .05 level), intimacy (t-value 2.13-significantat .05 level) and fair treatment (t-value 3.00significant at .01 level). While on other subscales no significant difference was found at all. Hypothesis 6 In testing sixth hypothesis we found that male and female students of adolescence period do not differ significantly in their mean scores on any of the subscales of WBMMS (see table 3). Between females and males no significant difference was found at all. On this scale the mean scores of females were higher than that of males on all subscales except the social involvement subscale. Table-2: Means, Standard Deviation, and tvalues of Students of Pre-Adolescence and Adolescence Periods on the Subscales of PMP and WBMMS. N = Adolescence 54; PreAdolescence 50
Subscales of PMP Mean SD t-value Achievement A 86.463 13.307 0.89 PA 88.48 9.192 Relationship A 47.888 8.522 1.21 PA 49.7 6.465 Religion A 47.388 8.666 0.6 PA 48.36 7.585 Self-Trans A 42.666 7.633 0.36 cendence PA 42.18 5.913 Self-Acceptance A 30.222 5.193 1.7 PA 31.96 5.038 Intimacy A 25.092 5.889 1.83 PA 27 4.553 Fair Treatment A 19.074 3.874 1.43 PA 20.06 3.046 Subscales of WBMMS Control of Self A 13.925 3.318 0.63 and Events PA 13.56 2.467 Happiness A 19.814 2.965 1.26 PA 20.52 2.712 Social Involve A 16.148 2.558 0.3 ment PA 16.3 2.533 Self-Esteem A 14.574 2.559 0.43 PA 14.78 2.261 Mental Balance A 14.518 3.094 1.74 PA 15.46 2.314

Sociability A 16.444 2.682 0.85 PA 16.06 1.766

**p< 0.01; * p< 0.05 A = Adolescence, P.A. = Pre-Adolescence

Meaning in Life and Psychological Well-Being 35

Table 3: Means, Standard Deviation and tvalues of Males and Females of Adolescence Period on Subscales of PMP and WBMMS. N = Males 34; Females 20
Subscales of PMP Mean SD t-value Achievement M 85.205 14.735 0.9 F 88.6 10.449 Relationship M 45.735 9.209 2.54* F 51.55 5.735 Religion M 46.794 8.689 0.65 F 48.4 8.756 Self-Trans M 42.176 8.269 0.61 cendence F 43.5 6.525 Self-Acceptance M 29.058 5.365 2.22* F 32.2 4.323 Intimacy M 23.823 5.859 2.13* F 27.25 5.418 Fair Treatment M 17.941 3.567 3.00** 21 3.684 Subscales of WBMMS Control of Self M 13.735 3.629 0.54 and Events F 14.25 2.769 Happiness M 19.47 3.202 1.11 F 20.4 2.479 Social Involve M 16.294 2.316 0.54 ment F 15.9 2.971 Self-Esteem M 14.117 2.567 1.74 F 15.35 2.412 Mental Balance M 14 3.265 1.63 F 15.4 2.623 Sociability M 16.294 2.668 0.53 F 16.7 2.754

**p< 0.01; * p< 0.05 Hypothesis 7 Between males and females of preadolescence period a significant difference was found on the subscales of achievement (tvalue 2.02-significant at .05 level), relationship (t-value 3.41-significant at .01 level) and selfacceptance (t-value 2.01-significant at .05 level) of PMP scale (see table 4). On rest of the subscales no significant difference at any level was found. Mean scores on all subscales of PMP are higher among female students than that of male students. Table 4: Means, Standard Deviation, and tvalues of Males and Females of PreAdolescence Period on the Subscales of PMP and WBMMS. N = Male 31; Female 19
Subscales of PMP Mean SD t-value Achievement M 86.483 9.705 2.02* F 91.736 7.415 Relationship M 47.483 6.114 3.41**

F 53.315 5.406 Religion M 46.871 6.37 1.81 F 50.789 8.885 Self-Trans M 41.064 4.434 1.73 cendence F 44 7.535 Self-Acceptance M 30.871 5.578 2.01* F 33.736 3.445 Intimacy M 26.225 4.951 1.55 F 28.263 3.587 Fair Treatment M 19.741 2.081 0.94 F 20.578 4.194 Subscales of WBMMS Control of Self M 13.451 2.406 0.39 and Events F 13.736 2.621 Happiness M 20.129 2.86 1.31 F 21.157 2.386 Social Involve M 15.935 2.407 1.3 ment F 16.894 2.685 Self-Esteem M 14.29 2.397 2.01* F 15.578 1.804 Mental Balance M 15.064 2.22 1.56 F 16.105 2.378 Sociability M 16.032 1.601 0.14 F 16.105 2.051

**p< 0.01; * p< 0.05 Hypothesis 8 Finally, results of males and females of preadolescence period were analyzed on WBMM scale. Results of both groups showed that on self-esteem (t-value 2.01-significant at .05 level) subscale of WBMMS males and females differ significantly (see table 4). While on other subscales no significant difference was found with reference to these two sexes. By having a look on mean scores of males and females on subscales of WBMMS it was found that the mean scores of females were higher than that of males on all subscales.
Neerpal Rathi and Renu Rastogi 36 Meaning in Life and Psychological Well-Being

The aim of the present study was to have a look on meaning in life and psychological wellbeing of different groups of students especially with reference to gender and grade of students. In our study it was found that meaning in life is highly correlated with psychological well-being (see table 5). This shows that if a person perceives his or her life to be meaningful then he or she will feel more psychologically well off than those who do not perceive their life to be meaningful. Some studies also show the similar results while evaluating the relationship between meaning in life and psychological well-being (Debats, Drost & Prartho, 1995; Shek, 1992; Zika & Chamberlain, 1987; Recker, Peacock & Wong 1987). In the present study it was found that

adolescents did not score significantly higher than pre-adolescents on subscales of PMP and WBMMS. Similar results were also found by Weber (1996). In his study scores of grade twelve students were not significantly higher than grade nine students on psychological well-being. A reason for the good psychological well-being of pre-adolescents may be that they have not started to take things very seriously and also that they do not have high pressure for their career formation. On the subscales of PMP females scored higher than that of males. In some other studies similar findings were observed. For example, Anderson (1999) found that the quality of salient parent-child and peer relationships significantly predicted adolescent relationship identity for girls but not for boys. Also, Beutel and Marini (1995) found that adolescent females were more likely than males to indicate that finding purpose and meaning in life is extremely important. Thus it can be said that there can be various factors such as developmental level of person, family and social environment and relationships, schooling, career orientation, grade and gender that influences meaning in life and psychological well-being of persons. Limitations It is felt that there are two main limitations of the study. First limitation is concerned with the sample size of the study. A sample of 104 students is not sufficient for any generalization on all students of similar age groups. Further Table 5: Correlation among the Subscales of Main Scales: Subscales of Well-Being Manifestation Measure Scale Achievement .499** .368** .232** .599** .328** .182 Relationship .426** .547** .284** .583** .412** .467** Religion .229* .413** .177 .166 .068 .178 Self-Transcendence .423** .357** .244* .438** .336** .124 Self-Acceptance .282** .368** .163 .287** .351** .304** Intimacy .210* .382** .110 .290** .271** .263** Fair Treatment .254** .244** .187 .438** .205* .096 **p< 0.01; * p< 0.05
Subscales of Personal Meaning Profile Social Involvement Control of Self and Events Happiness Sociability Self-Esteem Mental Balance Neerpal Rathi and Renu Rastogi 37

the sample was drawn from a particular locality, it would be more acceptable and representative if the samples are taken from diverse localities with students of diverse backgrounds. Second limitation is related with the age group of students taken in the study. Age difference between two groups is not large enough to show a clear difference on the dimensions studied. Results are expected to be more diverse if the intake of boys and girls is of wider age range, from 11-12 years to 2021 years. Conclusion This study has provided an insight of the meaning in life and psychological well-being of students of early and late adolescence period. It has been well established by prior studies in this field, that a meaningful and purposeful life enhances the psychological well-being of persons. With a better understanding of meaning and psychological well-being within adolescents, various counseling or educational implications can be derived for assisting adolescents to develop holistically in terms of body, mind, and spirit as they venture into the world of adulthood. References
Anderson, F. (1999). The prediction and correlates of adolescent relationship Identity (Doctoral dissertation, University of Minnesota, 1999). Dissertation Abstracts International: Section B: The Sciences and Engineering, 60, 2382. Baumeister, R. F. (1991). Meanings of life. New York: Guilford. Beutel, A., & Marini, M. (1995). Gender and values. American Sociological Review, 60, 436-448. Debats, D., Drost, J., & Prartho, P. (1995). Experiences of meaning in life: a combined qualitative and quantitative approach. British Journal of Psychology, 86, 359-375. Erikson, E. (1968). Identity, youth and crisis. New York: Norton. Erikson, E. (1982). The life cycle completed. New York: Norton. Ledbetter, M.F., Smith, L.A., & Vosler-Hunter, W.L. (1991). An evaluation of the research and clinical usefulness of the spiritual well-being scale. Journal of Psychology and Theology, 19, 4955. Lukas, E. (1991). Meaning-centered family therapy. The International Forum for Logotherapy, 14, 67-74. Masse, R., Poulin, C., Dasa, C., Lambert, J., Belair, S., & Battaglini, A. (1998a). Elaboration et validation dun outil de mesure du bien-etre

psychologique : Lemmbep. Canadian Journal of Public Health, 89, 352-357. Masse, R., Poulin, C., Dassa, C., Lambert, J., Belair, S., & Battaglini, A. (1998b). The structure of mental health higher-order confirmatory factor analyses of psychological distress and wellbeing measures. Social Indicators Research, 45, 475-504. Mechanic, D., & Hansell, S. (1987). Adolescent competence, psychological well-being, and selfassessed physical health. Journal of Health and Social Behavior, 28,364-374. Recker, G., Peacock, E., & Wong, P. (1987). Meaning and purpose in life and well-being: A life-span perspective. Journal of Gerontology, 42, 44-49. Ryff, C. D. (1989). Happiness is every thing, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069-1081. Sastre, M., & Ferriere, G. (2000). Family decline and the subjective well-being of adolescents. Social Indicators Research, 49, 69-82. Shek, D. (1992). Meaning in life and psychological well-being: an empirical study using the Chinese version of the purpose in life questionnaire. Journal of Genetic Psychology, 153, 185-190. Shek, D. (1997). The relation of family functioning to adolescent psychological well-being, school adjustment, and problem behavior. The Journal of Genetic Psychology, 158, 467-479. Siddique, C., & DArcy, C. (1984). Adolescents, stress and psychological well-being. Journal of Youth and Adolescence, 13, 459-473. Stephen, J., Fraser, E., & Marcia, J.E. (1992). Moratorium-achievement (MAMA) cycles in life
38

span identity development: Value orientations and reasoning system correlates. Journal of Adolescence, 15, 283-300. Townsend, M., McCracken, H., & Wilton, K. (1988). Popularity and intimacy as determinants of psychological well-being in adolescent friendships. Journal of Early Adolescence, 8, 421-436. VanWel, F., Linssen, H., & Abma, R. (2000). The parental bond and the well-being of adolescents and young adults. Journal of Youth and Adolescence, 29, 307-318. Weber, J. (1996). Meaning in life and psychological well-being among high school freshmen and seniors (Doctoral dissertation, Northern Arizona University, 1996). Dissertation Abstracts International: Section B: The Sciences and Engineering, 57, 2912. Wong, P. (1998). Implicit Theories of Meaningful Life and the Development of the Personal Meaning Profile. In P. Wong & P. Fry (Eds.) (1998). The human quest for meaning: a

handbook of psychological research and clinical applications. Mahwah, NJ: Erlbaum. Zika, S., & Chamberlain, K. (1987). Relation of hassles and personality to subjective well-being. Journal of Personality and Social Psychology, 53, 155-162.

Received: June 23, 2006 Accepted: December 04, 2006 Neerpal Rathi ,Research Scholar, Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee-247667, U. A., India. Email- neerishere@yahoo.co.in Renu Rastogi, PhD, Professor and Head, Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee-247667, U. A., India. Email- renurfhs@iitr.ernet.in Authors are thankful to Pooja Garg for her valuable suggestions in writing this paper

AUTHORS
Authors must submit their articles in soft copy, either on CD or E-mail to: j_iaap@hotmail.com along with one print out. The soft copy must be provided in MS Word. Prospective authors are requested to see (page 143) the information for authors printed in this issue and adhere to the general format of articles published in JIAAP. JIAAP does not permit an author to submit the same paper simultaneously for consideration to other journal/s. An undertaking to this effect should be submitted along with the MS. Authors may be expected to provide their raw data if required during review process. Unpublished tests/questionnaires if used in the study should be submitted along with the manuscript. Articles which do not conform to JIAAP guidelines and format will not be entertained.
Meaning in Life and Psychological Well-Being

Next:

Measurement of the psychological well-being of adolescents: The psychometric properties and assessment procedures of the how I feel
Journal Publisher ISSN Issue DOI Pages Subject Collection SpringerLink Date Journal of Youth and Adolescence Springer Netherlands 0047-2891 (Print) 1573-6601 (Online) Volume 6, Number 3 / September, 1977 10.1007/BF02138937 229-247 Behavioral Science Tuesday, September 27, 2005

Anne C. Petersen1, 2

and Sheppard G. Kellam2

(1) Laboratory for the Study of Adolescence, Michael Reese Hospital and Medical Center, Chicago, USA

(2) (3)

Department of Psychiatry, University of Chicago, Chicago, USA Social Psychiatry Study Center, 950 E. 61st Street, 60637 Chicago, Illinois

Received: 15 February 1977

Abstract The assessment procedures and psychometric properties of the How I Feel (HIF), an instrument used to assess psychological well-being in a population of Black adolescents are described. The audiovisual mode of presentation obviates problems related to reading skill; in addition, it standardizes the administration of the instrument. The How I Feel appears to measure reliably and validly several multi-item constructs representing psychological well-being. These constructs relate to other instruments and constructs in meaningful and interesting ways. A major result of our validity studies is that there appear to be two major components of psychological well-being, psychopathology and self-esteem. Research presented in this paper is from the Social Psychiatry Study Center, Department of Psychiatry, University of Chicago and was supported by a grant from the National Institute on Drug Abuse (DA-00787). Received her Ph.D. from the University of Chicago. Main research interests are biopsychosocial development in adolescence, especially for girls, and applications of statistical and psychometric methods to problems in longitudinal research. Received his M.D. from University of Maryland. His psychiatric residency and research training was at Yale University and National Institute of Mental Health. Main research interests are long-term studies of social adaptation, psychological well-being (including psychopathology), and social structure and processes of the family and other social fields such as the psychiatric ward.

References
Bradburn, N. M. (1969).The Structure of Psychological Well-Being, Aldine, Chicago. Bradburn, N. M., and Caplovitz, D. (1965).Reports on Happiness, Aldine, Chicago. Brownlee, K. A. (1965).Statistical Theory and Methodology, Wiley, New York. Bohrnstedt, G. (1974). Personal communication. Campbell, A., Converse, P. E., and Rodgers, W. L. (1976).The Quality of American Life, Russell Sage, New York. Cantril, H. (1965).The Pattern of Human Concerns Rutgers Univesity Press, New Brunswick, N.J. Clausen, J. A. (1968). Values, norms, and the health called mental : Purposes and feasibility of assessment. In Sells, S. B. (ed.),The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D.C. Connors, C. K. (1970). Symptom patterns in hyperkinetic, neurotic and normal children.Child Dev. 41: 667682.

Coopersmith, S. (1967).The Antecedents of Self-Esteem, Freeman, San Francisco. Crandall, R. (1973). The measurement of self-esteem and related constructs. In Robinson, P., and Shaver, R. (eds.),Measures of Social Psychological Attitudes, Institute for Social Research, Ann Arbor, Mich. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests.Psychometrika 15: 297334. Davis, J. (1962).Stipends and Spouses, University of Chicago Press, Chicago. French, J. R. P., Jr. (1963). The social environment and mental health.J. Soc. Iss. 19: 3956. French, J. R. P., Jr. (1968). The conceptualization and measurement of mental health in terms of selfidentity theory. In Sells, S. B. (ed.),The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D.C. Gardner, E. A. (1968). Concepts of mental disorder. In Sells, S. B. (ed.),The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D.C. Garmezy, N. (1974).The study of competence in children at risk for severe psychopathology. In Anthony, J., and Kouprinik, C. (eds.),The Child in His Family: Children at Psychiatric Risk, Wiley Interscience, New York. Glidewell, J. C., Gildea, M. C. L., Domke, H. R., and Kantor, M. B. (1959). Behavior symptoms in children and adjustment in public school.Hum. Organiz. 18: 123130. Grinker, R. R. (1969). Psychiatry in our dangerous world. In Heseltine, G. F. D. (ed.),Psychiatric Research in Our Changing World, Excerpta Medica Foundation, Amsterdam. Gump, J. P. (1972). Sex-role attitudes and psychological well-being.J. Soc. Iss. 28: 7992. Hodge, R. W. (1970). Social integration, psychological well-being and their socioeconomic correlates. In Laumann, J. O. (ed.),Social Stratification: Research and Theory for the 1970's, Bobbs-Merrill, Indianapolis. James, W. (1890).Principles of Psychology, 2 vols., Holt, New York. Kellam, S. G., Branch, J. D., Agrawal, K. C., and Ensminger, M. E. (1975).Mental Health and Going to School, University of Chicago Press, Chicago. Lapouse, R., and Monk, M. (1958). An epidemiologic study of behavior characteristics in children.Am. J. Pub. Hlth. 48: 11341144. Lord, F. M., and Novick, M. R. (1968).Statistical Theories of Mental Test Scores, Addison-Wesley, Reading, Mass. Macfarlane, J. W., Allen, L., and Honzik, M. (1954).A Developmental Study of the Behavior Problems of Normal Children between Twenty-One Months and Fourteen Years, University of California Press, Berkeley.

Masterson, J. F., Jr. (1967).The Psychiatric Dilemma of Adolescence, Little, Brown, Boston. Nowicki, S., Jr., and Strickland, B. R. (1972). A locus of control scale for children.J. Consult. Clin. Psychol. 36: 148154. Offer, D. (1969).The Psychological World of the Teenager, Basic Books, New York. Offer, D., and Howard, K. I. (1972). An empirical analysis of the Offer Self-Image Questionnaire for Adolescents.Arch. Gen. Psychiat. 27: 529537. Pasamanick, B. (1962). Thoughts on some epidemiological studies of tomorrow. In Hoch, P., and Zubin, J. (eds.),The Future of Psychiatry, Grune and Stratton, New York. Pasamanick, B. (1968). What's mental illness and how can we measure it? In Sells, S. B. (ed.),The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D. C. Petersen A., and Kellam, S. (1976). The measurement of psychological well-being: A multimedia approach. Paper presented at the Annual Meeting of the American Educational Research Association, April, San Francisco. Rosenberg, M. (1965).Society and the Adolescent Self-Image, Princeton University Press, Princeton, N.J. Rosenkrantz, P., Vogel, S., Bee, H., Broverman, I., and Broverman, D. (1968). Sex-role stereotypes and self-conceptions in college students.J. Consult. Clin. Psychology 32: 287295. Sells, S. B. (Ed.). (1968).The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D. C. Simmons, R. G., and Rosenberg, F. (1975). Sex, sex roles, and self-image.J. Youth Adoles. 4: 229258. Smith, M. B. (1959). Research strategies toward a conception of positive mental health.Amer. Psychologist. 14: 673681. Smith, M. B. (1968). Competence and mental health : Problems in conceptualizing human effectiveness. In Sells, S. B. (ed.),The Definition and Measurement of Mental Health, U.S. Department of Health, Education and Welfare, Public Health Service, National Center for Health Statistics, Washington, D.C. Syngg, D., and Combs, A. (1949).Individual Behavior: A New Frame of Reference for Psychology, Harper, New York.

Next:

Article: Parenting Characteristics and Adolescent Psychological Well-Being: A Longitudinal Study in a Chinese Context.
Article from: Genetic, Social, and General Psychology Monographs Article date: February 1, 1999

Author: SHEK, DANIEL T. L. | Copyright information

ABSTRACT. In this longitudinal study, the relationships between perceived parenting characteristics and adolescent psychological well-being were examined in a sample of Hong Kong Chinese adolescents (N = 378). The results indicated that global parenting styles and specific parenting behaviors are concurrently related to hopelessness, life satisfaction, self-esteem, purpose in life, and general psychiatric morbidity at Time 03 and Time 2. Longitudinal and prospective analyses (Time 1 predictors of Time 2 criterion variables) suggested that the relations between parenting characteristics and adolescent psychological well-being are bidirectional in nature. The results ... Next:

Psychological well-being in adolescence: the contribution of interpersonal relations and experience of being alone
Adolescence, Summer, 2006 by Paola Corsano, Marinella Majorano, Lorella Champretavy INTRODUCTION From the very origins of psychology, adolescence has been considered a difficult stage in the process of development into adulthood. It has been seen as a period of crisis characterized by profound change. In recent times some empirical studies have shown that in reality, the majority of adolescents go through this stage successfully without experiencing particular traumas, reporting a level of relative well-being (Bandura, 1964; Offer & Schonert-Reichl, 1992; Douvan & Adelson, 1996). The greater part of psychological reflection has been devoted to identification of the main factors which, at an individual and interpersonal level, contribute to the promotion and sustenance of adolescents' psychological well-being and those which tend to impede it. Recent literature has paid particular attention to the importance of interpersonal relations. Different studies recognize that satisfactory relations with parents and friends are connected to a more positive outcome in this stage of development (Hansell & Mechanic, 1990; Claes, 1992; Noom, Dekovic, & Meeus, 1999; Bina, Cattelino, & Bonino, 2004). As far as relations with peers are concerned, friendship is a major contributor to adolescents' psychosocial adaptation and constitutes an important protective element against deviant behavior, depression, and feelings of alienation (Schneider, Wiener, & Murphy, 1994; Bukowski, Newcomb, & Hartup, 1996). At the same time, the importance of the family's role has been recognized for its influence over adolescents' psychosocial adaptation and in avoiding deviant and risky behavior (Kirchler, Palmonari, & Pombeni, 1993; Seiffe-Krfenke, 1995; Meeus, Helsen, & Vollebergh, 1996; Cattelino & Bonino, 1999).

In contrast, however, little is known of how experiences of solitude are likely to affect adolescents' well-being. The universality of loneliness among adolescents has been recognized (Csikszentmihalyi & Larson, 1984; Goossens & Marcoen, 1999) but the greater part of research in this area has been limited to consideration of loneliness defined as social withdrawal and isolation, emphasizing the risk it poses to adolescents' ability to adapt. Many authors argue, indeed, that a preference for nonsocial behavior results in increasing unpopularity within adolescents' peer group, giving rise to a negative self-image and feelings of psyschosocial malaise (Younger & Boyko, 1987; Younger, Gentile & Burgess, 1993). A number of researchers describe solitary adolescents as passive, sad, and turned inward (Van Buskirk & Duke, 1991), experiencing greater stress (Cacioppo et al., 2000) and social anxiety (Goossens & Marcoen, 1999), and characterized by such problems as peer rejection and victimization (Boiving, Hymel, & Bukowski, 1995), shyness and social withdrawal (Kupersmidt, Sigda, Sedikides, & Voegler, 1999). Recent research by Seginer and Lilach (2004) also considered the effect of loneliness on adolescents' orientation toward the future, noting that lonely adolescents scored lower than socially embedded adolescents on future orientation variables applied to the relational and near future domains. It is important not to neglect the possibility, however, that different experiences of loneliness may be present during the normal growth process. Marcoen, Goossens, and Caes (1987), for example, have proposed a multi-dimensional conception of solitude, distinguishing two fundamental aspects of being alone: aversion to aloneness (unwanted isolation) and affinity for aloneness (voluntary isolation). Ammaniti, Ecolani, and Tambelli (1989), also emphasized that loneliness plays an important role during adolescence, marking different stages in the process of construction of an identity and gradual separation from parents. Ester Schaler Buchholz, an American psychoanalyst, who also studied this question, agreed that the capacity and need for aloneness are of particular importance for an adolescent involved in the process of separation and individualization and in the construction of an identity (Buchholz & Chinlund, 1994; Buchholz & Catton, 1999). According to this view alone time (time for one's self, Bucholtz, 1997) provides creative space, a time for rest as well as self-reflection and self-revelation, ideal for putting into practice the concept of moratorium suggested by Erikson (1950) and Marcia (1980). It was on the basis of these findings that it was decided to investigate how interpersonal relations and experiences of loneliness influence adolescents' psychological well-being. Two different aspects of being alone were taken into consideration: (1) the feeling of loneliness experienced in relations with parents and peer group members, and (2) adolescents' attitudes toward the experience of aloneness; that is, the positive or negative significance that adolescents attribute to being alone. We were particularly interested in learning if and how adolescents' feelings of loneliness with reference to parents and peer group members change with respect to age and gender. The second goal of the research was to investigate the quality of adolescents' interpersonal relations with mothers, fathers, and with both male and female peers, and to determine their importance in the promotion of psychological well-being and reduction of malaise (Hansell & Mechanic, 1990; Noom, Dekovic, & Meeus, 1999). The third goal of the research was to investigate whether there was a correlation between the quality of social relations and adolescents' attitude toward being alone.

Participants Participants were 330 adolescents of whom 162 were male and 168 female aged between 11 and 19 (M = 15.04, SD = 2.47). Students were from four different types of school in Northern Italy: an upper high school, a professional training institute, a technical institute for surveyors, and a middle school. A total of 18 classes were involved in the research: 6 classes in a middle-school and 4 classes in each upper high school. Participants were divided into three groups based on age. The first group (11 to 13) consisted of 103 students (56 males and 47 females). The second group (14 to 16) consisted of 115 students (57 males and 58 females), and the third group (17 to 19) was made up of 112 students (49 males and 63 females). Instruments Two instruments were used: the Louvain Loneliness Scale for Children and Adolescents (LLSCA) (Marcoen, Goossens, & Caes, 1987)--the Italian version, in preparation, by Melotti, Corsano, Majorano, & Scarpuzzi); and Test delle Relazioni Interpersonali (TRI)--Assessment of Interpersonal Relations (AIR) (Bracken, 1996)--Italian version (Janes, 1996). LLCA was used to obtain a complete evaluation of adolescents' perception of their own experience of loneliness. The test is made up of four sub-scales. In particular, two sub-scales are intended to measure feelings of loneliness with reference to parents (L-PART) and to peers (LPEER). In the first case, an evaluation is made of experiences of loneliness connected to the process of separation from parents and in the second sub-scale, loneliness is considered the type of isolation derived from separation from peers. This research instrument also seeks to investigate whether people attribute a positive or negative meaning to solitary experiences and if so, at what level. This effect is investigated by means of the other two sub-scales, A-POS and ANEG. The Italian version was used in this research. The four sub-scales contain 48 items--12 for each scale, expressed in the form of statements to which a response is requested using a four-point Likert scale (often = 4, sometimes = 3, rarely = 2, and never = 1). In the Italian version, scores range between 12 to 48 for each sub-scale. In general, a high score represents a strong feeling of loneliness with reference to peers (L-PEER) and the family (L-PART) and positive (A-POS) and negative (A-NEG) attitudes toward the experience of loneliness. The TRI on the other hand, evaluates the quality of relations of young persons with those most important to their lives: mothers, fathers, teachers, and their male and female peers. For the purposes of this study it was considered appropriate to focus on the family and peers; thus the scale evaluating relations with teachers was not used. Each scale was made up of the same 35 questions (the same for each stage) by which the quality of relations with different persons was evaluated. Responses were assessed on the basis of a fourpoint Likert scale (completely true = 4, true = 3, not true = 2 and completely untrue = 1). In those items formulated in negative form (5, 10, 15, 20, 25, 30, 35), scores were assigned inversely (completely true = 1, true = 2, not true = 3, and completely untrue = 4). Each questionnaire was accompanied by a brief explanation of how the test was to be completed. Participants were asked to indicate their age and the school they attended. In order to ensure that the questionnaires were correctly filled out, the data were collected in the presence of the test administrators who made

themselves available to provide any clarification required. The time needed the completion of the questionnaires was 45 to 50 minutes.

RESULTS LLCA First we sought to investigate if and how adolescents' feelings of loneliness in the context of their families and their peers changed, and also depending on their age and gender. The average scores of participants were thus calculated in each individual LLCA sub-scale and then, using the score obtained in each scale as the dependent variable, a series of 3 (age group) x 2 (gender) ANOVAs were conducted. A description of the scores is contained in Table 1. Table 1 shows that the main effect is the age factor in the sub-scales L-PART (F(2, 324) = 3.28, p < .05); A-NEG (F(2, 324) = 5.3, p < .01) and A-POS (F(2, 324) = 7.47, p < .001). The post hoc analysis (Tukey's test with p < .05) shows a different trend in the different sub-scales. Indeed, in L-PART, the scores of the oldest group of adolescents (17 to 19) were only significantly higher than those of the youngest age group (11 to 13). Contrary trends are shown in the sub-scales relating to attitudes to loneliness. The oldest age group had the lowest A-NEG and highest APOS scores with respect to the other groups. Table 2 shows the gender factor as the main effect in the sub-scales L-PEER (F(1, 324) = 7.98, p < .01), and A-POS (F(1, 324) = 17.77, p < .001). In particular, the girls scored higher in both sub-scales. The analysis also indicates an interaction between gender and age (F(2, 324) = 3.32, p < .05) in the A-NEG sub-scale. Thus, in particular, in the youngest age group, the boys had a lower negative attitude as compared to the girls, while the contrary was true in the oldest age group. TRI First we sought to investigate changes in the participants' relations with father, mother and peers (male and female) with respect to age and gender as set out in the respective TRI sub-scale. Scores of participants in the individual TRI scales were therefore calculated by adding the scores obtained for the items of each sub-scale. The standard score was then calculated corresponding to each unprocessed score. Using the standard scores obtained in this way as dependent variables, a series of 3 (age group) x 2 (gender) ANOVAs were then conducted. A description of the scores is shown in Table 3. Table 3 highlights the age factor as the main effect in the TRI-father (F(2, 324) = 3.61, p < .05), TRI-male peers (F(2, 324) = 7.61, p <.001) and TRI-female peers (F(2, 324) = 10.83, p < .001) sub-scales. The post hoc analysis (Tukey's test with p < .05) indicates different trends in the different sub-scales. In the TRI-father sub-scale, the 14 to 16 age group obtained only a significantly higher score with respect to the lowest age group (11 to 13). In the TRI-male peers and TRI-female peers, however, the score obtained by this latter age group was higher than that

for the other two groups. There was no statistically significant difference in the quality of male and female personal relations.
Most RecentHealth Care Articles

Healthcare Roundup: Enthoven's Take on Reform, Help For Small Practices, Docs... How Private Insurers Could Compete With a Public Plan Obama, Insurers Go Toe-to-Toe Insurance Is Not The Same as Healthcare Access More

Relations between Experience and Interpersonal Relations The way in which feelings of, and attitudes toward loneliness in adolescents correlated with the quality of their relations with those of greatest importance in their lives was then investigated. An analysis was made of Pearson's correlation r between the four LLCA sub-scales and the individual TRI scales. As can be seen in Table 4, the feeling of loneliness with regard to peers correlated with a low score for relations with male (r = -.16, p < .01) and female (r = -.19, p < .001) peers. Feelings of loneliness with reference to parents were correlated with low quality scores in mother (r = -.59, p < .001) and father (r = -.54, p < .001) relations. As far as attitude to loneliness was concerned, high aversion scores were correlated with satisfactory relations with male (r = .24, p < .001) and female (r = .29, p < .001) peers. High affinity scores, however, were correlated with unsatisfactory mother (r = -.14, p < .01) and female peer (r = -.15, p < .01) relations. The differences in relations between attitude to loneliness and peer and parent relations according to the different age groups were then investigated (Table 5). The data show that in all three groups a negative attitude toward loneliness is correlated with higher scores in the sub-scales relating to male peer relations (the r index varies between .20 and .24 with p < .05) and female peer relations (the r index varies between .24 and .33 with p < .05). A positive attitude was correlated only to unsatisfactory mother and father relations in the youngest age group. Analysis of the Items An analysis was made of differences based on age and gender in the sub-scale items relating to attitude toward loneliness (A-POS and A-NEG). A series of univaried ANOVAs was then made by first using age and then gender as factors with the average scores for each item as the dependent variable. It was found that the groups were significantly differentiated from each other in terms of age for those items describing loneliness above all as a time of boredom (8: "When I am lonely, I feel bored," F(2, 324) = 4.15, p < .05; 20: "When I am lonely, I don't know what to do," F(2, 324) = 8.57, p < .001; 24: "When I am lonely, time lasts long and no single activity seems attractive," F(2, 324) = 4.97, p < .001), in items when the idea of wishing somebody to be present is expressed (22: "To really have a good time, I have to be with my friends," F(2, 324) = 6.22, p < .001; 29: "When I am alone, I would like to have other people around," F(2, 324) = 5.39, p < .001) and in which loneliness is equated with unhappiness (34: "I feel unhappy when I

have to do things on my own," F(2, 324) = 3.45, p < .05). The youngest age group obtained higher scores as compared to the older groups. Differences based on age with regard to A-POS emerged in those items describing loneliness as a time to do something alone (46: "At home I am looking for moments to be alone, so that I can do things on my own," F(2, 324) = 5.62, p < .001; 36: "I want to be alone to do some things," F(2, 324) = 5.68, p < .001; 2: "I retire from others to do things that can hardly be done with a large number of people," F(2, 324) = 12.99, p < .001), as a time to reflect in tranquility (31: "I am happy when I am the only one at home for once, because I can do some quiet thinking then," F(2, 324) = 4.99, p < .001; 26: "When I am alone, I quiet down," F(2, 324) = 4.55, p < .05; 19: "When I am lonely I want to be alone to think it over," F(2, 324) = 6.57, p < .001; 21: "When I have an argument with someone, I want to be alone to think it over," F(2, 324) = 3.34, p < .05) or as something to be sought after (13: "I am looking for a moment to be on my own," F(2,324) = 6.21, p < .001). The oldest age group obtained higher scores than the younger groups. DISCUSSION The aim of the research was to investigate how interpersonal relations and experiences of being alone contribute to adolescents' psychological well-being. In particular, we hoped to be able to confirm how the feeling of loneliness in adolescents with reference to their peers and parents and their attitude toward being alone changes according to age and gender. It was also seen as important to investigate the quality of interpersonal relations of adolescents with their mothers, fathers, and their male and female peers and to determine whether there is a correlation between the quality of social relations and adolescents' attitude toward being alone.
Most RecentHealth Care Articles

Healthcare Roundup: Enthoven's Take on Reform, Help For Small Practices, Docs... How Private Insurers Could Compete With a Public Plan Obama, Insurers Go Toe-to-Toe Insurance Is Not The Same as Healthcare Access More

Most significantly, the importance of good parent and friend interpersonal relations in the promotion of adolescent' psychological well-being and the reduction of malaise was confirmed. It was shown, in particular, that psychological well-being, above all during early adolescence, depends on acceptance and integration into the peer group, and further, that even when they grow older, they continue to need the support of their parents. The data also showed that the presence of inadequate family and friend interpersonal relations gave rise to malaise (Kirchler, Palmonari, & Pombeni, 1993; Seiffe-Krenke, 1995; Meeus, Helsen, & Vollebergh, 1996); in effect, it is those who express unsatisfactory interpersonal relations who experience intense feelings of loneliness, while those who are able to rely on good social relations do not complain of these unhappy feelings.

Furthermore, the results obtained from this research clearly confirm that being alone is a multidimensional experience (Marcoen, Goossens, & Caes, 1987)--that adolescents are able to distinguish clearly among these different dimensions. On the one hand they recognize the painful aspects of being alone, the unhappiness and fear provoked by separation and isolation from their peers and family, but on the other, they are aware that loneliness can also entail a pleasurable dimension, to be desired in different ways according to age. In particular, consistent with the findings of Marcoen and Bromagne (1985) and Goossens and Marcoen (1999) the research indicated that girls, educated earlier in autonomy, demonstrate a more positive attitude toward being alone as compared with boys, although they experience more intense feelings of loneliness in relations with their peers. The findings of this research also have indicated the presence of interesting differences between the younger group (11 to 13) and the older group (17 to 19). An increase in positive attitudes toward being alone was found to increase with age (Marcoen, Goossens, & Caes, 1987). It was also found that while a positive attitude to being alone was associated with unsatisfactory interpersonal relations in early adolescence, the older adolescents (17 to 19) recognized the need for time on their own independent of the quality of their interpersonal relations. These findings can be interpreted in the light of the important changes occurring during adolescence and, in particular, suggest the possibility that different experiences of being alone may be part of the process of separation-identification and the construction of an identity. In effect, adolescents aged 11 to 13, involved in the process of separation from their parents, fear being alone and tend to consider it negatively. With the passing of the years, however, and with the affirmation of the individualization process, adolescents, having become more independent of their parents, no longer fear loneliness and learn to recognize the positive aspects of being alone. It is therefore possible that the individualization process and the construction of an autonomous identity are created thanks to time spent alone in reflection and elaboration (Buchholz, 1997). It thus seems to us that the stage has been reached when it is possible to distinguish between different experiences of being alone (Corsano, 2003) and to overcome the prejudice that has beset psychology in associating of the concept of being alone with suffering and pain, accepting the possibility that different experiences of being alone may be part of a normal process of personal development. REFERENCES Ammaniti, M., Ercolani, M. P., & Tambelli, R. (1989). Loneliness in the female adolescent. Journal of Youth and Adolescence, 18(4), 321-329. Bandura, A. (1964). The stormy decade: Fact or fiction? Psychology in the School, 1, 224-231.
Most RecentHealth Care Articles

Healthcare Roundup: Enthoven's Take on Reform, Help For Small Practices, Docs...

How Private Insurers Could Compete With a Public Plan Obama, Insurers Go Toe-to-Toe Insurance Is Not The Same as Healthcare Access More

Bina, M., Cattelino, E., & Bonino, S. (2004). Il ruolo delle relazioni con i coetanei ed i genitori nella promozione del benessere psicologico degli adolescenti. [Psychological well-being during adolescence: the role of relations with peers and with parents.] Eta evolutiva, 79, 43-52: Boiving, M., Hymel, S., Bukowski, W. M. (1995). The role of social withdrawal, peer relation, and victimization by peers predicting loneliness and depressed mood in childhood. Development and Psychopathology, 7, 765-785. Buchholz, E. S., & Chinlund, C. (1994). En route to a harmony of being: Viewing aloneness as a need in development and child analytic work. Psychoanalytic Psychology, 11(3), 357-374. Buchholz, E. S. (1997). The call of solitude: Alone in a world of attachment. New York; Simon and Schuster. Buchholz, E. S., & Catton, R. (1999). Adolescents' perceptions of aloneness and loneliness. Adolescence, 34(133), 203-213. Bukowski, W. M., Newcomb, A. F., & Hartup, W. W. (1996). The company they keep: Friendship in childhood and adolescence. New York: Cambridge University Press. Cacioppo, J. T., Ernst, J. M., Burleson, M. H., McClintock, M. K., Malarkey, W. B., Hawkley, L. C., Kowalewski, R. B., Paulsen, A., Hobson, J. A., Hugdahl, K., Spiegel, D., & Bernston, G. G. (2000). Lonely traits and concomitant psychological processes: The McArthur social neuroscience studies. International Journal of Psychophysiology, 35, 143-154. Cattelino, E., & Bonino, S. (1999). I comportamenti a rischio in adolescenza. Il ruolo delle relazioni con i genitori e con gli amici. [Risky behaviors in adolescence: The role of relationships with parents and with friends.] Eta evolutiva, 64, 67-78. Claes, M. (1992). Friendship and personal adjustment during adolescence. Journal of Adolescence, 15, 39-55. Corsano, P. (Ed.). (2003). Adolescenza e solitudini. In processi di sviluppo nel ciclo di vita. Saggi in onore di Marta Montanini Manfredi. [Adolescence and loneliness. Developmental processes in the lifespan. Essays in honor of Marta Montanini Manfredi.] Milan: Unicopli. Csikszentmihalyi, M., & Larson, R. (1984). Being adolescent. New York: Basic Books. Douvan, E., & Adelson, J. (1996). The adolescent experience. New York: Norton. Erikson, E. H. (1950). Childhood and society. New York: Norton.

Goossens, L., & Marcoen, A. (1999). Relationships during adolescence: Constructive vs. negative themes and relational dissatisfaction. Journal of Adolescence, 22, 65-79. Goossens, L., Marcoen, A. (1999). Adolescent loneliness, self-reflection, and identity: From individual differences to developmental processes. In K. J. Rotenberg & S. Hymel, Loneliness in childhood and adolescence (pp. 225-243). Cambridge, UK: Cambridge University Press. Hansell, S., & Mechanic, D. (1990). Parent and peer effects on adolescent health behavior. In K. Hurrelmann, F. Losel, (Eds.) Health hazards in adolescence. (pp. 43-46). Berlin-New York: Walter de Gruyter. Kirchler, E., Palmonari, A., & Pombeni, M. L. (1993). Developmental tasks and adolescents' relationship with their peers and their family. In S. Jackson & H. Rodriguez-Tome, Adolescence and its social worlds (pp. 145-167). Hove, UK: Erlbaum.
Most RecentHealth Care Articles

Healthcare Roundup: Enthoven's Take on Reform, Help For Small Practices, Docs... How Private Insurers Could Compete With a Public Plan Obama, Insurers Go Toe-to-Toe Insurance Is Not The Same as Healthcare Access More

Kupersmidt, J. B., Sigda, K. B., Sedikides, C., & Voegler, M. E. (1999). In K. J. Rotenberg & S. Hymel, Loneliness in childhood and adolescence (pp. 263-279). Cambridge, UK: Cambridge University Press. Marcia, I. E. (1980). Identity in adolescence. In I. Adelson (Ed.), Handbook of adolescent psychology. New York: Wiley. Marcoen, A., & Brumagne, M. (1985). Loneliness among children and young adolescents. Developmental Psychology, 21, 1025-1031. Marcoen, A., Goossens, L., & Caes, P. (1987). Loneliness in pre- through late-adolescence: Exploring the contributions of a multidimensional approach. Journal of Youth and Adolescence, 16(6), 561-576. Meeus, W., Helsen, M., & Vollebergh, W. (1996). Parents and peers in adolescence: From conflict to connectedness. Four studies. In L. Verhofstadt-Deneve, I. Kienhorst, & C. Braet (Eds.), Conflict and development in adolescence (pp. 103-115). Leiden: DSWO. Noom, M. J., Dekovic, M., & Meeus, H. J. (1999). Autonomy, attachment and psychosocial adjustment during adolescence: A double-edged sword. Journal of Adolescence, 22, 771-783.

Offer, D., & Schonert-Reichl, K. A. (1992). Debunking the myths of adolescence: Findings from recent research. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1003-1013. Schneider, B. H., Wiener, J., Murphy, K. (1994). Children's friendships: The giant step beyond acceptance. Journal of Social and Personal Relationships, 11, 323-340. Seginer, R., & Lilach, E. (2004). How adolescents construct their future: The effect of loneliness on future orientation. Journal of Adolescence, 27, 625-643. Seiffe-Krenke, I. (1995). Stress, coping and relationships in adolescence. Mahwah, NJ: Erlbaum. Van Buskirk, A. M., & Duke, M. P. (1991). The relationship between coping style and loneliness in adolescents. Can "sad passivity" be adaptive? The Journal of Genetic Psychology, 152, 144157. Younger, A., & Boyko, K. A. (1987). Aggression and withdrawal as social schemas underlying children's peer perceptions. Child Development, 58, 1094-1100. Younger, A., Gentile, C., & Burgess, K. (1993). Children's perceptions of withdrawal: Changes across age. In K. H. Rubin & J. Asendorf (Eds.), Social withdrawal, inhibition, and shyness in children. Hillsdale, NJ: Erlbaum. Reprint requests should be sent to Professor Paola Corsano, Department of Psychology, University of Parma, B.go Carissimi, 10, 43100 Parma, Italy. Next: 1. A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life. 2. A branch of medicine that deals with the achievement and maintenance of psychological well-being. 3. A person's overall emotional and psychological condition: Since witnessing the accident, his mental health has been poor. FOOD AND FITNESS MENTAL HEALTH: A positive state of mind engendering a sense of well being that enables a person to function effectively within society. Individuals who have good mental health are well-adjusted to society, are able to relate well to others, and basically feel satisfied with themselves and their role in society. Breakdown of mental health is a major problem in Western societies: it has been estimated that at least one in four adults will suffer from some form of mental disorder, such as depression, during their life. Many physicians and psychologists believe that individuals are physical, mental, and spiritual beings and that these aspects are interrelated. Consequently, mental health

is not possible without both physical and spiritual health. Although there is no clear cause-and-effect relationship between exercise and mental health, aerobic exercise can improve self-esteem, lessen anxiety, and relieve depression. Exercise can act as a form of meditation, changing the state of consciousness and providing a distraction from stressful situations. Many doctors believe that exercise improves mental health and prescribe exercise to relieve depression and anxiety. Walking is the most frequently prescribed exercise, followed by swimming, bicycling, strength training, and running. ENCYCLOPEDIA OF PUBLIC HEALTH: MENTAL HEALTH The field of mental health has made many advances, particularly since 1980. These developments include an increased understanding of the brain's function through the study of neuroscience, the development of effective new medications and therapies, and the standardization of diagnostic codes for mental illnesses. However, many questions about mental health remain unanswered, and many people around the world are unable to benefit from the knowledge and treatments that are available. Seven in ten Americans with a mental illness do not receive treatment. Biases against mental illness and lack of public awareness are among the obstacles that limit access to treatment and affect willingness to seek care. Fewer individuals with major psychiatric illnesses were institutionalized in the United States in the year 2000 than in 1980, but limited community resources had not yet met existing treatment needs. Over one-third of the homeless in the United States have a severe mental illness. The prevalence of dementia is rising as people are living longer, adding to the need for more resources. One of the main challenges for the field of mental health is overcoming the gap between an increasingly sophisticated understanding and treatment of mental illness and the availability of these advances to individuals and populations in need. Mental, or psychiatric, illnesses are a major public health concern. They adversely affect functioning, economic productivity, the capacity for healthy relationships and families, physical health, and the overall quality of life. They cut across racial, ethnic, and socioeconomic lines to affect a significant proportion of communities worldwide. They tend to develop and manifest in the early adult years, often preventing individuals from leading full and productive lives. The National Comorbidity Survey of 1994 found nearly half of the individuals in its random U.S. sample had a psychiatric disorder over their lifetime, and almost 30 percent had one in the past year. The World Health Organization's World Health Report 1998 lists mood and anxiety disorders among the leading causes of morbidity and mood disorders as the leading cause of severely limited activity. Mental disorders account for a quarter of the world's disability. Comorbidity (having more than one illness) is common and even further increases the risk of disability. Suicide is the eighth leading cause of death in the United States and the third leading cause in the fifteen- to twenty-four-year-old age group. More people die by suicide than homicide. Dianne Hales and Robert Hales define mental health as

the capacity to think rationally and logically, and to cope with the transitions, stresses, traumas, and losses that occur in all lives, in ways that allow emotional stability and growth. In general, mentally healthy individuals value themselves, perceive reality as it is, accept its limitations and possibilities, respond to its challenges, carry out their responsibilities, establish and maintain close relationships, deal reasonably with others, pursue work that suits their talent and training, and feel a sense of fulfillment that makes the efforts of daily living worthwhile (p. 34). A healthy pregnancy, adequate parenting, secure attachments to caretakers, regular involvement in groups, and stable intimate relationships all contribute to the development and maintenance of mental health. Mental health does not imply the absence of distress and suffering, or strict societal conformity. Mental health and illness, idiosyncratic beliefs and delusions, sadness and depression, and worry and severe anxiety lie on a continuum. An essential criterion for defining behavioral patterns or symptoms of psychological distress as a mental disorder is that they become significant enough to be functionally disabling and impose substantial increased risks ranging from an important loss of freedom to suffering pain, disability, or death. Both genetic inheritance and environmental factors influence one's vulnerability to mental illness. Twin and family studies and genetic research have demonstrated the former, though specific genes have been difficult to identify, and there may be multiple genes involved in most psychiatric disorders. Traumatic events throughout one's lifetime, including childhood abuse or neglect, major losses, violence, military combat, and dislocation (as among the urban homeless or wartime refugees) are known to threaten mental stability. Nontraumatic stressors, including unemployment, bereavement, and relational or occupational problems, can impact mental health. Nutritional deficiencies (such as vitamin B12), infections (such as syphilis and HIV [human immunodeficiency virus]), and heavy metal poisoning (such as lead) can all cause psychiatric syndromes. Substance abuse contributes significantly to the exacerbation or even precipitation of other psychiatric illnesses and complicates their treatment. Poverty and home-lessness are risk factors for many of these problems, but may also be the outcome of psychiatric illness and the inability to function independently. Many models of mental health and illness have been proposed. Emil Kraepelin (18561926) contributed to the development of the precise categorization of mental illnesses, particularly in distinguishing the long-term course of psychotic and mood disorders. Sigmund Freud (1856 1939) developed the theory of psychoanalysis, through which he claimed that symptoms of psychiatric disorders, as well as many phenomena of everyday life, have unconscious meanings and sources. Erik Erikson (19021994) formulated a theory of human development with specific tasks and crises at different stages of the life cycle. Failure to master these stages can lead to various forms of psychopathology. Neuroscientists have demonstrated molecular models of illness, which involve genetic, developmental, functional, anatomical, and molecular abnormalities of the brain. The biopsychosocial model, proposed by George Engel in the 1970s, integrates the biological, genetic, and molecular mechanisms of illness with a psychological understanding of personality development and response to stress as well as social, cultural, and environmental influences. The Diagnostic and Statistical Manual of Mental Disorders (its 4th edition, DSM-IV, was published in 1994) is the product of research on standardized diagnostic criteria aimed at creating

a common, validated descriptive system for all mental health care providers. It is nearly universally accepted, as it classifies and describes categories of illness and aims to be neutral about controversial theories of etiology (see Table 1). The following descriptions of various mental disorders are based on DSM-IV criteria. Affective disorders involve a cyclical pattern of significant mood disturbance. A major depressive episode may be precipitated by a stressful life situation but also has genetic factors. Disturbances in appetite, sleep, energy, concentration, and sexual interest are common symptoms. The majority of patients respond to treatment with antidepressant medication and/or psychotherapy. An individual who has long-term (over two years) of minor to moderate depressive symptoms may have Table 1
Lifetime and 12-month prevalence of DSM-III-R disorders Lifetime prevalence (%) Disorders M F Total 12-month prevalence (%) M F Total

*Includes schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, and atypical psychosis.
SOURCE: Kessler, R.C. et al. (1994). "Lifetime and TwelveMonth Prevalence of DSM

IIIR Psychiatric Disorders in the United States: Results from the National Comorbidity Study." Archives of General Psychiatry 51:819. Affective disorders Major depressive episode Manic episode Dysthymia Any affective disorder Anxiety disorders Panic disorder Agoraphobia without panic disorder Social phobia Simple phobia 2.0 3.5 11.1 6.7 5.0 7.0 15.5 15.7 3.5 5.3 13.3 11.3 1.3 1.7 6.6 4.4 3.2 3.8 9.1 13.2 2.3 2.8 7.9 8.8 12.7 1.6 4.8 14.7 21.3 1.7 8.0 23.9 17.1 1.6 6.4 19.3 7.7 1.4 2.1 8.5 12.9 1.3 3.0 14.1 10.3 1.3 2.5 11.3

Lifetime and 12-month prevalence of DSM-III-R disorders Lifetime prevalence (%) Disorders Generalized anxiety disorder Any anxiety disorder Substance use disorders Alcohol abuse without dependence Alcohol dependence Drug abuse without dependence Drug dependence 12.5 20.1 5.4 9.2 6.4 8.2 3.5 5.9 17.9 9.4 14.1 4.4 7.5 26.6 3.4 10.7 1.3 3.8 16.1 1.6 3.7 0.3 1.9 6.6 2.5 7.2 0.8 2.8 11.3 M 3.6 19.2 F 6.6 30.5 Total 5.1 24.9 12-month prevalence (%) M 2.0 11.8 F 4.3 22.6 Total 3.1 17.2

Any substance abuse/dependence 35.4 Other disorders Antisocial personality Nonaffective psychosis* Any of the disorders above 5.8 0.6 48.7

1.2 0.8 47.3

3.5 0.7 48.0

0.5 27.7

0.6 31.2

0.5 29.5

dysthymia. Substance abuse, medical disorders (such as hypothyroidism), and normal life cycle events in which hormonal changes are prominent (such as the postpartum period) can all cause symptoms of depression and should be considered carefully during an assessment. An adjustment disorder is a milder disturbance of mood that may occur in response to a stressful life situation, such as a personal loss or financial crisis, and that usually resolves when the stress is relieved. About 1 percent of the general population has bipolar disorder, also called manicdepressive disorder, in which manic episodes are present as well as depressive episodes. Mania is characterized by a persistently elevated or irritable mood for at least a week, often with decreased need for sleep, rapid speech, impulsivity in spending and other behaviors, and grandiosity. In more severe manic and depressive episodes, psychotic symptoms may emerge, which can complicate treatment. Bipolar disorder is treated with mood stabilizers, such as lithium or valproic acid, and supportive management. Antidepressant medications alone can precipitate mania in susceptible patients. Psychotic disorders are characterized by "positive" symptoms such as hallucinations, delusions, and bizarre behaviors, as well as "negative" symptoms such as paucity of speech, poverty of ideas, blunting of affective expression, and functional deterioration. Cognitive problems such as

disorganization of thought processes also occur. Schizophrenia is a chronic, disabling illness that affects almost 1 percent of the world population, independent of ethnic or cultural background. Risk factors include a family history and possibly psychosocial stressors. The precise cause is still unknown, but it is clear that certain areas of the brain and certain neurotransmitters are involved. Many of those affected are unable to maintain work or relationships and require supportive services to help them manage basic needs such as shelter and food. Treatment includes antipsychotic medication, comprehensive social services including social and occupational rehabilitation if possible, and substance abuse treatment if necessary. Newer antipsychotic medications such as clozapine, olanzapine, and risperidone have been able to treat more symptoms generally with fewer side effects, allowing many to lead more productive lives. Some patients with schizophrenic-type illness also experience prominent affective symptoms nonconcurrently and may have schizoaffective disorder. These patients often require a mood stabilizer as well as antipsychotic medication. Substance use, especially hallucinogens and stimulants (such as amphetamines and cocaine), can precipitate psychotic symptoms, and these may even endure beyond the period of substance use. Some medical conditions (such as epilepsy and delirium) and some medications (such as steroids) can also cause psychotic symptoms and should be considered in the assessment and treatment of psychosis. Anxiety disorders are among the most prevalent psychiatric disorders in the general population, and these disorders lead to both psychological distress and increased health care utilization. Panic disorder often manifests with somatic symptoms, such as palpitations, chest pain, nausea, trembling, dizziness, and shortness of breath, and can be easily confused with a medical disorder by both patients and doctors. Patients develop persistent concerns about having further panic attacks. Some develop agoraphobia, or a fear of being in public places where their attacks may be triggered. Other phobias include simple phobia, such as fear of heights or specific animals, and social phobia, which is a marked and persistent fear of certain or all social situations, such as speaking in public or being around others in general. People with obsessive-compulsive disorder have obsessions, characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate, and/or compulsions, characterized by repetitive behaviors or mental acts often performed in response to an obsession. After one experiences a traumatic event, in which actual or threatened death or severe injury is witnessed or experienced, one may develop post-traumatic stress disorder. Intrusive recollections of the event (such as nightmares), avoidance of reminders of the event, and increased arousal (such as increased vigilance for potential threats) can all cause significant distress and impairment following a wide range of traumatic events, including an accident, military combat, torture, or rape. Generalized anxiety disorder is characterized by excessive and persistent anxiety or worry about a number of events or activities, such as work or school performance. For all anxiety disorders, specific psychopharmacologic and psychotherapeutic (such as cognitive-behavioral therapy) techniques of treatment can be effective and complementary. Substance-use disorders are quite common and occur in all segments of society. They can lead to accidents, violent crime, and major problems in school and at work. They can cause or complicate various medical and psychiatric illnesses. Liver failure, ulcers, heart attacks, cognitive disorders, and depression are among the potential outcomes of various substances. These disorders pose major public health concerns for public safety, health costs, economic productivity, and pregnancy risks, among others. Substance abuse is defined as a maladaptive

pattern of use indicated by continued use despite persistent or recurrent social, occupational, psychological, or physical problems caused or exacerbated by the use of the substance; or recurrent use in situations that could be physically hazardous (such as driving while intoxicated). With substance dependence, signs of physical dependence such as withdrawal symptoms are often present, and the person spends a great deal of time involved in substance-related activities, uses more of the substance than intended, is unable to cut down, and continues to use the substance despite social, occupational, or physical problems related to it. The first steps of treatment involve developing insight, acknowledging the problem, and wanting to change. There are various self-help groups (such as Alcoholics Anonymous), comprehensive treatment programs, psychosocial interventions, and medications that can help lead to successful recovery for the majority of those with substanceuse disorders. Childhood disorders include pervasive developmental disorders, such as autism, which occurs in four out of ten thousand people; mental retardation, which can be caused by a variety of genetic abnormalities or prenatal insults; and attention deficithyperactivity disorder, which can lead to significant problems in school and in social relationships. Childhood abuse and neglect are tragically quite common, with one million children affected annually in the United States alone. These can have major adverse effects on development of personality, relationships, and the ability to function in the world. Personality disorders are usually first evident in late adolescence and are characterized by pervasive, persistent maladaptive patterns of behavior that are deeply ingrained and are not attributable to other psychiatric disorders. Biological and genetic factors, as well as developmental difficulties, are significant contributors. Other disorders described in DSM-IV include eating disorders, with restriction (anorexia) and/or binging and purging (bulimia) and impulse control disorders (e.g., kleptomania). Somatoform disorders cause physical symptoms with no apparent medical cause (e.g., hysterical paralysis). Gender, race, ethnicity, and culture are important factors in determining the expression and risk of mental disorders, and these factors also impact on treatment considerations. Certain disorders are more prevalent in women, such as depression and eating disorders, and some in men, such as substance abuse. Cultural background may influence the idioms of psychological distress. For example, nervios describes for many Latinos a constellation of somatic, anxiety, and depressive symptoms distinct from particular DSM-IV diagnoses. Psychiatric disorders are the main risk factor for suicide, but rates vary significantly depending on gender, age, race, religion, marital status, and culture. (SEE ALSO: Community Mental Health Centers; Dementia; Depression; Schizophrenia; Stress) Bibliography Bromet, E. J. (1998). "Psychiatric Disorders." In Maxcy-Rosenau-Last Public Health and Preventive Medicine, 14th edition, ed. Robert B. Wallace. Stamford, CT: Appleton and Lange. Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (1994), 4th edition. Washington, DC: American Psychiatric Association.

Eisendrath, S. J., and Lichtmacher, J. (1999). "Psychiatric Disorders." In Current Medical Diagnosis and Treatment 1999, eds. L. M. Tierney, Jr., S. J. McPhee, and M. A. Papadakis. Stamford, CT: Appleton and Lange. Engel, G. (1980). "The Clinical Application of the Biopsychosocial Model." American Journal of Psychiatry 137(5):535544. Hales, D., and Hales, R. E. (1995). Caring for the Mind: The Comprehensive Guide to Mental Health. New York: Bantam Books. Jamison, K. R. (1999). Night Falls Fast. New York: Alfred Knopf. Kaplan, Harold I., and Sadock, Benjamin J., eds. (1995). Comprehensive Textbook of Psychiatry. 6th edition. Philadelphia: Williams and Wilkins. Kessler, R. C.; McGonagle, K. A.; Zhao, S.; Nelson, C. B.; Hughes, M.; Eshleman, S.; Wittchen, H. U.; and Kendler, K. S. (1994). "Lifetime and Twelve Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results from the National Comorbidity Study." Archives of General Psychiatry 51:819. U.S. Public Health Service (1999). The Surgeon General's Call to Action to Prevent Suicide. Washington, DC: Author. World Health Organization (1998). World Health Report 1998: Life in the Twenty-first Century, A Vision for All. Report of the Director-General. Geneva: Author. PAUL J. ROSENFIELD; STUART J. EISENDRATH

WORLD OF THE MIND MENTAL HEALTH:

Answers given nowadays to the question 'What are the characteristics of a mentally healthy person?' are likely to refer to such signs as the capacity to cooperate with others and sustain a close, loving relationship, and the ability to make a sensitive, critical appraisal of oneself and the world about one and to cope with the everyday problems of living. At other times or places, different qualities would have been mentioned, according to the values prevailing in the culture. For the English middle class at the turn of the 19th century, mens sana in corpore sano a sound mind in a sound body would have included a disciplined intelligence, a well-stocked memory, qualities of leadership appropriate to the person's station, a respect for morality, and a sense of what life means. There was at that time an absolute refusal, as Clouston (1906) put it, 'to admit the possibility of a healthy mind in an unsound body, or at all events in an unsound brain'. Nowadays we regard mental health as attainable by even the severely crippled. Brain injury may put limits on the degree to which social capacities can be developed, but it does not prevent

their development altogether; the influence of the milieu may be as strong as that of the severity of the injury. For a vigorous critique of the concept of mental health one can hardly do better than turn to Barbara Wootton's review (1960) in which, after commenting on a number of proposed definitions, she concluded that 'whichever way, therefore, the problem may be approached, no solid foundation appears to be discoverable on which to establish the propositions [as] formulated'. The shift in emphasis from intellectual ability to harmonious relationships as the criterion of mental health can be partly attributed to the recognition that, whatever part physical inheritance plays in determining intelligence, intellectual development depends largely on learning in the setting of a relationship. The publication in 1951 by the World Health Organization of John Bowlby's monograph Maternal Care and Mental Health was a landmark because it made it widely known that an essential condition for the mental health and development of the child is 'a warm, intimate, and continuous relationship with his mother in which both find satisfaction and enjoyment'. 'Sound cognitive development', it has been said, 'occurs in a context of communication.' The abilities which enable the child to play the roles appropriate to a boy or girl are acquired through the learning engendered by the expectations of the family. Interruption, or disturbance, during early childhood in the relationship with the mother has been shown to retard or distort the development of language and the skills related to it, and to lead in some circumstances to an impairment in social relationships which lasts into adult life. The effects depend on the character of the 'support' or 'security' system, of which the mother is usually the chief member. The father, the grandparents, older siblings, and family friends contribute to the system. The young child is vulnerable if the system is weak or fragile. The young child tends to attach himself to one person especially, usually the one who mothers him, and this relationship, established in the second half of the first year of life, prepares him for a monogamous relationship when sexual maturity is reached, and influences then his choice of partner. (See attachment.) Social training of other kinds, in the family and outside it, prepares him for the several roles he is to play in adult life. A boy tends to take his father as a model, and a girl, her mother. Of importance too is membership of a peer group in the early teenage years. From his experience in relationships with his mother and father, peers of the same sex, and then a peer of opposite sex, the young person discovers what sort of person he is i.e. he forms a conception of himself, or establishes his 'identity', especially his sexual identity. His education and early experience in a job establish his occupational identity. This conception of himself is tested out by further experience which confirms or modifies it. The first affaire confirms or, if it goes badly, confuses his sexual identity. He becomes emancipated in greater or lesser degree from his parents, and free to form relationships outside the family. The rapid intellectual development at the time of puberty helps the young person to understand, and in some degree gain control over, the world around him.

The social training he has had during childhood is put to the test at turning points in circumstances, or 'crises', which require old habits to be abandoned, new habits to be developed. Crises are conveniently divided, following Erikson (1968), into 'developmental' and 'accidental'. By developmental crises are meant those decisive changes in circumstances ordinarily expected to occur in the life cycle for example, being born, going to school, leaving school, getting married, becoming a parent, or retiring from work. Examples of accidental crises are the untimely loss of a member of the family, a spouse or other loved person, the loss of a job, or illness. If he is prepared for the new circumstances, as is usual when the crisis is developmental, a person acquires new habits quickly through the processes of learning. If not prepared, because the crisis is untimely, or social training has been lacking or inappropriate, a person may go through a period of instability and distress while he works out new ways of coping. In studies of bereavement for example, by C. M. Parkes are to be found illustrations of the differences between mental health and illness. After the loss of a loved one, one person mourns for a time. While doing so, he is able to express to others his grief and distress openly and authentically, and thus to review his relationship with the person lost. He soon re-engages in relationships with others, which change and develop. Another person becomes preoccupied by his fantasies about the person lost. These may be out of keeping with the realities, which are denied. He withdraws from other relationships, and shows a general contraction of activities and interests. He feels diminished and depreciated. Withdrawing from relationships, and unable to communicate his distress, his conception of himself remains uncorrected, and he does not work out a new pattern of relationships. This kind of severe reaction to bereavement occurs especially when the loss has been sudden or unexpected, or there have been distressing circumstances: for instance, if the death was due to suicide, or to the negligence or misconduct of others. Such a reaction may also reflect the personality of the bereaved person and his relationship with the person lost. He may have been unaccustomed to taking decisions for himself, or have had limited personal resources, or have been unduly dependent, or the relationship may have been discordant and fraught with unresolved difficulties. The features of the reaction of this person are the antithesis of mental health, and amount to mental illness if he also claims exemption from normal social responsibilities. Yet they reflect psychological processes which are part of the organism's normal reactive equipment, and which are adaptive in that they serve to reduce anxiety. They can be described as due to 'the renunciation of functions which give rise to anxiety' (which Sigmund Freud said was the essence of neurosis). The psychological processes are maladaptive in the particular circumstances in that they do nothing to remove the sources of the anxiety. There is thus a deadlock. By avoiding a situation or staying out of relationships in which he

has experienced pain or anxiety, a person does not explore and re-evaluate the situation, or learn to cope with it in more effective ways. Other characteristics of behaviour in mental illness are persistence or repetitiveness and resistance to modification by experience, whereas behaviour in mental health tends to be flexible and modifiable. To break the deadlock, and to restore mental health, a therapist creates conditions in which the testing of reality and learning can be resumed. New habits can then be acquired which are more appropriate to the circumstances. The person's conception of himself can be corrected by further experience. He is encouraged to re-enter into relationships. In other words, the therapist intervenes or mediates in order to bring about reconciliation, and to enable communication with others to be reopened. (Published 1987)

Derek Russell Davis

Bibliography

Clouston, T. C. (1906). The Hygiene of Mind. Erikson, E. H. (1968). Identity: Youth and Crisis. Goodwin, I. (2003). 'The relevance of attachment theory to the philosophy, organization, and practice of adult mental health care'. Clinical Psychology Review, 23/1. Parkes, C. M. (2001). Bereavement (3rd edn.). Wootton, B. (1960). Social Science and Social Pathology.

WIKEPEDIA MENTAL HEALTH: Mental health is a term used to describe either a level of cognitive or emotional well-being or an absence of a mental disorder.[1][2] From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience.[1] The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.[3] It was previously stated that there was no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined.[4] Contents

[hide]

1 History 2 Perspectives o 2.1 Mental wellbeing o 2.2 Lack of a mental disorder o 2.3 Cultural and religious considerations 3 See also o 3.1 Related concepts o 3.2 Related disciplines and specialties 4 References
o

4.1 External links

History
See also: History of mental disorders

In the mid-19th century, William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health.[5] Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.[5] At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States.[5][6] Perspectives
Mental wellbeing

Mental health can be seen as a continuum, where an individual's mental health may have many different possible values[7]. Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if they do not have any diagnosable mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness of otherwise healthy people. Positive psychology is increasingly prominent in mental health. A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.[8][9] An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks essence or spirituality, work and leisure, friendship, love and selfdirectionand twelve sub taskssense of worth, sense of control, realistic beliefs, emotional

awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identityare identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning. Most of the US Population is not educated on Mental Health.[10]
Lack of a mental disorder See also: Mental disorder

Mental health can also be defined as an absence of a major mental health condition (for example, one of the diagnoses in the Diagnostic and Statistical Manual of Mental Disorders) though recent evidence stemming from positive psychology (see above) suggests mental health is more than the mere absence of a mental disorder or illness. Therefore the impact of social, cultural, physical and education can all affect someone's mental health.
Cultural and religious considerations

Mental health can be socially constructed and socially defined; that is, different professions, communities, societies and cultures have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions are appropriate.[11] Thus, different professionals will have different cultural and religious backgrounds and experiences, which may impact the methodology applied during treatment. Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association.[12]
Psychology portal

See also Global Mental Health Health

Self-help groups for mental health Mental health law

Public health Dissociation (psychology) Mental environment Mental disorder Mental health professional Psychology Positive psychology

Related concepts

Sanity Structured Clinical Interview for DSMIV

Related disciplines and specialties

Social work

Psychiatry

Youth Health Psychiatric nurse

DSM-IV Codes References

1. ^
a b

About.com (2006, July 25). What is Mental Health?. Retrieved June 1, 2007, from http://mentalhealth.about.com/cs/stressmanagement/a/whatismental.h tm 2. ^ Princeton University. (Unknown last update). Retrieved June 1, 2007, from http://wordnet.princeton.edu/perl/webwn?s=mental%20health 3. ^ World Health Organization (2005). Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. World Health Organization. Geneva.

4. ^ World Health Report 2001 - Mental Health: New Understanding, New Hope, World Health Organization, 2001 5. ^ a b c Johns Hopkins University. (2007). Origins of Mental Health. Retrieved June 1, 2007, from http://www.jhsph.edu/dept/mh/about/origins.html 6. ^ Clifford Beers Clinic. (2006, October 30). About Clifford Beers Clinic. Retrieved June 1, 2007, from http://www.cliffordbeers.org/aboutus.htm 7. ^ Keyes, Corey (2002). "The mental health continuum: from languishing to flourishing in life". Journal of Health and Social Behaviour 43: 207-222. 8. ^ Witmer, J.M.; Sweeny, T.J. (1992). "A holistic model for wellness and prevention over the lifespan". Journal of Counseling and Development 71: 140148. 9. ^ Hattie, J.A.; Myers, J.E.; Sweeney, T.J. (2004). "A factor structure of wellness: Theory, assessment, analysis and practice". Journal of Counseling and Development 82: 354364. 10. ^ Myers, J.E.; Sweeny, T.J.; Witmer, J.M. (2000). "The wheel of wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling and Development". Journal of Counseling and Development 78: 251266. 11. ^ Weare, Katherine (2000). Promoting mental, emotional and social health: A whole school approach. London: RoutledgeFalmer. p. 12. ISBN 9780415168755. 12. ^ Richards, P.S.; Bergin, A. E. (2000). Handbook of Psychotherapy and Religious Diversity. Washington D.C.: American Psychological Association. p. 4. ISBN 978-1557986245

http://www.answers.com/topic/mental-health NEXT:
Contact: Prentsa Bulegoa

UPV/EHU Contact details: comunicacion@sv.ehu.es (+34) 946012178

2009/2/2 Boys have greater psychological well-being than girls, due to a better physical self-concept A PhD thesis defended at the University of the Basque Country (UPV/EHU) has investigated the relationship between adolescents perception of their physical qualities and their psychological wellbeing and unwellness. Self-concept may be defined as the totality of perceptions that each person has of themselves, and this self identity plays an important role in the psychological functioning of everyone. To date, however, there has been no investigation into the relationship that physical self-concept has with psychological well-being or psychological unwellness. The author of the thesis is Ms Arantzazu Rodrguez Fernndez, who presented her work under the title, El autoconcepto fsico y el bienestar/malestar psicolgico en la adolescencia (Physical selfconcept and psychological well-being/unwellness during adolescence). Ms Rodrguez is a graduate in Psychology and carried out her PhD under the direction of doctors Alfredo Goi Grandmontagne and Igor Esnaola Etxaniz, of the Department of Evolutionary Psychology and the University School of Education at the UPV/EHU. She currently works as a research worker at the university. This research had three fundamental objectives: to study the relationship between physical selfconcept and psychological well-being, to identify the relationship between physical self-concept and anxiety and depression and, finally, to analyse the relationship between physical self-concept and Eating Behaviour Disorders (EBDs) amongst both the non-clinical population in general as well as amongst patients previously diagnosed with anorexia or bulimia nerviosa. A study on adolescents To undertake the research, a total of 1,959 young people between the ages of 12 and 23 from the Basque Country, Burgos and Rioja were studied. 48 of these were patients diagnosed with some form of EBD. The data obtained indicated that physical self-concept is related in a positive manner with the psychological well-being of the individual and in a negative manner to psychological unwellness, in such a way that the more one is happy with ones physique, the more psychological well-being one has, with less levels of anxiety and depression and less risk of suffering from an EBD. This relationships have also been analysed as a function of age, gender and physical activity. As a general rule, it is seen that, taking into account physical self identity, male adolescents present higher scoring for psychological well-being than their female peers. This same relationship is established between12-14 year old adolescents on the one hand and 15+ adolescents on the other, and between those who do physical activity and those who do not. But, considering all the variables at the same time, it was seen that adolescents with more positive physical self-concept and who are, at the same time, between 12 and 14 or carry out physical activity, score higher for psychological well-being, without any significant difference between the sexes being observed.

This research also showed young people experienced psychological unwellness in relation to their physical appearance throughout their adolescence, whether their perception of their physique is low, average or high. Nevertheless, undertaking sporting activity appears to be a good way to minimise any psychological unwellness, probably because it enhances physical self-concept. It is only when physical self-concept is low that doing physical exercise gives rise to the potential risk of suffering EBD. As a rule, however, sport can be defended as a way of increasing personal well-being and reducing psychological unwellness. Stages of greater risk As regards disorders associated with physical appearance, the greatest risk of developing an anxiety disorder is after the age of 15; for a depressive disorder the risk stage is between 12 and 17; and for anorexia or bulimia nerviosa the risk period is between 18 and 23. Finally, of all the elements conditioning physical self-concept, the outstanding one is that of an attractive physical appearance, because the self-perception of this is strongly related to anxiety, depression and psychological well-being. All this, of course, is a reflection of how society favours relationships between what is attractive as perceived by one and how anxious, how depressed or how happy one feels with oneself.

NEXT:

Valkenburg, P. M., & Peter, J. (2007). Online communication and adolescent well-being: Testing the stimulation versus the displacement hypothesis. Journal of Computer-Mediated Communication, 12(4), article 2. http://jcmc.indiana.edu/vol12/issue4/valkenburg.html

Online Communication and Adolescent Well-Being: Testing the Stimulation Versus the Displacement Hypothesis
Patti M. Valkenburg Jochen Peter
The Amsterdam School of Communications Research (ASCoR) University of Amsterdam

Abstract
The aim of this study was to contrast the validity of two opposing explanatory hypotheses about the effect of online communication on adolescents' well-being. The displacement hypothesis predicts that online communication reduces adolescents' well-being because it displaces time spent with existing friends, thereby reducing the quality of these friendships. In contrast, the stimulation hypothesis states that online communication stimulates well-being via its positive effect on time spent with existing friends and the quality of these friendships. We conducted an online survey among 1,210 Dutch teenagers between 10 and 17 years of age. Using mediation analyses, we found support for the stimulation hypothesis but not for the displacement hypothesis. We also found a moderating effect of type of online communication on adolescents' well-being: Instant messaging, which was mostly used to communicate with existing friends, positively predicted well-being via the mediating variables (a) time spent with existing friends and (b) the quality of these friendships. Chat in a public chatroom, which was relatively often used to talk with strangers, had no effect on adolescents' well-being via the mediating variables.

Introduction

Opportunities for adolescents to form and maintain relationships on the Internet have multiplied in the past few years. Not only has the use of Instant Messaging (IM) increased tremendously, but Internet-based chatrooms and social networking sites are also rapidly gaining prominence as venues for the formation and maintenance of personal relationships. In recent years, the function of the Internet has changed considerably for adolescents. Whereas in the 1990s they used the Internet primarily for entertainment (Valkenburg & Soeters, 2001), at present they predominantly use it for interpersonal communication (Gross, 2004; Lenhart, Madden, & Hitlin, 2005).

The rapid emergence of the Internet as a communication venue for adolescents has been accompanied by

diametrically opposed views about its social consequences. Some authors believe that online communication hinders adolescents' well-being because it displaces valuable time that could be spent with existing friends (e.g., Kraut et al., 1998; Nie, 2001; Nie, Hillygus, & Erbring, 2002). For example, Kraut et al. (1998) argue that "by using the Internet, people are substituting poorer quality social relationships for better relationships, that is, substituting weak ties for strong ones" (p. 1028). Adherents of this displacement hypothesis assume that the Internet motivates adolescents to form online contacts with strangers rather than to maintain friendships with their offline peers. Because online contacts are seen as superficial weak-tie relationships that lack feelings of affection and commitment, the Internet is believed to reduce the quality of adolescents' existing friendships and, thereby, their well-being.

Conversely, other authors suggest that online communication may enhance the quality of adolescents' existing friendships and, thus, their well-being. Adherents of this stimulation hypothesis argue that more recent online communication technologies, such as IM, encourage communication with existing friends (Bryant, Sanders-Jackson, & Smallwood, 2006). Much of the time adolescents spend alone with computers is actually used to keep up existing friendships (Gross, 2004; Subrahmanyam, Kraut, Greenfield, & Gross, 2000; Valkenburg & Peter, 2007). If adolescents use the Internet primarily to maintain contacts with their existing friends, the prerequisite for a displacement effect is not fulfilled. After all, if existing friendships are maintained through the Internet, it is implausible that the Internet reduces the quality of these friendships and, thereby, adolescents' well-being (Valkenburg & Peter, 2007).

Several studies have investigated the effect of Internet use on the quality of existing relationships and wellbeing. Some of these studies used depression or loneliness measures as indicators of well-being; others employed measures of life-satisfaction or positive/negative affect. The studies have provided mixed results: Some have yielded results in agreement with the displacement hypothesis (Kraut et al., 1998; Morgan & Cotten, 2003, for surfing; Nie, 2001; Nie, Hillygus, & Erbring, 2002; Weiser, 2001). Others have produced results in support of the stimulation hypothesis. They demonstrated, for example, that Internet use is positively related to time spent with existing friends (Kraut et al., 2002), to the closeness of existing

friendships (Valkenburg & Peter, 2007), and to well-being (Kraut et al., 2002, study 1; Morgan & Cotten, 2003, for email and chat; Shaw & Gant, 2002). Finally, several other studies produced no significant results (Gross, 2004; Kraut et al., 2002, study 2; Jackson, von Eye, Barbatsis, Biocca, Fitzgerald, & Zhao, 2004; LaRose, Ghuay, & Bovin, 2002; Mesch, 2001, 2003; Sanders, Field, Diego, & Kaplan, 2000; Waestlund, Norlander, & Archer, 2001).

At least one omission in earlier research may contribute to the inconsistent findings regarding the Internetwell-being relationship. Most research to date has been descriptive or exploratory in nature. The studies investigate direct linear relationships between Internet use and one or more dependent variables, such as social involvement, depression, or loneliness (Matei & Ball-Rokeach, 2001). Hardly any research has been based on a-priori explanatory hypotheses regarding how Internet use is related to well-being. More importantly, there is no research that contrasts opposing explanatory hypotheses in the same study. With some exceptions (LaRose et al., 2001; Morgan & Cotten, 2003; Weiser, 2001), most research has conceptualized the relationship between Internet use and well-being as a simple stimulus-response process. Little research has hypothesized possible mediating variables that might cause a displacement or stimulating effect of Internet use on well-being.

The main aim of this study is to fill the gap in earlier research and pit the predictions of the displacement hypothesis against those of the stimulation hypothesis. By empirically studying the validity of the processes proposed by the two hypotheses, we hope to improve theory formation and contribute to a more profound understanding of the social consequences of the Internet. In fact, the two hypotheses are based on the same two mediators. Both hypotheses state that online communication affects adolescents' well-being through its influence on (1) their time spent with existing friends and (2) the quality of these friendships. However, the displacement hypothesis assumes a negative effect from online communication on time spent with existing friends, whereas the stimulation hypothesis predicts a positive relationship between these two variables. The two opposing hypotheses are stated below and modeled through paths 1a and 1b in Figure 1:

H1a:

Online communication will reduce time spent with existing friends.

H1b:

communication will enhance time spent with existing friends.

Figure 1. The displacement and the stimulation hypothesis modeled

As Figure 1 shows, apart from paths 1a and 1b, the remaining assumptions of the displacement and stimulation hypotheses are similar. Neither hypothesis predicts a direct relationship between online communication and well-being. Rather, both suggest that the influence of online communication on well-being will be mediated by the quality of friendships. There is general agreement that the quality of friendships is an important predictor of well-being (Hartup & Stevens, 1997). Quality friendships can form a powerful buffer against potential stressors in adolescence (Bukowski, 2001; Hartup, 2000), and adolescents with high-quality friendships are often more socially competent and happier than adolescents without such friendships (Hartup & Stevens, 1997). Based on these considerations, we hypothesize that if online communication influences well-being, it will be through its influence on the quality of existing friendships. Our second hypothesis, which is modeled via path 3 in Figure 1, therefore states:

H2:

Adolescents' quality of friendships will positively predict their well-being and act as a mediator between online communication and well-being.

However, the relationship between online communication and the quality of friendships may also not be direct. Both the displacement and stimulation hypotheses assume that time spent with existing friends acts as a mediator between online communication and the quality of friendships. Based on these assumptions, we hypothesize an indirect relationship between online communication and the quality of friendships, via the time spent with existing friends (see paths 1a, 1b, and 2 in Figure 1):

H3:

Adolescents' time spent with friends will predict the quality of their friendships and act as a mediator between online communication and the quality of friendships.

Type of Online Communication: IM Versus Chat

In earlier Internet effects studies, the independent variable Internet use has often been treated as a onedimensional concept. This may be another important reason why the findings of these studies are so mixed (Baym, Zhang, & Lin, 2004). Many studies only employed a measure of daily or weekly time spent on the Internet and did not distinguish between different types of Internet use, such as surfing or online communication (e.g., Kraut et al., 1998, 2002). Such a simple conceptualization of the independent variable was already problematic when investigating traditional broadcast media (Baym et al., 2004; Jung, Qio, & Kim, 2001), but it becomes even more problematic when researching effects of multi-use platforms such as the Internet (Jung et al., 2001).

It is quite possible that daily time spent on the Internet does not affect one's well-being, whereas certain types of Internet use do have such an effect. In this study, we focus on the type of Internet use that is theoretically most likely to influence well-being and the quality of existing friendships: online communication. We believe that if the Internet influences well-being, it will be through its potential to alter the nature of social interaction through the use of online communication technologies. In this study, well-being is defined as happiness or a positive evaluation of one's life in general (Diener, 1984; Diener, Suh, Luca, & Smith, 1999).

Online communication in itself is a multidimensional concept. We focus on two types of communication that

are often used by adolescents: IM and chat in public chatrooms (Lenhart, Madden, & Hitlin, 2005; Valkenburg & Peter, 2007). Both types of online communication are synchronous and often used for private communication. However, they differ in several respects. First, whereas chat in a public chatroom is often based on anonymous communication between unacquainted partners, IM mostly involves non-anonymous communication between acquainted partners (Bryant et al., 2006; Valkenburg & Peter, 2007). Second, whereas chat is more often used to form relationships, IM is typically used to maintain relationships (Grinter & Palen, 2004). Although there is no previous research on the social consequences of IM versus chat, it is entirely possible that these two types of online communication differ in their potential to influence the quality of existing friendships and well-being. For example, IM, as used to maintain friendships, may contribute positively to the quality of existing relationships and well-being, whereas chat in a public chatroom may have the opposite or no effect. The second aim of our study is to investigate the differential effects of IM versus chat on well-being and the two mediating variables. Because previous research does not allow us to formulate a hypothesis regarding these differential effects of different types of online communication, our research question asks:

RQ1:

How do the causal predictions of the displacement and stimulation hypothesis differ for IM and chat in a public chatroom?

Method
Sample

In December 2005, an online survey was conducted among 1,210 Dutch adolescents between 10 and 17 years of age (53% girls, 47% boys). Sampling and fieldwork were done by Qrius, a market research company in Amsterdam, the Netherlands. Respondents were recruited from an existing online panel managed by Qrius. The sample was representative of Dutch children and adolescents who use the Internet in terms of age, gender, and education. Prior to the implementation of the survey, institutional approval, parental consent, and adolescents' informed consent were obtained. Adolescents were notified that the study would be about

Internet and well-being and that they could stop participation at any time they wished. We took the following measures to improve the confidentiality, anonymity, and privacy of the response process (Mustanski, 2001): On the introduction screen of the online questionnaire, we emphasized that the answers would be analyzed only by us, the principal investigators. Moreover, we ensured the respondents that their answers would remain anonymous. Finally, respondents were asked to make sure that they filled in the questionnaire in privacy. Completing the questionnaire took about 15-20 minutes.

We preferred an online interviewing mode to more traditional modes of interviewing, such as face-to-face or telephone interviews. There is consistent research evidence that both adolescents and adults report sensitive behaviors more easily in computer-mediated interviewing modes than in non-computer-mediated modes, whereas for non-sensitive behaviors no differences in interviewing modes have been reported (e.g., Beebe, Harrison, McRae, Anderson, & Fulkerson, 1998; Brener et al., 2006; Tourangeau & Smith, 1996). Therefore, the response patterns in our study may have benefited from our choice of a computer-mediated interviewing mode as far as more intimate issues, such as the quality of friendships and well-being, are concerned.

Measures
IM Use

We measured adolescents' IM use with four questions: (a) "On weekdays (Monday to and including Friday), how many days do you usually use IM?" (b) "On the weekdays (Monday to and including Friday) that you use IM, how long do you then usually use it?" (c) "During weekends (Saturday and Sunday), how many days do you usually use IM?" The response options were: (1) Only on Saturday; (2) Only on Sunday; (3) On both days; and (4) I do not use IM on the weekends. If respondents selected response options 1 to 3 in the question on IM weekend use, they were asked the following question for Saturday and/or Sunday: (d) "On a Saturday (a Sunday), how long do you usually use IM?" Respondents' IM use per week was calculated by multiplying the number of days per week that they used IM (range 0 through 7) by the number of minutes they used it on each day. This operationalization of weekly time spent with a medium has been proven valid for children older than 9 (Van der Voort & Vooijs, 1990). The mean time spent with IM per week was 15 hours

and 15 minutes (SD=21 hours and 10 minutes).

Chat Use

We measured respondents' chat use in the same way as their IM use. Using the same four questions, we asked the respondents to evaluate how much time per week they used chat in public chatrooms. The mean time spent with chat per week was 1 hour and 23 minutes (SD=7 hours and 30 minutes).

Time Spent with Friends

Time spent with existing friends was measured with three items that were adopted from the companionship subscale of Buhrmester's (1990) Network of Relationship Inventory. We first asked respondents to think of the friends they know from their offline environment, such as from school and the neighborhood. Then we asked them three questions: (a) "How often do you meet with one or more of these friends?," (b) "How often do you and these friends go to places and do things together?," and (c) "How often do you go out and have fun with one or more of these friends?" Response options ranged from 1 (never) to 9 (several times a day). The three items loaded on one factor, which explained 69% of the variance (Cronbach's alpha=.76; M=5.78; SD=1.65).

Quality of Friendships

The quality of existing friendships was measured with the relationship satisfaction (three items), approval (three items), and support (three items) subscales of Buhrmester's (1990) Network of Relationship Inventory. We asked respondents to think of the friends they know from their offline environment, such as from school and the neighborhood. Example items were: (1) "How often are you happy with your relationship with these friends?" (satisfaction), "How often do these friends praise you for the kind of person you are?" (approval), and (3) "How often do you turn to these friends for support with personal problems?" Response options ranged from 1 (never) to 5 (always). The nine items were averaged to form a quality of friendship scale (Cronbach's alpha=.93; M=3.44; SD=0.72).

Well-Being

We used the five-item satisfaction with life scale developed by Diener, Emmons, Larsen, and Griffin (1985). Examples of items of this scale are "I am satisfied with my life" and "In most ways my life is close to my ideal." Response categories ranged from 1 (agree entirely) to 5 (disagree entirely) and were reversely coded. Cronbach's alpha for the scale was .88, which is comparable to the alpha of .87 reported by Diener et al. (1985).

Findings
Time Spent with IM and Chat

Respondents spent significantly more time per day on IM than on chat. Specifically, they spent on average two hours and 11 minutes per day on IM and on average 12 minutes per day on chat. This greater amount of time spent on IM suggests that if any effect of the Internet is to be expected, it will occur through the use of IM. However, to verify this claim, we test the separate effects of IM and chat in the subsequent analyses.

Online Communication with Existing Friends

We also investigated the assumption in this and earlier studies that IM is most often used to communicate with existing friends, whereas chat in a public chatroom is more often used to communicate with strangers. This assumption was supported. Ninety-one percent of the respondents indicated that they "often" to "always" used IM to communicate with existing friends. Thirty-seven percent of the respondents indicated that they "often" to "always" used chat to communicate with existing friends.

Pitting the Displacement Hypothesis against the Stimulation Hypothesis

Following the displacement and stimulation hypothesis, we did not assume a direct relationship between online communication and well-being. Rather, we expected that the direct relationship between online communication would be mediated by the time spent with existing friends and the quality of these friendships (see Figure 1). Table 1 presents the zero-order correlations between the independent variables (IM and chat

use), the first mediating variable (time spent with friends), the second mediating variable (quality of friendships), and the dependent variable (well-being). In line with our expectations, neither IM nor chat use was directly related to well-being. However, the results in Table 1 do suggest a mediated positive effect of IM use and, to a lesser extent, a positive mediated effect of chat use on well-being through the time spent with friends and the quality of friendships.
Variables Time spent with IM .33*** Time spent with chat Time spent with friends Quality of friendships Well-being

Time spent with chat Time spent with friends Quality of friendships Well-being Age Gender (male)

.16***

.07*

-.01

-.07*

.30***

-.03 .20*** .05

.01 .03 .02

.18*** -.03 .00

.20*** .06* -.17*** -.12* .05

Table 1. Zero-order correlations among all variables in the study Note: * p<.05; ** p<.01; *** p<.001

We used a formal mediation analysis to test our hypotheses. In recent years, several approaches to examining indirect or mediated effects have been discussed (for a review, see MacKinnon, Lockwood, Hoffman, West, & Sheets, 2002). The most widely used approach is the causal steps approach developed by Judd and Kenny (1981) and Baron and Kenny (1986). This approach assumes that in order to test mediation, the independent, dependent, and mediator (or intervening) variables must all be correlated with each other. The causal steps approach has recently been criticized, first because it does not provide a statistical test of the size of the indirect effects, and second because the requirement that there must be a significant direct association between the independent and dependent variable is considered too restrictive (MacKinnon, Krull, & Lockwood, 2000; MacKinnon, Lockwood, et al., 2002; Shrout & Bolger, 2002).

The problems inherent in the causal steps approach are solved in the intervening variable approach proposed by MacKinnon and his colleagues (MacKinnon, Krull, et al., 2000; MacKinnon, Lockwood, et al., 2002), which was used in the present study. The first step in this approach is to run a regression analysis with the independent variable predicting the mediator. The second step is to estimate the effect of the mediator on the dependent variable, after controlling for the independent variable. However, because we hypothesized that two (rather than one) intervening variables would mediate the effect of online communication on well-being, we used a four-step procedure to test for mediation.

In the first step, the independent variable (online communication) predicted the first intervening variable (time spent with friends). In the second step, the first intervening variable (time spent with friends) predicted the second intervening variable (quality of friendships), while controlling for the independent variable (online communication). In the third step, the first intervening variable (time spent with friends) predicted the second intervening variable (quality of friendships), and in the fourth and final step, the second intervening variable (quality of friendships) predicted well-being, while controlling for the first intervening variable (time spent with friends). The results of these four regression analyses are presented in Table 2.
B First mediation analysis DV: Time spent with friends IV: IM frequency IV: chat frequency DV: Quality of friendships IV: IM frequency MV: Time spent with friends Second mediation analysis DV: Quality of friendships -.0002 .1376 .0001 .0121 -.05 .32* .0014 .0005 .0003 .0008 .15* .02 SE

IV: Time spent with friends DV: Well-being IV: Time spent with friends MV: Quality of friendships

.1339

.0119

.30*

.0646 .1858

.0146 .0335

.13* .16*

Table 2. Mediation analyses Notes: DV=Dependent variable; IV=Independent variable; MV=Mediating variable * p<.001; The 4 decimals for the Bs are presented to enable the reader to recalculate the Sobel test.

As the first mediation analysis in Table 2 shows, time spent with IM was positively related (=.15, p<.001) to the time spent with existing friends, a result which supports the stimulation hypothesis and our H1b (see Figure 1). The opposite displacement hypothesis expressed in H1a, which predicted a negative path between these two variables, was not supported. As Table 1 shows, the regression analysis showed that time spent with chat was not significantly related to time spent with friends (=.02, n.s.). This implies that the first condition for mediation was not met in the case of time spent with chat. In other words, the causal predictions of the two hypotheses (H1a and H1b) only applied to IM, but not to chat. Therefore, the subsequent mediation analyses were only conducted for time spent with IM.

Our second hypothesis stated that the quality of friendships would positively predict well-being and act as mediator between time spent with friends and well-being (path 3 in Figure 1). This hypothesis was supported. As the second mediation analysis in Table 2 shows, the quality of friendships significantly predicted well-being (=.16, p<.001), even when the first mediating variable (time spent with friends) was controlled. The fact that time spent with friends remained a significant predictor (=.13, p<.001) of well-being when the quality of friendship was controlled indicates that the mediation of quality of friendship was only partial. Finally, in support of our third hypothesis (path 2 in Figure 1), time spent with friends acted as a full mediator between time spent with IM and the quality of friendships (see the significant of .32 for time spent with friends versus the nonsignificant of -.05 for time spent with IM).

We tested the significance of the indirect effects by means of a formula developed by Sobel (1982). If the

Sobel test leads to the critical z-value of 1.96, the mediator carries the influence of the independent variable to the dependent variable. An online version of this test is available at

http://www.unc.edu/~preacher/sobel/sobel.htm (Preacher & Leonardelli, 2005). The zvalue for the first mediation analysis was 5.03, p=.001; the z-value for the second mediation analysis was 4.98, p=.001. These significant z-values indicate that both the time spent with friends and the quality of friendships are valid underlying mechanisms through which the effect of IM on well-being can be explained.

Discussion

The aim of this study was to test the validity of two opposing explanatory hypotheses on the effect of online communication on well-being: the displacement hypothesis and the stimulation hypothesis. Both hypotheses assume that online communication affects adolescents' well-being through its influence on their time spent with existing friends and the quality of those friendships. However, the displacement hypothesis assumes a negative effect from online communication to time spent with existing friends, whereas the stimulation hypothesis predicts a positive relationship between these variables.

We used formal mediation analyses to test the validity of the two mediating variables. Our results were more in line with the stimulation hypothesis than with the displacement hypothesis. We found that time spent with IM was positively related to the time spent with existing friends. In addition, the quality of friendships positively predicted well-being and acted as a first mediator between time spent with IM and well-being. Finally, we found that time spent with friends mediated the effect of time spent with IM on the quality of friendships.

However, the positive effects of our study held only for the time spent with IM and not for time spent with chat in a public chatroom. IM and chat seem to have very different functions for adolescents. In line with earlier studies, we found that the majority of adolescents use IM to talk with their existing friends. Chat in a public chatroom is less often used by adolescents. However, when utilized, adolescents primarily seem to chat with strangers. It is important for future research to differentiate between the uses of online communication

technologies, because there is a risk of finding misleading null-effects when these different uses are unknowingly combined in a survey.

Overall, our study suggests that Internet communication is positively related to the time spent with friends and the quality of existing adolescent friendships, and, via this route, to their well-being. These positive effects may be attributed to two important structural characteristics of online communication: its controllability and its reduced cues. Several studies have shown that these characteristics of online communication may encourage intimate self-disclosure (e.g., Joinson, 2001; Leung, 2002; McKenna, Green, & Gleason, 2002; Tidwell & Walther, 2002; Valkenburg & Peter, 2007), especially when adolescents perceive these characteristics of Internet communication as important (Schouten, Valkenburg, & Peter, in press; Valkenburg & Peter, 2007). Because intimate self-disclosure is an important predictor of reciprocal liking, caring, and trust (Collins & Miller, 1994), Internet-enhanced intimate self-disclosure may be responsible for a potential increase in the quality of adolescents' friendships.

Our results have several implications for future research. Because the stimulation hypothesis seems to be the best working hypothesis, follow-up research can be specifically designed to explore this hypothesis further and pursue a next step in theory formation: Attempting to answer why online communication may stimulate the quality of existing friendships. Although there is growing evidence for the positive effect of online communication on intimate self-disclosure, to date no research has demonstrated whether this potential mediator may account for a stimulation effect on the quality of existing friendships.

Although this study pitted two causal effects hypotheses against one another, we acknowledge that the assumptions of these hypotheses were tested with cross-sectional data. Although our study was theory driven, a reverse explanation for our findings may also be plausible. That is, how people choose to use online communication may be influenced by the quality of their existing relationships and/or by their trait sociability (see also Baym et al., 2004). There is a pressing need for causal-correlational research to investigate the longitudinal relationships between online communication and the quality of adolescent existing relationships. Not only are longitudinal designs better able to distinguish causation from covariance, but they are also pre-

eminently suitable for exploring the validity of the underlying mechanisms by which Internet communication influences adolescents' social relationships.

Acknowledgment

We would like to thank the Netherlands Organisation for Scientific Research [NWO] for providing support for this study.

References

Baron, R., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51 (6), 1173-1182.

Baym, N. K., Zhang, Y. B., & Lin, M. C. (2004). Social interactions across media: Interpersonal communication on the Internet, telephone and face-to-face. New Media & Society, 6 (3), 299-318.

Beebe, T. J., Harrison, P. A., McRae, J. A., Anderson, R. E., & Fulkerson, J. A. (1998). An evaluation of computer-assisted self-interviews in a school setting. Public Opinion Quarterly, 62 (4), 623-632.

Brener, N. D., Eaton, D. K., Kann, L., Grunbaum, J. A., Gross, L. A., Kyle, T. M., et al. (2006). The association of survey setting and mode with self-reported health risk behaviors among high school students. Public Opinion Quarterly, 70 (3), 354-374.

Bryant, J. A., Sanders-Jackson, A., & Smallwood, A. M. K. (2006). IMing, text messaging, and adolescent social networks. Journal of Computer-Mediated Communication, 11 (2), article 11. Retrieved July 2, 2007 from

http://jcmc.indiana.edu/vol11/issue2/bryant.html

Buhrmester, D. (1990). Intimacy of friendship, interpersonal competence, and adjustment during preadolescence and adolescence. Child Development, 61 (4), 1101-1111.

Bukowski, W. M. (2001). Friendships and the worlds of childhood. New Directions for Child and Adolescent Development, 91, 93-105.

Collins, N. L., & Miller, L. C. (1994). Self-disclosure and liking: A meta-analytic review. Psychological Bulletin, 116, 457-475.

Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95 (3), 542-575.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71-75.

Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125 (2), 276-302.

Grinter, R. E., & Palen, L. (2004). Instant messaging in teen life. Proceedings of the 2002 ACM Conference on Computer Supported Cooperative Work (CSCW '02). Retrieved July 5, 2004 from

http://doi.acm.org/10.1145/587078.587082
Gross, E. F. (2004). Adolescent Internet use: What we expect, what teens report. Journal of Applied Developmental Psychology, 25 (6), 633-649.

Hartup, W. W. (2000). The company they keep: Friendships and their developmental significance. In W. Craig (Ed.), Childhood Social Development: The Essential Readings (pp. 61-84). Malden, MA: Blackwell.

Hartup, W. W., & Stevens, N. (1997). Friendships and adaptation in the life course. Psychological Bulletin, 121 (3), 355-370.

Jackson, L. A., von Eye, A., Barbatsis, G., Biocca, F., Fitzgerald, H. E., & Zhao, Y. (2004). The impact of Internet use on the other side of the digital divide. Communications of the ACM, 47 (7), 43-47.

Joinson, A. N. (2001). Self-disclosure in computer-mediated communication: The role of self-awareness and visual anonimity. European Journal of Social Psychology, 31, 177-192.

Judd, C. M., & Kenny, D. A. (1981). Process analysis: Estimating mediation in treatment evaluations. Evaluation Review, 5 (5), 602-619.

Jung, J. Y., Qiu, L. J., & Kim, Y.-C. (2001). Internet connectedness and inequality. Communication Research, 28 (4), 507-535.

Kraut, R., Kiesler, S., Boneva, B., Cummings, J., Helgeson, V., & Crawford, A. (2002). Internet paradox revisited. Journal of Social Issues, 58 (1), 49-74.

Kraut, R., Patterson, M., Lundmark, V., Kiesler, S., Mukopadhyay, T., & Scherlis, W. (1998). Internet paradox: A social technology that reduces social involvement and psychological well being? American Psychologist, 53 (9), 1017-1031.

LaRose, S., Ghuay, F., & Boivin, M. (2002). Attachment, social support, and loneliness in young adulthood: A test of two models. Personality and Social Pscyhology Bulletin, 28 (5), 684-693.

Lenhart, A., Madden, M., & Hitlin, P. (2005). Teens and Technology. Washington, DC: Pew Internet & American Life Project.

Leung, L. (2002). Loneliness, self-disclosure and ICQ ("I Seek You") use. CyberPsychology & Behavior, 5 (3), 241-251.

MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000). Equivalence of the mediation, confounding, and suppression effect. Prevention Science, 1 (4), 173-181.

MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7 (1), 83-104.

Matei, S., & Ball-Rokeach, S. J. (2001). Real and virtual social ties: Connections in the everyday lives of seven ethnic neighborhoods. American Behavioral Scientist, 45 (3), 550-564.

McKenna, K. Y., Green, A. S., & Gleason, M. E. (2002). Relationship formation on the internet: What's the big attraction? Journal of Social Issues, 58 (1), 9-31.

Mesch, G. (2001). Social relationships and Internet use among adolescents in Israel. Social Science Quarterly, 82 (2), 329-340.

Mesch, G. (2003). The family and the Internet: The Israeli case. Social Science Quarterly, 84 (4), 1083-1050.

Morgan, C., & Cotten, S. R. (2003). The relationship between Internet activities and depressive symptoms in a sample of college freshmen. CyberPsychology & Behavior, 6 (2), 133-141.

Mustanski, B. S. (2001). Getting wired: Exploiting the Internet for the collection of sexually valid data. The Journal of Sex Research, 38 (4), 292-301.

Nie, N. H. (2001). Sociability, interpersonal relations and the Internet: Reconciling conflicting findings. American Behavioral Scientist, 45 (3), 420-435.

Nie, N. H., Hillygus, D. S., & Erbring, L. (2002). Internet use, interpersonal relations, and sociability: A time diary study. In B. Wellman & C. Haythornthwaite (Eds.), The Internet in Everyday Life (pp. 215-243). Oxford: Blackwell.

Preacher, K. J., & Leonardelli, G. J. (2005). Calculation for the Sobel test: An interactive calculation tool for mediation tests. Retrieved March 1, 2006 from

http://www.unc.edu/~preacher/sobel/sobel.htm
Sanders, C. E., Field, T. M., Diego, M., & Kaplan, M. (2000). The relationship of Internet use to depression

and social isolation. Adolescence, 35 (138), 237-242.

Schouten, A. P., Valkenburg, P. M., & Peter, J. (in press). Precursors and underlying processes of adolescents online self-disclosure: Developing and testing an "Internet-attribute-perception" model. Media Psychology.

Shaw, L. H., & Gant, L. M., (2002). In defense of the Internet: The relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support. CyberPsychology & Behavior, 5 (2), 157-170.

Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7 (4), 422-445.

Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological Methodology (pp. 290-312). San Francisco: Jossey-Bass.

Subrahmanyam, K., Kraut, R. E., Greenfield, P. M., & Gross, E. (2000). The impact of home computer use on children's activities and development. Future of Children, 10 (2), 123-144.

Tidwell, L. C., & Walther, J. B. (2002). Computer-mediated communication effects on disclosure, impressions, and interpersonal evaluations. Human Communication Research, 28 (3), 317-348.

Tourangeau, R., & Smith, T. W. (1996). Asking sensitive questions: The impact of data collection mode, question format, and question context. Public Opinion Quarterly, 60 (2), 275-304.

Valkenburg, P. M., & Peter, J. (2007). Preadolescents' and adolescents' online communication and their closeness to friends. Developmental Psychology, 43 (2).

Valkenburg, P. M., & Soeters, K. (2001). Children's positive and negative experiences with the Internet. Communication Research, 28 (5), 653-676.

Van der Voort, T. H., & Vooijs, M. W. (1990). Validity of children's direct estimates of time spent television viewing. Journal of Broadcasting and Electronic Media, 34 (1), 93-99.

Waestlund, E., Norlander, T., & Archer, T. (2001). Internet blues revisited: Replication and extension of an Internet paradox study. CyberPsychology & Behavior, 4 (3), 385-391.

Weiser, E. B. (2001). The functions of Internet use and their psychological consequences. Cyberpsychology & Behavior, 4 (6), 723-744.

About the Authors

Patti M. Valkenburg is a professor in the Amsterdam School of Communications Research (ASCoR) at

the University of Amsterdam. Her research interests include the effects of media on children and adolescents. She is chair of CAM, the research center of Children, Adolescents, and the Media; see

http://www.cam-ascor.nl
Address: Amsterdam School of Communication Research, ASCoR, University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands

Jochem Peter is an associate professor in the Amsterdam School of Communications Research (ASCoR)
at the University of Amsterdam. His research focuses on the consequences of adolescents' Internet use for their sexual socialization and psycho-social development; see

http://www.cam-ascor.nl

Address: Amsterdam School of Communication Research, ASCoR, University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam. Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands 2007 Journal of Computer-Mediated Communication

NEXT:

Boys Have Greater Psychological Well-being Than Girls, Due To Better Physical Self-concept, Study Finds
ScienceDaily (Feb. 12, 2009) A PhD thesis defended at the University of the Basque Country (UPV/EHU) has investigated the relationship between adolescents perception of their physical qualities and their psychological wellbeing and unwellness.
See also: Health & Medicine Mental Health Research Fitness Sports Medicine

Mind & Brain Child Psychology Child Development Anxiety

Reference Separation anxiety disorder Self-concept Neurosis Eating disorder

Self-concept may be defined as the totality of perceptions that each person has of themselves, and this self identity plays an important role in the psychological functioning of everyone. To date, however, there has been no investigation into the relationship that physical self-concept has with psychological well-being or psychological unwellness. The author of the thesis is Ms Arantzazu Rodrguez Fernndez, who presented her work under the title, El autoconcepto fsico y el bienestar/malestar psicolgico en la adolescencia (Physical self-concept and psychological well-being/unwellness during adolescence). Ms Rodrguez is a graduate in Psychology and carried out her PhD under the direction of doctors Alfredo Goi Grandmontagne and Igor Esnaola Etxaniz, of the Department of Evolutionary Psychology and the University School of Education at the UPV/EHU. She currently works as a research worker at the university. This research had three fundamental objectives: to study the relationship between physical self-concept and psychological well-being, to identify the relationship between physical self-concept and anxiety and depression and, finally, to analyse the relationship between physical self-concept and Eating Behaviour Disorders (EBDs)

amongst both the non-clinical population in general as well as amongst patients previously diagnosed with anorexia or bulimia nerviosa. Study on adolescents To undertake the research, a total of 1,959 young people between the ages of 12 and 23 from the Basque Country, Burgos and Rioja were studied. 48 of these were patients diagnosed with some form of EBD. The data obtained indicated that physical self-concept is related in a positive manner with the psychological well-being of the individual and in a negative manner to psychological unwellness, in such a way that the more one is happy with ones physique, the more psychological well-being one has, with less levels of anxiety and depression and less risk of suffering from an EBD. This relationships have also been analysed as a function of age, gender and physical activity. As a general rule, it is seen that, taking into account physical self identity, male adolescents present higher scoring for psychological well-being than their female peers. This same relationship is established between12-14 year old adolescents on the one hand and 15+ adolescents on the other, and between those who do physical activity and those who do not. But, considering all the variables at the same time, it was seen that adolescents with more positive physical self-concept and who are, at the same time, between 12 and 14 or carry out physical activity, score higher for psychological well-being, without any significant difference between the sexes being observed. This research also showed young people experienced psychological unwellness in relation to their physical appearance throughout their adolescence, whether their perception of their physique is low, average or high. Nevertheless, undertaking sporting activity appears to be a good way to minimise any psychological unwellness, probably because it enhances physical self-concept. It is only when physical self-concept is low that doing physical exercise gives rise to the potential risk of suffering EBD. As a rule, however, sport can be defended as a way of increasing personal well-being and reducing psychological unwellness. Stages of greater risk As regards disorders associated with physical appearance, the greatest risk of developing an anxiety disorder is after the age of 15; for a depressive disorder the risk stage is between 12 and 17; and for anorexia or bulimia nerviosa the risk period is between 18 and 23. Finally, of all the elements conditioning physical self-concept, the outstanding one is that of an attractive physical appearance, because the self-perception of this is strongly related to anxiety, depression and psychological well-being. All this, of course, is a

reflection of how society favours relationships between what is attractive as perceived by one and how anxious, how depressed or how happy one feels with oneself.
Adapted from materials provided by Basque Research. Email or share this story: | More

Need to cite this story in your essay, paper, or report? Use one of the following formats: APA MLA Basque Research (2009, February 12). Boys Have Greater Psychological Well-being Than Girls, Due To Better Physical Self-concept, Study Finds. ScienceDaily. Retrieved July 6, 2009, from http://www.sciencedaily.com /releases/2009/02/090203081618.htm

NEXT:
Journal of Pediatric Psychology Advance Access originally published online on July 12, 2006
Journal of Pediatric Psychology 2007 32(3):260-272; doi:10.1093/jpepsy/jsl018 The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Illness Centrality and Well-Being Among Male and Female Early Adolescents with Diabetes
Vicki S. Helgeson, PhD and Sarah A. Novak, PhD
Carnegie Mellon University All correspondence concerning this article should be addressed to Vicki S. Helgeson, PhD, Department of Psychology, Carnegie Mellon University, Pittsburgh 15213. E-mail:

Abstract
Top Abstract Method Results Discussion Acknowledgme nts References

Objective We examined the implications of illness centrality for psychological and physical health among male and female early adolescents with type 1 diabetes. Methods We interviewed 132

adolescents before or after a routine clinic appointment. We measured the extent to which they defined themselves in terms of their illness, their views of the illness, psychological well-being, self-care behavior, and metabolic control. Results Females scored higher on illness centrality than males. Illness centrality was related to poor psychological well-being when the illness was perceived in negative terms, but only for females. For males, illness centrality was unrelated to psychological well-being. Illness centrality was related to poor metabolic control. Conclusions The extent to which adolescent females define themselves in terms of their illness is most problematic when the illness is perceived in highly negative terms. Future research should examine how illness centrality and views of illness change over the course of adolescence. Key words: adolescents with diabetes; gender; health; self-concept.
The advances in cognitive development that occur during adolescence provide for the possibility of a greater differentiation of the self (Harter, 1990a , 1999 ; Harter, Bresnick, Bouchey, & Whitesell, 1997 ). Ones conception of the self expands during adolescence to represent the increasing number of roles and diverse experiences (Harter et al., 1997 ). Contemporary research on the self has emphasized that there are multiple facets to the self during adolescence (Harter, 1986 , 1990b ; Marsh, 1987 ). According to Jones et al. (1984) , an "individual actively constructs a selfconcept from the information contained in his or her unfolding experiences" (p. 115). In this report, we focus on how adolescents integrate a particular experience into their self-conceptthe presence of a chronic illness.

In the adult literature, there is discussion as to how the diagnosis of a chronic illness affects ones sense of self. According to Charmaz (1991) , ones sense of self is transformed from a healthy self to a sick self. To the extent that a chronic illness is viewed as a stigmatizing condition, there may be difficulties integrating this experience into ones sense of self (Jones et al., 1984 ). However, there is variability in the extent to which people incorporate an illness into their self-concepts. Charmaz (1991) made the distinction between people who incorporate the illness into their self-concepts, making it a defining part of who they are, and people who "contain" the illness by trying not to let it intrude or interfere with their lives. Research on stigma has noted that some individuals build their self-concepts around the stigmatizing condition but others disregard it (Jones et al., 1984 ). That is, individuals vary in the extent to which they define themselves in terms of their illness, or what we refer to as "illness centrality." What are the implications of illness centrality for psychological and physical health among adolescents? To the extent that an illness is viewed as a stigmatizing condition (and it may not be we will return to this point later), the stigma literature predicts that illness centrality will be related to more psychosocial difficulties (Jones et al., 1984 ). To the extent that an illness is regarded as an area of weakness or viewed as underperformance in the health domain, other work suggests that illness centrality will be related to low self-esteem. More specifically, drawing on the work of William James (1890 , 1892 ), Harter and colleagues (see Harter, 1999 , for a review) have suggested that adolescent self-esteem is a function of ones performance in a domain as well as the importance that one attaches to that domain. Performing well in domains that are regarded as important is associated with high self-esteem, whereas performing poorly in

domains that are regarded as important is associated with low self-esteem (Harter, Whitesell, & Junkin, 1998 ). Overall, the relation of performance to self-esteem is much stronger for domains that are self-defining than domains that are not (Harter, 2003 ). These ideas also are reflected in self-evaluation maintenance (SEM) theory (Tesser, 1988 ), which focuses on self-evaluations as a product of comparisons with others. SEM theory states that self-esteem will be threatened when one performs worse than another in a domain that one regards as self-relevant. Both theories suggest that how one perceives an illness will be more strongly related to self-esteem for those who attach greater importance to the illness or view the illness as more central to their selfconcepts. The literature also suggests that people can preserve their self-esteem when performance is poor by discounting the importance of a domain (Harter, 2003 ; Tesser, 1988 ). Performing poorly in a domain that is defined as less central to the self will not have negative implications for selfesteem (Harter & Whitesell, 2001 ; Harter et al., 1998 ). Thus, one way to preserve self-esteem in the face of chronic illness may be to make it less central to the self-concept. Although the predictions for the relation of illness centrality to psychological health may be clear, the predictions for physical health outcomes are less clear. These theorists were not specifically discussing aspects of the self that would have implications for physical health, like managing a chronic illness such as diabetes. Discounting diabetes as less central to the self might be related to good mental health but also could be related to poor self-care behavior which could then affect overall physical health. We now know that self-care behaviors during childhood and adolescence can have long-term consequences for physical health (Diabetes Control and Complications Trial Research Group, 1993 ). In fact, some have argued that viewing an illness as central to ones self-concept might have beneficial effects on physical health if it leads individuals to take better care of themselves. For that reason, Wiebe, Berg, Palmer, Korbel, and Beveridge (2002) argued that illness centrality would be adaptive when the demands of an illness were high, as they are in the case of diabetes, because illness centrality would lead to better selfcare behavior. Thus far, we have been assuming that people perceive a chronic illness in negative terms, as a stigmatizing condition or as a domain of underperformance. However, it is likely that people vary in their attitudes toward having a chronic illness. In his seminal work on stigma, Goffman (1963) noted that there is variability in the extent to which an individual attaches shame to the condition. Wiebe et al. (2002) suggested that the impact of illness centrality on health outcomes would depend on the individuals attitude toward the illness, that is, whether the individual perceived the illness in positive or negative terms. They predicted that perceiving an illness that one views negatively as central to the self would be associated with poor health outcomes, whereas perceiving an illness that one views positively (or less negatively) as central to the self would have fewer negative consequences for health. They tested this hypothesis in a study of 128 children, 1016 years of age, with diabetes. Illness centrality was related to more depressive symptoms only when the illness was perceived in highly negative terms. Illness centrality also was related to poor metabolic control only when the illness was perceived negatively. Thus, the goal of the present research was to examine the effect of illness centrality on psychological and physical health among adolescents with diabetes and to determine the extent to which ones attitude toward the illness (i.e., illness valence) affects these relations.

One issue that Wiebe et al. (2002) neglected in their research on illness centrality and health is the participants sex. There are reasons to believe that females may be more likely than males to integrate an illness into their identities. Women are more interested in health matters than men. Women report that they think about health and read about health in newspapers and magazines more than men do (Green & Pope, 1999 ). Females visit the doctor more frequently than males (Kandrack, Grant, & Segall, 1991 ), are more likely to take vitamins than males (Slesinski, Subar, & Kahle, 1996 ), engage in better health behavior than males (Shi, 1998 ), and attach greater value to good health behavior than males (Weissfeld, Kirscht, & Brock, 1990 ). In one study, females attached more importance to healthy eating than males, and this finding generalized across 23 cultures (Wardle et al., 2004 ). All of this evidence suggests that girls growing up in an environment where women are more concerned with health than men may learn to do the same. Females also respond to illness quite differently than males. Females are said to be more likely than males to adopt the "sick role," meaning that they are more likely than males to respond to illness by taking medication, restricting activities, or seeking the help of health care professionals (Green & Pope, 1999 ; Kandrack et al., 1991 ; Waldron, 1997 ). By contrast, males reject the sick role, for example, by acting as if they are healthy when ill. One of the clearest arenas in which this can be observed is the area of sports, where males are socialized to deny pain, hide pain, and suppress pain (White, Young, & McTeer, 1995 ). Admitting pain is a sign of weakness. Men have been found to be less willing than women to report pain and to associate pain with embarrassment, and these sex differences have been linked to gender-role expectations (Klonoff, Landrine, & Brown, 1993 ; Wise, Price, Myers, Heft, & Robinson, 2002 ). Even as children, boys are more likely than girls to keep their feelings about an illness to themselves. Two classic studies conducted several decades ago showed a sex difference in stoicism among children that increased with age (Campbell, 1978 ; Mechanic, 1966 ). In a study of children with chronic disease, parents reported that girls had more problems with dependence than boys, although mothers perceived the illness as equally restrictive for boys and girls (Eiser, Havermans, Pancer, & Eiser, 1992 ). Another study showed that girls report more sympathy from parents and greater encouragement of illness behaviors such as taking medication and missing school than boys when ill (Walker & Zeman, 1992 ). Sweeting (1995) has argued that illness behaviors among children become more differentiated by sex during adolescence. The links of being female to a greater concern for health and a greater willingness to assume the sick role when ill suggest that girls attach more importance to the status of their health and may be more likely than boys to integrate an illness into their self-concepts. The only evidence to date that this is the case is that girls with a chronic illness are more likely to share their illness with others (Miller, Willis, & Wyn, 1993 ; Prout, 1989 ). Boys may be more likely than girls to compartmentalize an illness and keep it from others. Not only may girls be more likely than boys to integrate an illness into their self-concepts, it also is possible that such integration (i.e., illness centrality) has stronger implications for behavior and well-being among girls than boys. Thus, the goal of this study is to examine the impact of illness centrality on psychological and physical health among male and female early adolescents with diabetes. We focused on early adolescents for three reasons. First, early adolescence is a difficult time for those with diabetes. Difficulties with self-care behavior increase during early adolescence (Anderson, Ho, Brackett,

Finkelstein, & Laffel, 1997 ; Glasgow et al., 1999 ; Weissberg-Benchell et al., 1995 ), and metabolic control declines (Anderson et al., 1997 ; Pound, Sturrock, & Jeffcoate, 1996 ). Thus, early adolescence is an important time to study the relation of psychosocial factors to psychological and physical health. Second, the presence of a chronic illness during early adolescence might pose particular challenges for ones sense of self. It is during early adolescence that the self becomes more differentiated (Harter, 2003 ). In addition, the goals of adolescence are to establish a sense of identity and independence from parents (Baumrind, 1987 ; Collins, Gleason, & Sesma, 1997 ). Taking care of a chronic illness poses demands that may interfere with these goals. Thus, early adolescence is an important time to study the implications of an illness for ones self-concept. Third, early adolescence is a time of gender intensification (Galambos, Almeida, & Petersen, 1990 ; Hill & Lynch, 1983 ; McNeill & Petersen, 1985 ) that is, ones identity as a male or a female becomes quite salient. Thus, to the extent that illness is more consistent with the female than the male role, females should perceive the illness as more central to the self than males, and illness centrality is likely to have greater implications for female than male health. First, we hypothesized that girls would be more likely than boys to define themselves in terms of their illness; that is, score higher on a measure of illness centrality. Second, in accordance with Wiebe et al. (2002) , we hypothesized that the relation of illness centrality to health outcomes would depend on whether the illness was viewed in positive or negative terms, or what we refer to as "illness valence." Specifically, we hypothesized that illness centrality would be related to increased psychological distress, poor self-care behavior, and worse metabolic control when one viewed the illness negatively. However, when one perceived the illness in positive terms (or less negatively), we predicted that illness centrality would be either unrelated to these outcomes or related to less psychological distress, better self-care behavior, and better metabolic control. Third, we hypothesized that the relation of illness centrality to these outcomes would be stronger for females than males. That is, we examined whether gender moderated the relations of illness centrality and illness valence to health.

Method

Participants Participants were 132 adolescents with diabetes (70 girls, 62 boys). Ages ranged from 10.73 to 14.21 years, with a mean of 12.10. The majority of the children (80%) were aged 11 and 12. Males and females were of a similar age. Length of illness ranged from 1 to 13 years (M = 4.91, SD = 2.96). The majority of participants were white (93%), 2% were African American, 1% were Asian, 1% were American Indian, and 3% were mixed races. These figures are consistent with the diabetes population seen at

Top Abstract Method Results Discussion Acknowledgme nts References

Childrens Hospital, which draws from a largely suburban and partly rural area. The four-factor Hollingshead index (1975) (mother and father education and occupation) of social status revealed an average family score of 41.97 (SD = 11.05), which reflects the lower end of technical workers, medium business, and minor professionals. Procedure The study was approved by the appropriate Institutional Review Boards. Letters (N = 307) of invitation were sent to all adolescents with diabetes who were between the ages of 1014 (approaching 11 or having just turned 14 to keep the age range as homogenous as possible) attending Childrens Hospital. Families could return a postcard indicating that they did not want to be contacted by telephone about the study. Twenty families returned these postcards, refusing contact about the study without us being able to determine eligibility. We were able to reach 261 of the remaining 287 families by telephone and determined that 90 were not eligiblemeaning that they no longer went to Childrens Hospital; they had had diabetes for less than 1 year; they were not in 5th, 6th, or 7th grade; or they had another major chronic illness (i.e., cancer and rheumatoid arthritis). Of the 171 eligible families, 39 refused and 132 agreed. Thus, our effective response rate was 77%. For families who agreed, we set up an appointment immediately before or after the next clinic visit. Interviews were conducted at the hospital in a research room that was on a separate floor from the clinic and not associated with the clinic. Parent consent and child assent were obtained at that time. Interviews with children were conducted aloud. (The CDI was completed by the child in private because of the sensitive nature of these items.) Research assistants unrelated to Childrens Hospital administered measures of illness centrality, illness valence, psychological distress, self-perceived competence, and self-care behavior. Children were provided with response cards (i.e., 1 = not at all; 2 = a little; 3 = a lot) for standardized instruments. Children were paid for their participation in the study. Instruments Illness Centrality Illness centrality was measured with four items, three of which were used by Wiebe et al. (2002) ["I think of diabetes when I think of who I am," "I think a lot about my diabetes," and "I think of my diabetes only when I need to take care of it" (reverse scored)], and one of which we added ["Diabetes is a small part of my life" (reverse scored)]. The internal consistency was .51 for our 4-item measure in this study. [Inspection of the inter-correlations among the four items revealed that the first two were most strongly related (r = .47, p < .001). Thus, we reran the analyses with this 2-item index and found largely the same results. Therefore, we retained the 4-item index. We acknowledge the low reliability of the 4-item index, but also point out that the best way to increase the reliability of an index is to add items (Nunnally, 1978 ). According to Nunnally (1978) , adding eight items to this index would increase the reliability to .76.] On average, adolescents varied in their perceptions of illness centrality, with the mean reflecting the midpoint of the scale (M = 3.08; SD = .81). Illness Valence To determine how positively or negatively adolescents viewed the illness, we asked adolescents to identify up to five words that described themselves as a person with diabetes. To familiarize

adolescents with the nature of the task, we adapted the procedure that Wiebe et al. (2002) used and asked them to consider two more concrete tasksasking them first to think about themselves as a friend and second to think about themselves as a girl or boy. Descriptors were elicited for each of these two questions. We believed that providing participants with the opportunity to form responses to these two more concrete domains (friend and boy/girl) would make responding to the more abstract diabetes domain easier. Then they were told, "Now, I want you to think of yourself as someone with diabetes. Fill in the blank: [name] is a ____ person with diabetes. How would you describe yourself as someone with diabetes?" Two raters coded each of the responses into three categories: positive, neutral, or negative. Disagreements were resolved by a third independent rater. Inter-rater reliability was high ( = .80). Six participants were unable to identify any characteristics of being a person with diabetes. Thus, these individuals were not included in the data analysis. Remaining adolescents identified between 1 and 5 features of being a person with diabetes, with an average of 2. The average person identified 1 positive feature, .5 neutral features, and .5 negative features. There was no sex difference in the overall number of features named, the number of features coded into each of the three categories, or the percentage of features coded into the three categories. Because we were focused on those who perceived their illness negatively, we used the percentage of attributes named that were coded as negative (which ranged from 0 to 100%) as our measure of valence. Examples of items coded negatively are "abnormal," "weird," "scary," and "restricted." Higher numbers reflect a more negative view of the illness, and lower numbers reflect a less negative view of the illness. Psychological Distress We examined three indicators of psychological distress: depressive symptoms, anxiety, and anger. We used the abbreviated form of the Childrens Depression Inventory (CDI) to assess depressive symptoms (Kovacs, 1985 , 2001 ). The CDI is a self-report measure that was designed for children and adolescents. The abbreviated form consists of 10 items that are comprehensible at a first-grade reading level. Reliability of the CDI has been established through administration to psychiatric and medical outpatient populations. Internal consistency and testretest reliability are high. In the present study, the was .76. We measured anxiety with the seven items from the Revised Childrens Manifest Anxiety Scale. These were the seven items that were unique to anxiety when the instrument was factor analyzed with the CDI (Stark & Laurent, 2001 ). To increase variability in our scale (because we had reduced the number of items), we changed the true/false format to 3-point scale (not at all true, sort of true, or very true of me). The internal consistency in the present study was .68. We used the 3-item anger subscale of the Differential Emotions Scale (Izard, Libero, Putman, & Haynes, 1993 ). This is a self-report scale of different emotions that has been used with children. Test-retest reliability is high, and validity with comparable scales has been reported. The anger scale has been associated with aggression. We mixed these items with the seven anxiety items. For consistency, we changed the response format to a 3-point scale. The internal consistency was .76. Because depressive symptoms, anxiety, and anger were only modestly related (rs ranged from .22 to .43), we examined them separately.

Self-Perceived Competence We administered three subscales from the Self-Perception Profile for Children (Harter, 1985 ) to assess childrens judgments of their perceived competence. We selected two domains that we thought would be most relevant to adolescentsphysical appearance and social competence and also administered the global self-worth scale. The authors have shown that children are able to discriminate among domains of perceived competence, which has been confirmed by factor analytic studies. The internal consistencies for the three subscales were high in the present study (physical appearance .81; social competence .73; global self-worth .75). The three scales were moderately related (rs ranged from .31 to .53, ps < .001). Diabetes Outcomes We measured self-care behavior with the 14-item Self-Care Inventory (La Greca, Swales, Klemp, & Madigan, 1988 ). This instrument asks respondents to indicate how well they followed their physicians recommendations for glucose testing, insulin administration, diet, exercise, and other diabetes-related behaviors. This scale reflects domains of self-care that have been regarded as important by the American Diabetes Association, and it has been associated with metabolic control among adolescents in several studies (Delameter, Applegate, Edison, & Nemery, 1998 ; La Greca et al., 1988 ; La Greca, Follansbee, & Skyler, 1990 ). Validity of this self-report measure was established by comparisons with the 24-h recall gold standard measure of self-care behavior (Greco et al., 1990 ). Each item is rated on a 1 (never do it) to 5 (always do this as recommended) scale. We updated this scale by adding eight more contemporary items: three negative behaviors from Weissberg-Benchell et al. (1995 : made up blood tests results because numbers were too high, made up blood test results because did not really test, and took extra insulin because ate inappropriate food); three negative behaviors of our own (skipping meals, skipping injections, and eating foods that should be avoided); and two positive behaviors (rotating injection sites and measuring food). We reverse scored the negative items, summed across all the items, and took the average. The internal consistency was high ( = .78). Our revised measure was correlated .94 with La Grecas original 14-item scale. Metabolic control was measured with hemoglobin A1C (HbA1C) obtained at the clinic appointment. HbA1C values indicate the average blood glucose level over the course of the past 3 months. For the laboratory that conducted the tests, the range of blood glucose values for healthy individuals without diabetes is 4.36.1. In the current sample, the average HbA1C for our sample of adolescents with diabetes was 8.04 (SD = 1.31). A normal HbA1C in a population without diabetes is <6%. Current recommendations for 13- to 19-year-old adolescents are that their HbA1C be <8% (American Diabetes Association, 2006 ).

Results

Sex Differences in Illness Centrality As predicted, females viewed diabetes as more central to their self-concepts (M = 3.25; SD = .79) than males (M = 2.88; SD = .79), t(130) = 2.75, p < . 01 (partial 2 = .06).

Top Abstract Method Results Discussion Acknowledgme nts References

Correlates of Illness Centrality Illness centrality was unrelated to illness valence. Social status and race were not related to illness centrality. Although pubertal status was related to sex, that is, girls higher than boys, t(130) = 7.53, p < .001, it was not related to illness centrality or illness valence. Age was negatively associated with illness centrality, such that older children viewed the illness as less central to their self-concepts (r = .19, p < .05). Children who had had diabetes for a longer period also viewed the illness as less central to their self-concepts (r = .23, p < .01). Age and length of diabetes were independent correlates. When the length of diabetes was statistically controlled, age continued to predict illness centrality. (When all of the demographic variables and valence were entered into a multiple regression analysis to predict centrality, age and length of illness emerged as significant predictors; sex became marginally significant; and pubertal status, social status, race, and valence were not significant.) Illness Centrality and Illness Valence as Predictors of Outcomes To test whether the relation of illness centrality to outcomes was influenced by illness valence, we conducted hierarchical regression analyses. We entered sex, age, and length of diabetes on the first step of the equation as statistical controls, because they were related to illness centrality. We did not control for race, pubertal status, or social status, as these variables were not related to illness centrality or valence. Thus, although they may independently predict outcomes, they cannot account for any relations we obtain with illness centrality or valence. (Controlling for pubertal status and social status did not alter any of the findings that we report in this article.) The main effects of illness centrality and valence were entered on the second step of the equation, the two-way interactions between sex, illness valence, and centrality were entered on the third step (sex x valence; sex x centrality; centrality x valence), and the three-way interaction of sex, valence, and centrality was entered on the final step of the equation. Variables were centered before computing interaction terms. Significant interactions were interpreted using the procedures outlined by Aiken and West (1991) to plot slopes (i.e., outcomes of adolescents who scored 1 SD from the mean on centrality for those who regarded the illness as high or low in negativity). Psychological Distress For depressive symptoms, there was a main effect of sex ( = .20, p < .05), such that females had more depressive symptoms than males. There also was a sex x valence interaction ( = .18, p < . 05) that was qualified by a sex x valence x centrality interaction ( = .31, p < .005). To examine the nature of this interaction, we conducted separate regression analyses for males and females and found that the predicted valence x centrality interaction emerged for females ( = .32, p < . 01) but not for males. These findings are depicted in Fig. 1, using the procedures outlined by Aiken and West (1991) for plotting slopes. For females, illness centrality was related to more depressive symptoms when the illness was perceived the most negatively but was unrelated to

depressive symptoms when the illness was viewed as low in negativity. For males, illness centrality was unrelated to depressive symptoms regardless of illness valence.

Figure 1. The relation of illness centrality and illness valence to depressive symptoms for females and males.

View larger version (15K):

[in this window] [in a new window] [Download PowerPoint slide]

For anxiety, there was a main effect of centrality ( = .27, p = .005), such that centrality was associated with more anxiety that was qualified by the anticipated sex x valence x centrality interaction ( = .27, p < .01). Again, the valence x centrality interaction was significant for females ( = .32, p < .01) but not for males. The findings were similar to those shown in Fig. 1. For females, illness centrality was related to more anxiety when the illness was viewed as high in negativity but was unrelated to anxiety when the illness was not viewed negatively. For males, illness centrality was related to more anxiety, regardless of valence.

For anger, there was a sex x valence interaction ( = .18, p < .05) that was qualified by a threeway interaction involving centrality ( = .23, p < .05). The valence x centrality interaction was significant for females ( = .32, p < .01) but not for males. Similar to the findings shown in Fig. 1, for females, illness centrality was related to more anger when the illness was perceived as high in negativity but less anger when the illness was perceived as low in negativity. For males, illness centrality was unrelated to anger. Self-Perceived Competence We examined three domains of perceived competence: appearance, social, and global self-worth. For global self-worth, there was a main effect of sex ( = .20, p < .05), such that males had

higher self-worth than females. There also was a main effect of valence ( = .21, p < .05) that was qualified by a significant sex x valence interaction ( = .29, p = .001). As shown in Fig. 2, perceiving the illness in highly negative terms was related to lower self-worth for females only. There were no centrality effects.

Figure 2. The relation of illness valence to perceived self-worth for females and males.

View larger version (9K):

[in this window] [in a new window] [Download PowerPoint slide]

For appearance esteem, there was a main effect of sex ( = .35, p < .001) and a main effect of valence ( = .23, p < .005). Being male and perceiving the illness less negatively were associated with greater appearance esteem. There also was a significant sex x valence interaction ( = .34, p < .001) that was qualified by a three-way interaction with centrality ( = .20, p < .05). Separate regression analyses for males and females revealed that the predicted valence x centrality interaction appeared for females ( = .23, p < .05) but not for males, as shown in Fig. 3. For females, illness centrality was related to lower appearance esteem when the illness was viewed as highly negative but was unrelated to appearance esteem when the illness was viewed as low in negativity. For males, neither centrality nor valence was related to appearance esteem. There were no effects of centrality or valence on perceived social competence.

Figure 3. The relation of illness centrality and illness valence to perceived appearance esteem for females and males.

View larger version (16K):

[in this window] [in a new window] [Download PowerPoint slide]

Self-Care Behavior There was a marginally significant centrality x valence interaction ( = .17, p = . 07). As shown in Fig. 4, centrality was associated with good self-care behavior only when the illness was perceived as low in negativity. There were no other main effects or interactions involving sex, illness centrality, or illness valence on self-care behavior.

Figure 4. The relation of illness centrality and illness valence to self-care behavior.

View larger version (9K):

[in this window] [in a new window] [Download PowerPoint slide]

Metabolic Control

Illness centrality was related to worse metabolic control ( = .25, p < .05). There were no other main effects or interactions involving sex, illness centrality, or illness valence. We also note that, although the relation of self-care to good metabolic control was in the predicted direction, it was not significant (r = .13, p = .13).

Discussion
Top Abstract Method Results Discussion Acknowledgme nts References

Sex and Centrality We predicted that females with diabetes would view their illness as more central to their self-concepts than males. Our results confirmed this prediction. Perhaps, because females are more attentive to matters of health in our society and are more likely to assume the "sick role" when ill compared with males; females also are more likely than males to incorporate a chronic illness into their self-definitions.

Illness Centrality and Psychological Health We predicted that the extent to which adolescents defined themselves in terms of their diabetes would only be harmful to their psychological health if they viewed the illness in highly negative terms. This hypothesis was supported, replicating the findings of Wiebe et al. (2002) but only for females. Wiebe et al. (2002) did not examine whether sex moderated their findings. In our study, sex was a significant moderator. Illness centrality was related to all three indicators of greater psychological distress (depressive symptoms, anxiety, and anger), when females regarded the illness negatively. Illness centrality was generally unrelated to psychological health when females did not view the illness negatively. Thus, the extent to which one integrates an illness into ones self-concept alone does not necessarily predict how one will respond psychologically. It is the combination of viewing the illness as integral to the self and viewing the illness in aversive terms that is distressingat least for females. Perceiving something benign as integral to the self has few implications for psychological well-being. These findings are consistent with Harters (1999) and Tessers (1988) basic theoretical work on the selfconcept. Interestingly, the one domain in which findings for centrality did not appear was global selfworth. This is surprising because Harters (1999) work on the self-concept, as well as SEM theory (Tesser, 1988 ), focuses specifically on self-esteem, predicting that ones performance in a domain has stronger implications for self-esteem when the domain is regarded as more central to the self-concept. Instead, only valence or ones attitude toward the illness affected overall feelings of self-worthand, again, only for females. However, Harters and Tessers theories were supported when a specific aspect of self-esteem was investigatedappearance esteem.

Once again, for females, illness centrality was related to lower appearance esteem when the illness was viewed more negatively but unrelated to appearance esteem when the illness was viewed less negatively. Centrality and valence did not influence mens appearance esteem. Physical appearance is a domain of self-worth that is especially relevant to adolescent females (Polce-Lynch, Myers, Kilmartin, Forssmann-Falck, & Kliewer, 1998 ). The psychological aspects of the illness that we studiedillness centrality and illness valence seemed far less important for psychological health among males. Perhaps, because males have compartmentalized the illness, their view of the illness has fewer implications for their overall psychological well-being. Our finding that sex influenced the relations of centrality and valence to psychological health can be linked to the developmental literature on the self. Harter et al. (1997) have found sex differences in the emergence of contradictory aspects of the self during adolescence. During middle adolescence, youth come to recognize contradictions within different aspects of the self. Prior to this time, children are either unaware of the contradictions or not bothered by them. The literature on this topic has shown that girls recognize the contradictions earlier than boys over the course of adolescence and that these contradictions are more troublesome for girls than boys (see Harter et al., 1997 , for a review). To the extent that having diabetes is perceived as a contradiction with healthy aspects of the self, it makes sense that girls would be more adversely affected by an illness that they regard negatively. Perceiving diabetes in negative terms was more strongly related to low self-esteem for girls than boys in this study. Future research should examine the extent to which these sex differences are due to gender-role characteristics, as the prior work also found that adolescents who held the female gender role were most disturbed by contradictory aspects of the self (Harter et al., 1997 ). Illness Centrality and Diabetes Outcomes In terms of diabetes outcomes, there was some evidence that centrality was associated with good self-care behavior, consistent with the predictions of Wiebe et al. (2002) but only when the illness was perceived as low in negativity. It makes sense that those who perceive the illness as more central to their identities would integrate the illness into their everyday lives and enact better self-care behaviors. The finding here suggests that this may only be the case if the illness is not viewed in highly negative terms. We interpret this finding with caution, however, as it was only marginally significant. In terms of metabolic control, illness centrality was related to poor physical health. This finding might seem counterintuitive, given that illness centrality was associated with better self-care behavior for a subset of participants (i.e., those who viewed the illness less negatively). However, self-care behavior and metabolic control were unrelated in this study. [Interestingly, when one controls for illness centrality, self-care behavior reveals a modest relation ( = .17, p = .07) to better metabolic control.] Although previous studies that have employed our measure of self-care behavior have obtained relations to metabolic control, the evidence for relations of selfreport measures of self-care behavior to metabolic control has been underwhelming. There are several reasons for the lack of a relation between the two (see Delameter, 2000 , for a review). First, studies are less likely to obtain a relation of self-care to metabolic control when global indices rather than specific aspects of self-care are measured (e.g., blood glucose monitoring;

Johnson, Freund, Silverstein, Hansen, & Malone, 1990 ; Lloyd, Wing, Orchard, & Becker, 1993 ; Van Tilburg et al., 2001 ). Second, our measure of self-care behavior was based on self-report, which may be vulnerable to demand characteristics. We guarded against this by emphasizing the confidentiality of the interview, and that the data that adolescents provided would not be reported to their physician. Third, physiological factors related to puberty affect metabolic control (Amiel, Sherwin, Simonson, Lauritano, & Tamborlane, 1986 ; La Greca & Skyler, 1991 ), which may weaken any relations of behavior to metabolic control. The relation of illness centrality to poor metabolic control in this study may be better understood in terms of centrality resulting from poor control than causing poor control. Adolescents who are not in good control may perceive their life as more disrupted by diabetes and the illness as all encompassing. That is, the poor control could directly result in greater perceptions of illness centrality. Future research should examine the sources of illness centrality. Implications for Health Care Professionals These results have implications for health care professionals as well as family members who interact with children with diabetes. People should be less concerned with whether or not a child is defining himself or herself as a person with diabetes. Consistent with the psychological literature on the self-concept, there may be advantages and disadvantages to integrating an illness into ones self-concept. Instead, people should be concerned that they do not engender a negative view of diabetesespecially in the case of females who are more prone to psychological distress during adolescence than males, regardless of the presence of a chronic illness (Twenge & NolenHoeksema, 2002 ). Rather than dwell on the negative aspects of the illness, health care professionals could emphasize the fact that diabetes is an illness for which one has some degree of control over its effects on the body. Again, this may be particularly important in the case of females who tend to perceive that they have less control over their lives than males in general (Nolen-Hoeksema, Larson, & Grayson, 1999 ). Although one would not want to minimize an illness such as diabetes, there may be opportunities to identify positive consequences of having diabetes. A burgeoning field of research in the area of health psychology is "post-traumatic growth" or "benefit-finding," which has to do with the ability to derive benefits from trauma (Helgeson, Reynolds, & Tomich, in press; Park, Cohen, & Murch, 1996 ; Tedeschi & Calhoun, 1995 ). Clinicians and researchers alike could explore whether this field of research has promise for children with diabetes. We have anecdotal evidence from some of the physicians in this study that they point out the potential for benefits of diabetes, such as becoming more responsible and more organized. There is also evidence from a recent meta-analytic review of the literature that females are more likely than males to respond to a traumatic event, such as a chronic illness, by construing benefits (Helgeson et al., in press); however, this literature focused on adults. It remains to be seen whether female adolescents are receptive to construing benefits from their illness. Limitations and Future Directions A major limitation of this study is its cross-sectional design. Because centrality and health outcomes were measured at the same time, one cannot be sure whether centrality is leading to health or health is leading to centrality. Reciprocal relations are likely.

Another limitation had to do with the low reliability of our measure of illness centrality. Low internal consistency, however, typically detracts from ones ability to detect significant associations. In our case, we had numerous interactions involving centrality, despite its low internal consistency, that were consistent with predictions. Thus, we can be more confident of the findings that did than those did not emerge for illness centrality. A thornier issue is whether conceptually our measure of illness centrality was capturing a single or multiple constructs. Two of our items seem to be more central to the construct of centrality"thinking about diabetes when I think of who I am" and "diabetes is a small part of my life" (reverse scored). However, the other two items might also tap rumination"thinking a lot about diabetes" and "only thinking of diabetes when taking care of it" (reverse scored). Given the well-documented sex difference in rumination (e.g., Nolen-Hoeksema, 1994 ), we wondered whether our sex difference in centrality was reducible to rumination. An examination of the four individual centrality items revealed that the largest sex difference and the only statistically significant difference (p < .01) occurred for an item that was less reflective of rumination"diabetes is a small part of my life." The smallest sex difference, which was not significant (p = .33), appeared for the clearest rumination item"thinking a lot about diabetes." Nonetheless, our illness centrality items may be tapping other dimensions relevant to psychosocial adjustment, such as preoccupation with the illness. Future research should examine the potential for multiple dimensions of illness centrality. Future research also should examine the extent to which the sex differences in this study are due to gender role rather than biological sex. Our theoretical explanations for why women are more concerned with their health and why their self-concepts might be more affected by an illness are grounded in the gender-role socialization literature (see Ruble & Martin, 1998 , for a review). That is, psychological femininity, or more specifically, communion, may be more strongly linked to illness centrality than sex. Similarly, the effects of illness centrality and valence may have a greater impact on high-communion individuals rather than females. There were several other study limitations. First, we interviewed adolescents at Childrens Hospital which might have heightened their awareness of having diabetes, increasing the measure of illness centrality. When ones attention is drawn to a specific aspect of the self, that aspect of the self can be overemphasized, a phenomenon known as a "focusing illusion" (Schkade & Kahneman, 1998 ). However, the interviews did not take place in the clinic and were conducted by university research staff who were not associated with the clinic or the hospital. Nonetheless, by conducting the interviews in the hospital at a time coincident with their diabetes clinic visit, participants illness was made more salient than it otherwise might have been. Second, the racial composition of our sample was quite homogenous, making unclear the extent to which our findings generalize to ethnic groups other than Caucasians. Third, several of our measures did not have a lengthy history of psychometric validation. The centrality and valence measures were adapted from a single previous study of adolescents with diabetes. We also used a modified measure of anxiety to distinguish it more clearly from depressive symptoms. In addition, our primary outcomes were based on self-report rather than on behavior.

Finally, we only examined adolescents at one point in their lives, during the early stage of adolescence. The measure that we used to evaluate illness valence may have been limited by the age of our participants. These early adolescents did not provide a lot of descriptors about themselves in relation to their diabetes. We know that differentiation of the self is only just beginning in early adolescence (Harter, 2003 ). With cognitive maturation, we may gain more variability in how negatively or positively adolescents perceive their illness. We also know that the emergence of awareness of contradictory characteristics within the self does not appear until middle adolescence, which suggests that diabetes might pose greater difficulties for self-esteem over the next couple of years. Future research should examine how centrality and illness valence change over the course of adolescence. Adolescence is a difficult period for those with diabetes as they are beginning to assume more responsibility for taking care of their illness (Anderson et al., 1997 ) at a time when their attention is increasingly focused on the development of peer relations (Collins, Gleason, & Sesma, 1997 ). Although one might predict that the emergence of additional roles would reduce the salience of diabetes, the extent to which diabetes interferes with those roles (e.g., disrupts peers relations, makes it more difficult to fit in with peers) may increase illness centrality, while also heightening the negative aspects of the disease. Future work with adolescents might examine the role that parental support can play in alleviating some of these demands, possibly affecting the valence that adolescents attach to the disease.

Acknowledgments
Top Abstract Method Results Discussion Acknowledgme nts References

The authors acknowledge the support of grant R01 DK60586 from the National Institutes of Health to conduct this work. The authors are grateful to Pamela Snyder for supervising the day-to-day functioning of this project and to Michelle Merriman, Elizabeth Muia, Erin Nowak-Vache, and Laura Viccaro for their assistance with this research. We also acknowledge the support of the faculty, clinic staff, and the GCRC of Childrens Hospital of Pittsburgh.

Received January 13, 2006; revision received April 10, 2006; revision received June 7, 2006; accepted June 7, 2006

References

Aiken L. S. and West S. G. (1991) Multiple regression: Testing and interpreting interactions(Sage, Thousand Oaks, CA). American Diabetes Association. (2006) Standards of medical care in diabetes-2006. Diabetes Care 29:S4S42 (Suppl.).[Free Full Text]

Top Abstract Method Results Discussion Acknowledgme nts References

Amiel S., Sherwin R. S., Simonson D. C., Lauritano A. A., Tamborlane W. V. (1986) Impaired insulin action in puberty: A contributing factor to poor glycemic control in adolescents with diabetes. The New England Journal of Medicine 315:215219.[Abstract] Anderson B. J., Ho J., Brackett J., Finkelstein D., Laffel L. (1997) Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics 130:257265.[CrossRef][Web of Science][Medline] Baumrind D. (1987) A developmental perspective on adolescent risk taking in contemporary America. In Irwin J. C. E. (Ed.). Adolescent social behavior and health(Jossey-Bass, San Francisco) pp. 93124. Campbell J. D. (1978) The child in the sick role: Contributions of age, sex, parental status, and parental values. Journal of Health and Social Behavior 19:3551.[CrossRef][Web of Science] [Medline] Charmaz K. (1991) Good days, bad days: The self in chronic illness and time(Rutgers University Press, New Brunswick). Collins W. A., Gleason T., Sesma A. (1997) Internalization, autonomy, and relationships: Development during adolescence. In Grusec J. E. and Kuczynski L. Jr. (Eds.). Parent and childrens internalization of values: A handbook of contemporary theory(John Wiley and Sons, New York) pp. 7899. Delameter A. M. (2000) Critical issues in the assessment of regimen adherence in children with diabetes. In Drotar D. (Ed.). Promoting adherence to medical treatment in chronic childhood illness: Concepts, methods and interventions(Lawrence Erlbaum Associates, Mahwah, NJ) pp. 173195. Delameter A. M., Applegate B., Edison M., Nemery R. (1998) Increased risks for poor metabolic control in minority youths with type 1 diabetes. Diabetes 47:A326. Diabetes Control and Complications Trial Research Group. (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications of insulin-

dependent diabetes mellitus. The New England Journal of Medicine 329:977986. [Abstract/Free Full Text] Eiser C., Havermans T., Pancer M., Eiser J. (1992) Adjustment to chronic disease in relation to age and gender: Mothers and fathers reports of their childrens behavior. Journal of Pediatric Psychology 17:261275.[Abstract/Free Full Text] Galambos N. L., Almeida D. M., Petersen A. C. (1990) Masculinity, femininity and sex role attitudes in early adolescence: Exploring gender intensification. Child Development 61:1905 1914.[CrossRef][Web of Science][Medline] Glasgow R. F., Marrero D., Fisher E. B., Johnson S. B., Anderson B. J., Rubin R. R., La Greca A., Cox D. J. (1999) Behavioral science in diabetes: Contributions and opportunities. Diabetes Care 22:832843.[Abstract/Free Full Text] Goffman E. (1963) Stigma: Notes on the management of spoiled identity(Prentice Hall, Englewood Cliffs, NJ). Greco P., La Greca A. M., Auslander W. F., Spetter D., Skyler J., Fisher E. B., Santiago J. V. (1990) Assessing adherence in IDDM: A comparison of two methods. Diabetes 40:Suppl. 2, 108A. Green C. A. and Pope C. R. (1999) Gender, psychosocial factors and the use of medical services: A longitudinal analysis. Social Science and Medicine 48:13631372. Harter S. (1985) Manual for the self-perception profile for children(University of Denver, Denver, CO). Harter S. (1986) Processes underlying the construct, maintenance and enhancement of the selfconcept in children. In Suls J. and Greenwald A. (Eds.). Psychological perspectives on the self(Lawrence Erlbaum, Hillsdale, NJ) Vol. 3: pp. 137181. Harter S. (1990a) Developmental differences in the nature of self-representations: Implications for the understanding, assessment, and treatment of maladaptive behavior. Cognitive Therapy and Research 14:113142. Harter S. (1990b) Issues in the assessment of the self-concept of children and adolescents. Through the eyes of the child: Obtaining self-reports from children and adolescents (Allyn and BaconIn La Greca A. M. (Ed.). , Needham Heights, MA)292325. Harter S. (1999) The construction of the self(The Guilford Press, New York). Harter S. (2003) The development of self-representations during childhood and adolescence. In Leary M. R. and Tangney J. P. (Eds.). Handbook of self and identity(The Guilford Press, New York) pp. 610642.

Harter S., Bresnick S., Bouchey H. A., Whitesell N. R. (1997) The development of multiple rolerelated selves during adolescence. Development and Psychopathology 9:835853.[CrossRef] [Web of Science][Medline] Harter S. and Whitesell N. R. (2001) On the importance of importance ratings in understanding adolescents self-esteem: Beyond statistical parsimony. In Riding R. J. and Rayner S. G. (Eds.). Self perception(Ablex Publishing, Westport, CT) pp. 323. Harter S., Whitesell N. R., Junkin L. J. (1998) Similarities and differences in domain-specific and global self-evaluations of learning-disabled, behaviorally disordered, and normally achieving adolescents. American Educational Research Journal 35:653680. Helgeson V. S., Reynolds K. A., Tomich P. L. A meta-analytic approach to benefit finding and growth. Journal of Consulting and Clinical Psychology (in press). Hill J. P. and Lynch M. E. (1983) The intensification of gender-related role expectations during early adolescence. In Brooks-Gunns J. and Petersen A. C. (Eds.). Girls at puberty(Plenum, New York) pp. 201228. Hollingshead A. B. (1975) Four factor index of social status Unpublished manuscript. Izard C. E., Libero D. Z., Putman P., Haynes O. M. (1993) Stability of emotion experiences and their relations to traits of personality. Journal of Personality and Social Psychology 64:847860. [CrossRef][Web of Science][Medline] James W. (1890) Principles of psychology(Encyclopedia Britannica, Chicago). James W. (1892) Psychology: The briefer course(Henry Holt, New York). Johnson S. B., Freund A., Silverstein J., Hansen C. A., Malone J. (1990) Adherence-health status relationships in childhood diabetes. Health Psychology 9:606631.[CrossRef][Web of Science] [Medline] Jones E. E., Farina A., Hastorf A. H., Markus H., Miller D. T., Scott R. A. (1984) Social stigma: The psychology of marked relationships(W.H. Freeman, New York). Kandrack M.-A., Grant K. R., Segall A. (1991) Gender differences in health related behavior: Some unanswered questions. Social Science & Medicine 32:579590. Klonoff E. A., Landrine H., Brown M. A. (1993) Appraisal and response to pain may be a function of its bodily function. Journal of Psychosomatic Research 37:661670.[CrossRef][Web of Science][Medline] Kovacs M. (1985) The Childrens Depression Inventory (CDI). Psychopharmacology Bulletin 21:995998.[Web of Science][Medline]

Kovacs M. (2001) Childrens depression inventory: Technical manual(Multi-Health Systems, North Tonawanda, NY). La Greca A. M., Follansbee D. J., Skyler J. S. (1990) Developmental and behavioral aspects of diabetes management in children and adolescents. Childrens Health Care 19:132139. La Greca A. M. and Skyler J. S. (1991) Psychosocial issues in IDDM: A multivariate framework. In McCabe P. M., Schneiderman N., Field T. M., Skyler J. S. (Eds.). Stress, coping, and disease(Lawrence Erlbaum, Hillsdale, NJ) pp. 169190. La Greca A. M., Swales T., Klemp S., Madigan S. (1988) Paper presented at the Ninth Annual Convention of the Society for Behavioral Medicine. Self-care behaviors among adolescents with diabetes. Lloyd C. E., Wing R. R., Orchard T. J., Becker D. J. (1993) Psychosocial correlates of glycemic control: The Pittsburgh Epidemiology of Diabetes Complications (EDC) study. Diabetes Research and Clinical Practice 21:187195.[CrossRef][Web of Science][Medline] Marsh H. W. (1987) The hierarchical structure of self-concept and the application of hierarchical confirmatory factor analysis. Journal of Pediatric Psychology 24:1719. McNeill S. and Petersen A. C. (1985) Gender role and identity in early adolescence: Reconsideration of theory. Academic Psychology Bulletin 7:299315. Mechanic D. (1966) Response factors in illness: The study of illness behavior. Social Psychiatry 1:1120. Miller R., Willis E., Wyn J. (1993) Paper presented at the BSA Medical Sociology Conference. Gender and compliance in the management of a medical regimen for young people with cystic fibrosis.(UK, University of York). Nolen-Hoeksema S. (1994) An interactive model for the emergence of gender differences in depression in adolescence. Journal of Research on Adolescence 4:519534. Nolen-Hoeksema S., Larson J., Grayson C. (1999) Explaining the gender differences in depressive symptoms. Journal of Personality and Social Psychology 77:10611072.[CrossRef] [Web of Science][Medline] Nunnally J. C. (1978) Psychometric theory 2nd ed.) (McGraw-Hill Co, New York). Park C. L., Cohen L. H., Murch R. L. (1996) Assessment and prediction of stress-related growth. Journal of Personality 64:71105.[CrossRef][Web of Science][Medline] Polce-Lynch M., Myers B. J., Kilmartin C. T., Forssmann-Falck R., Kliewer W. (1998) Gender and age patterns in emotional expression, body image, and self-esteem: A qualitative analysis. Sex Roles 38:10251048.

Pound N., Sturrock N. D. C., Jeffcoate W. J. (1996) Age related changes in glycosylated hemoglobin in patients with insulin-dependent diabetes mellitus. Diabetic Medicine 13:510 513.ink_type=DOI" >[CrossRef][Web of Science][Medline] Prout A. (1989) Sickness as a dominant symbol in life course transitions: An illustrated theoretical framework. Sociology of Health & Illness 11:336359. Ruble D. N. and Martin C. L. (1998) Gender development. In Damon W. and Eisenberg N. (Eds.). Handbook of child psychology(John Wiley, New York) Vol. 3: pp. 9331016. Schkade D. A. and Kahneman D. (1998) Does living in California make people happy? Psychological Science 9:340346. Shi L. (1998) Sociodemographic characteristics and individual health behaviors. Southern Medical Journal 19:933941. Slesinski M. J., Subar A. F., Kahle L. L. (1996) Dietary intake of fat, fiber and other nutrients is related to the use of vitamin and mineral supplements in the United States: The 1992 National Health Interview Survey. Journal of Nutrition 126:30013008.[Abstract/Free Full Text] Stark K. D. and Laurent J. (2001) Joint factor analysis of the Childrens Depression Inventory and the Revised Childrens Manifest Anxiety Scale. Journal of Clinical Child Psychology 30:552567.[CrossRef][Web of Science][Medline] Sweeting H. (1995) Reversals of fortune? Sex differences in health in childhood and adolescence. Social Science & Medicine 40:7790. Tedeschi R. G. and Calhoun L. G. (1995) Trauma and transformation: Growing in the aftermath of suffering(Thousand Oaks, CA, Sage). Tesser A. (1988) Toward a self-evaluation maintenance model of social behavior(Academic Press, Orlando, FL) Vol. 21:. Twenge J. M. and Nolen-Hoeksema S. (2002) Age, gender, socioeconomic status, and birth cohort differences on the Childrens Depression Inventory: A meta-analysis. Journal of Abnormal Psychology 111:578588.[CrossRef][Web of Science][Medline] Van Tilburg M. A. L., McCaskill C. C., Lane J. D., Edwards C. L., Bethel A., Feinglos M. N., Surwit R. S. (2001) Depressed mood is a factor in glycemic control in type 1 diabetes. Psychosomatic Medicine 63:551555.[Abstract/Free Full Text] Waldron I. (1997) Changing gender roles and gender differences in health behavior. In Gochman D. S. (Ed.). Handbook of health behavior research I: Personal and social determinants(Plenum Press, New York) pp. 303328.

Walker L. S. and Zeman J. L. (1992) Parental response to child illness behavior. Journal of Pediatric Psychology 17:4971.[Abstract/Free Full Text] Wardle J., Haase A. M., Steptoe A., Nillapun M., Jonwutiwes K., Bellisle F. (2004) Gender differences in food choice: The contribution of health beliefs and dieting. Annals of Behavioral Medicine 27:107116.[CrossRef][Web of Science][Medline] Weissberg-Benchell J., Wirtz P., Glasgow A. M., Turek J., Tynan W. D., Ward J. (1995) Adolescent diabetes management and mismanagement. Diabetes Care 18:7782.[Abstract] Weissfeld J. L., Kirscht J. P., Brock B. M. (1990) Health beliefs in a population: The Michigan Blood Pressure Study. Health Education Quarterly 17:141155.[Web of Science][Medline] White P. G., Young K., McTeer W. G. (1995) Sport, masculinity and the injured body. In D. F. Sabo & D. F. Gordon (Eds.). Mens health and illness: Gender, power, and the body(Sage, Thousand Oaks, CA) pp. 158182. Wiebe D., Berg C., Palmer D., Korbel C., Beveridge R. ( April 2002) Paper presented at the annual Meeting of the Society of Behavioral Medicine. Illness and the self: Examining adjustment among adolescents with diabetes, Washington, DC. Wise E. A., Price D. D., Myers C. D., Heft M. W., Robinson M. E. (2002) Gender role expectations of pain: Relationship to experimental pain perception. Pain 96:335342.[CrossRef] [Web of Science][Medline NEXT:

Boys have greater psychological well-being than girls, due to a better physical self-concept
Science Centric | 5 February 2009 10:52 GMT

Self-concept may be defined as the totality of perceptions that each person has of themselves, and this self identity plays an important role in the psychological functioning of everyone. To date, however, there has been no investigation into the relationship that physical self-concept has with psychological well-being or psychological unwellness. The author of the thesis is Ms Arantzazu Rodriguez Fernandez, who presented her work under the title, Physical self-concept and psychological well-being/unwellness during adolescence. Ms Rodriguez is a graduate in Psychology and carried out her PhD under the direction of doctors Alfredo Goni Grandmontagne and Igor Esnaola Etxaniz, of the Department of Evolutionary Psychology and the University School of Education at the UPV/EHU. She currently works as a research worker at the university. This research had three fundamental objectives: to study the relationship between physical self-concept and psychological well-being, to identify the relationship between physical self-concept and anxiety and depression and, finally, to analyse the relationship between physical self-concept and Eating Behaviour Disorders (EBDs) - amongst both the non-clinical population in general as well as amongst patients previously diagnosed with anorexia or bulimia nervosa.

To undertake the research, a total of 1,959 young people between the ages of 12 and 23 from the Basque Country, Burgos and Rioja were studied. 48 of these were patients diagnosed with some form of EBD. The data obtained indicated that physical self-concept is related in a positive manner with the psychological well-being of the individual and in a negative manner to psychological unwellness, in such a way that the more one is happy with one's physique, the more psychological well-being one has, with less levels of anxiety and depression and less risk of suffering from an EBD. This relationships have also been analysed as a function of age, gender and physical activity. As a general rule, it is seen that, taking into account physical self identity, male adolescents present higher scoring for psychological well-being than their female peers. This same relationship is established between 12-14 year old adolescents on the one hand and 15+ adolescents on the other, and between those who do physical activity and those who do not. But, considering all the variables at the same time, it was seen that adolescents with more positive physical self-concept and who are, at the same time, between 12 and 14 or carry out physical activity, score higher for psychological well-being, without any significant difference between the sexes being observed. This research also showed young people experienced psychological unwellness in relation to their physical appearance throughout their adolescence, whether their perception of their physique is low, average or high. Nevertheless, undertaking sporting activity appears to be a good way to minimise any psychological unwellness, probably because it enhances physical self-concept. It is only when physical self-concept is low that doing physical exercise gives rise to the potential risk of suffering EBD. As a rule, however, sport can be defended as a way of increasing personal well-being and reducing psychological unwellness. As regards disorders associated with physical appearance, the greatest risk of developing an anxiety disorder is after the age of 15; for a depressive disorder the risk stage is between 12 and 17; and for anorexia or bulimia nervosa the risk period is between 18 and 23. Finally, of all the elements conditioning physical self-concept, the outstanding one is that of an attractive physical appearance, because the self-perception of this is strongly related to anxiety, depression and psychological well-being. All this, of course, is a reflection of how society favours relationships between what is attractive as perceived by one and how anxious, how depressed or how happy one feels with oneself.

NEXT:
Id: 16837740 Autor: Helgeson VS; Novak SA. Ttulo: Illness centrality and well-being among male and female early adolescents with diabetes.. Fonte: J Pediatr Psychol;32(3):260-72, 2007 Apr. Resumo: OBJECTIVE: We examined the implications of illness centrality for psychological and physical health among male and female early adolescents with type 1 diabetes. METHODS: We interviewed 132 adolescents before or after a routine clinic appointment. We measured the extent to which they defined themselves in terms of their illness, their views of the illness, psychological well-being, self-care behavior, and metabolic control. RESULTS: Females scored higher on illness centrality than males. Illness centrality was related to poor psychological well-being when the illness was perceived in negative terms, but only for females. For males, illness centrality was

unrelated to psychological well-being. Illness centrality was related to poor metabolic control. CONCLUSIONS: The extent to which adolescent females define themselves in terms of their illness is most problematic when the illness is perceived in highly negative terms. Future research should examine how illness centrality and views of illness change over the course of adolescence.. Descritores: Depresso/epidemiologia Depresso/psicologia Diabetes Mellitus Tipo 1/epidemiologia Diabetes Mellitus Tipo 1/psicologia Qualidade de Vida/psicologia Auto-Imagem Papel do Doente -Adolescente Criana Feminino Humanos Masculino Autocuidado Responsvel: BR1.1 - BIREME

NEXT:
Adolescents Psychological Well-Being and Memory for Life Events: Influences on Life Satisfaction with Respect to Temperamental Dispositions
Journal Publisher ISSN Category DOI Subject Collection SpringerLink Date Journal of Happiness Studies Springer Netherlands 1389-4978 (Print) 1573-7780 (Online) Research Paper 10.1007/s10902-008-9096-3 Humanities, Social Sciences and Law Tuesday, April 01, 2008

Danilo Garcia1
(1) (2) (3)

and Anver Siddiqui2, 3

Department of Psychology, Karlstad University, 651 88 Karlstad, Sweden Vxj University, Vaxjo, Sweden Ume University, Umea, Sweden

Received: 8 December 2007 Accepted: 17 March 2008 Published online: 1 April 2008

Abstract The aim of the present study was to explore how the number of recalled life events (positive and negative) predicts psychological well-being (PWB) and how PWB predicts life satisfaction (LS). In addition, participants were categorized into one of four different affective temperaments (self-actualizing, high affective, low

affective, and self-destructive). One hundred and thirty-five high school students participated in completing the SWLS (LS), PWB (short-version), PANAS (to create affective temperaments), and the life events recollection task. Results indicated that adolescents with high positive affect also had high PWB; adolescents with low affective profiles also had high PWB. Positive and negative life events predicted PWB for self-destructive temperaments, whereas positive life events predicted PWB for low affective temperaments. PWB predicted LS for all temperaments except the self-actualizing group. In conclusion, the temperament combinations may allow the individual to achieve PWB and LS. Even more importantly, selfacceptance may foster LS regardless of temperament and may have more impact on LS than life events.

Keywords Adolescence - Life events - Psychological wellbeing - Satisfaction with life - Temperament NEXT:

Psychological well-being in adolescence: the contribution of interpersonal relations and experience of being alone.
Publication: Adolescence Publication Date: 22-JUN-06 Ads by Google Child Psychology Research Full-text child psychology books, articles, journals at Questia. Psychological Research India's largest Jobs and Recruitment Search. Apply Now! Child Behavior Problems How to get your child to listen and behave. Simple, Effective System. Format: Online Delivery: Immediate Online Access

Article Excerpt INTRODUCTION From the very origins of psychology, adolescence has been considered a difficult stage in the process of development into adulthood. It has been seen as a period of crisis characterized by profound change. In recent times some empirical studies have shown that in reality, the majority of adolescents go through this stage successfully without experiencing particular traumas, reporting a level of relative well-being (Bandura, 1964; Offer & Schonert-Reichl, 1992; Douvan & Adelson, 1996). The greater part of psychological reflection has been devoted to identification of the main factors which, at an individual and interpersonal level, contribute to the promotion and sustenance of adolescents' psychological wellbeing and those which tend to impede it. Recent literature has paid particular attention to the importance of interpersonal relations. Different studies recognize that satisfactory relations with parents and friends are connected to a more positive outcome in this stage of development (Hansell & Mechanic, 1990; Claes, 1992; Noom, Dekovic, & Meeus, 1999; Bina, Cattelino, & Bonino, 2004). As far as relations with peers are concerned, friendship is a major contributor to adolescents' psychosocial adaptation and

constitutes an important protective element against deviant behavior, depression, and feelings of alienation (Schneider, Wiener, & Murphy, 1994; Bukowski, Newcomb, & Hartup, 1996). At the same time, the importance of the family's role has been recognized for its influence over adolescents' psychosocial adaptation and in avoiding deviant and risky behavior (Kirchler, Palmonari, & Pombeni, 1993; Seiffe-Krfenke, 1995; Meeus, Helsen, & Vollebergh, 1996; Cattelino & Bonino, 1999). In contrast, however, little is known of how experiences of solitude are likely to affect adolescents' well-being. The universality of loneliness among adolescents has been recognized (Csikszentmihalyi & Larson, 1984; Goossens & Marcoen, 1999) but the greater part of research in this area has been limited to consideration of loneliness defined as social withdrawal and isolation, emphasizing the risk it poses to adolescents' ability to adapt. Many authors argue, indeed, that a preference for nonsocial behavior results in increasing unpopularity within adolescents' peer group, giving rise to a negative self-image and feelings of psyschosocial malaise (Younger & Boyko, 1987; Younger, Gentile & Burgess, 1993). A number of researchers describe solitary adolescents as passive, sad, and turned inward (Van Buskirk & Duke, 1991), experiencing greater stress (Cacioppo et al., 2000) and social anxiety (Goossens & Marcoen, 1999), and characterized by such problems as peer rejection and victimization (Boiving, Hymel, & Bukowski, 1995), shyness and social withdrawal (Kupersmidt, Sigda, Sedikides, & Voegler, 1999). Recent research by Seginer and Lilach (2004) also considered the effect of loneliness on adolescents' orientation toward the future, noting that lonely adolescents scored lower than socially embedded adolescents on future orientation variables applied to the relational and near future domains. It is important not to neglect the possibility, however, that different experiences of loneliness may be present during the normal growth process. Marcoen, Goossens, and Caes (1987), for example, have proposed a multi-dimensional conception of solitude, distinguishing two fundamental aspects of being alone: aversion to aloneness (unwanted isolation) and affinity for aloneness (voluntary isolation). Ammaniti, Ecolani, and Tambelli (1989), also emphasized that loneliness plays an important role during adolescence, marking different stages in the process of construction of an identity and gradual separation from parents. Ester Schaler Buchholz, an American psychoanalyst, who also studied this question, agreed that the capacity and need for aloneness are of particular importance for an adolescent involved in the process of separation and individualization and in the construction of an identity (Buchholz & Chinlund, 1994; Buchholz & Catton, 1999). According to this view alone time (time for one's self, Bucholtz, 1997) provides creative space, a time for rest as well as self-reflection and self-revelation, ideal for putting into practice the concept of moratorium suggested by Erikson (1950) and Marcia (1980). It was on the basis of these findings that it was decided to investigate how interpersonal relations and experiences of loneliness influence adolescents' psychological well-being. Two different aspects of being alone were taken into consideration: (1) the feeling of loneliness experienced in relations with parents and peer group members, and (2) adolescents' attitudes toward the experience of aloneness; that is, the positive or negative significance that adolescents attribute to being alone. We were particularly interested in learning if and how adolescents' feelings of loneliness with reference to parents and peer group members change with respect to age and gender. The second goal of the research was to investigate the quality of adolescents' interpersonal relations with mothers, fathers, and with both male and female peers, and to determine their importance in the promotion of psychological wellbeing and reduction of malaise (Hansell & Mechanic, 1990; Noom, Dekovic, & Meeus, 1999). The third goal of the research was to investigate whether there was a correlation between the quality of social relations and adolescents' attitude toward being alone. Participants Participants were 330 adolescents of whom 162 were male and 168 female aged between 11 and 19 (M = 15.04, SD = 2.47). Students were from four different types of school in Northern Italy: an upper high school, a professional training institute, a technical institute for surveyors, and a middle school. A total of 18 classes were involved in the research: 6 classes in a middle-school and 4 classes in each upper high school. Participants were divided into three groups based on age. The first group (11 to 13) consisted of 103 students (56 males and 47 females). The second group (14 to 16) consisted of 115 students (57 males and 58 females), and the third group (17 to 19) was made up of 112 students (49 males and 63 females). Instruments Two instruments were used: the Louvain Loneliness Scale for Children and Adolescents (LLSCA) (Marcoen, Goossens, & Caes, 1987)--the Italian version, in preparation, by Melotti, Corsano, Majorano, & Scarpuzzi); and Test delle Relazioni Interpersonali (TRI)--Assessment of Interpersonal Relations (AIR) (Bracken, 1996)--Italian version (Janes, 1996).

LLCA was used to obtain a complete evaluation of adolescents' perception of their own experience of loneliness. The test is made up of four sub-scales. In particular, two sub-scales are intended to measure feelings of loneliness with reference to parents (L-PART) and to peers (L-PEER). In the first case, an evaluation is made of experiences of loneliness connected to the process of separation from parents and in the second sub-scale, loneliness is considered the type of isolation derived from separation from peers. This research instrument also seeks to investigate whether people attribute a positive or negative meaning to solitary experiences and if so, at what level. This effect is investigated by means of the other two sub-scales, A-POS and A-NEG. The Italian version was used in this research. The four sub-scales contain 48 items--12 for each scale, expressed in the form of statements to which a response is requested using a four-point Likert scale (often = 4, sometimes = 3, rarely = 2, and never = 1). In the Italian version, scores range between 12 to 48 for each sub-scale. In general, a high score represents a strong feeling of loneliness with reference to peers (L-PEER) and the family (L-PART) and positive (A-POS) and negative (A-NEG) attitudes toward the experience of loneliness. The TRI on the other hand, evaluates the quality of relations of young persons with those most important to their lives: mothers, fathers, teachers, and their male and female peers. For the purposes of this study it was considered appropriate to focus on the family and peers; thus the scale evaluating relations with teachers was not used. Each scale was made up of the same 35 questions (the same for each stage) by which the quality of relations with different persons was evaluated. Responses were assessed on the basis of a four-point Likert scale (completely true = 4, true = 3, not true = 2 and completely untrue = 1). In those items formulated in negative form (5, 10, 15, 20, 25, 30, 35), scores were assigned inversely (completely true = 1, true = 2, not true = 3, and completely untrue = 4). Each questionnaire was accompanied by a brief explanation of how the test was to be completed. Participants were asked to indicate their age and the school they attended. In order to ensure that the questionnaires were correctly filled out, the data were collected in the presence of the test administrators who made themselves available to provide any clarification required. The time needed the completion of the questionnaires was 45 to 50 minutes. RESULTS LLCA First we sought to investigate if and how adolescents' feelings of loneliness in the context of their families and their peers changed, and also depending on their age and gender. The average scores of participants were thus calculated in each individual LLCA sub-scale and then, using the score obtained in each scale as the dependent variable, a series of 3 (age group) x 2 (gender) ANOVAs were conducted. A description of the scores is contained in Table 1. Table 1 shows that the main effect is the age factor in the sub-scales L-PART (F(2, 324) = 3.28, p < .05); A-NEG (F(2, 324) = 5.3, p < .01) and A-POS (F(2, 324) = 7.47, p < .001). The post hoc analysis (Tukey's test with p < .05) shows a different trend in the different sub-scales. Indeed, in L-PART, the scores of the oldest group of adolescents (17 to 19) were only significantly higher than those of the youngest age group (11 to 13). Contrary trends are shown in the subscales relating to attitudes to loneliness. The oldest age group had the lowest A-NEG and highest A-POS scores with respect to the other groups. Table 2 shows the gender factor as the main effect in the sub-scales L-PEER (F(1, 324) = 7.98, p < .01), and A-POS (F(1, 324) = 17.77, p < .001). In particular, the girls scored higher in both sub-scales. The analysis also indicates an interaction between gender and age (F(2, 324) = 3.32, p < .05) in the A-NEG sub-scale. Thus, in particular, in the youngest age group, the boys had a lower negative attitude as compared to the girls, while the contrary was true in the oldest age group. TRI First we sought to investigate changes in the participants' relations with father, mother and peers (male and female) with respect to age and gender as set out in the respective TRI sub-scale. Scores of participants in the individual TRI scales were therefore calculated by adding the scores obtained for the items of each sub-scale. The standard score was then calculated corresponding to each unprocessed score. Using the standard scores obtained in this way as dependent variables, a series of 3 (age group) x 2 (gender) ANOVAs were then conducted. A description of the scores is shown in Table 3. Table 3 highlights the age factor as the main effect in the TRI-father (F(2, 324) = 3.61, p < .05), TRI-male peers (F(2, 324) = 7.61, p <.001) and TRI-female peers (F(2, 324) = 10.83, p < .001) sub-scales. The post hoc analysis (Tukey's test with p < .05) indicates different trends in the different sub-scales. In the TRI-father sub-scale, the 14 to 16 age group obtained only a significantly higher score with respect to the lowest age group (11 to 13). In the TRI-male peers and TRI-female

peers, however, the score obtained by this latter age group was higher than that for the other two groups. There was no statistically significant difference in the quality of male and female personal relations. Relations between Experience and Interpersonal Relations The way in which feelings of, and attitudes toward loneliness in adolescents correlated with the quality of their relations with those of greatest importance in their lives was then investigated. An analysis was made of Pearson's correlation r between the four LLCA sub-scales and the individual TRI scales. As can be seen in Table 4, the feeling of loneliness with regard to peers correlated with a low score for relations with male (r = -.16, p < .01) and female (r = -.19, p < .001) peers. Feelings of loneliness with reference to parents were correlated with low quality scores in mother (r = -.59, p < .001) and father (r = -.54, p < .001) relations. As far as attitude to loneliness was concerned, high aversion scores were correlated with satisfactory relations with male (r = .24, p < .001) and female (r = .29, p < .001) peers. High affinity scores, however, were correlated with unsatisfactory mother (r = -.14, p < .01) and female peer (r = -.15, p < .01) relations. The differences in relations between attitude to loneliness and peer and parent relations according to the different age groups were then investigated (Table 5). The data show that in all three groups a negative attitude toward loneliness is correlated with higher scores in the sub-scales relating to male peer relations (the r index varies between .20 and .24 with p < .05) and female peer relations (the r index varies between .24 and .33 with p < . 05). A positive attitude was correlated only to unsatisfactory mother and father relations in the youngest age group. Analysis of the Items An analysis was made of differences based on age and gender in the sub-scale items relating to attitude toward loneliness (A-POS and A-NEG). A series of univaried ANOVAs was then made by first using age and then gender as factors with the average scores for each item as the dependent variable. It was found that the groups were significantly differentiated from each other in terms of age for those items describing loneliness above all as a time of boredom (8:... NEXT:

CyberPsychology & Behavior

Friend Networking Sites and Their Relationship to Adolescents' Well-Being and Social Self-Esteem
To cite this article: Patti M. Valkenburg, Jochen Peter, Alexander P. Schouten. CyberPsychology & Behavior. October 2006, 9(5): 584-590. doi:10.1089/cpb.2006.9.584. Full Text: PDF for printing (99.1 KB) PDF w/ links (134.9 KB)

Dr. Patti M. Valkenburg, Ph.D. Amsterdam School of Communications Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands. Jochen Peter, Ph.D. Amsterdam School of Communications Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands.

Alexander P. Schouten, M.A. Amsterdam School of Communications Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands. The aim of this study was to investigate the consequences of friend networking sites (e.g., Friendster, MySpace) for adolescents' self-esteem and well-being. We conducted a survey among 881 adolescents (1019-year-olds) who had an online profile on a Dutch friend networking site. Using structural equation modeling, we found that the frequency with which adolescents used the site had an indirect effect on their social self-esteem and well-being. The use of the friend networking site stimulated the number of relationships formed on the site, the frequency with which adolescents received feedback on their profiles, and the tone (i.e., positive vs. negative) of this feedback. Positive feedback on the profiles enhanced adolescents' social self-esteem and well-being, whereas negative feedback decreased their selfesteem and well-being.

This paper was cited by:

On the Rapid Rise of Social Networking Sites: New Findings and Policy Implications Sonia Livingstone, David R Brake Children & Society. Jul 2009 CrossRef Self-Concept, Self-Esteem, Gender, Race, and Information Technology Use Linda A. Jackson, Yong Zhao, Edward A. Witt, Hiram E. Fitzgerald, Alexander von Eye, Rena Harold CyberPsychology & Behavior. , Vol. 0, No. 0 Abstract | Full Text PDF The (Potential) Benefits of Campaigning via Social Network Sites Sonja Utz Journal of Computer-Mediated Communication. Feb 2009, Vol. 14, No. 2: 221-243 CrossRef Social networks, gender, and friending: An analysis of MySpace member profiles Mike Thelwall Journal of the American Society for Information Science and Technology. Jul 2008, Vol. 59, No. 8: 1321-1330 CrossRef MySpace and Facebook: Applying the Uses and Gratifications Theory to Exploring Friend-Networking Sites John Raacke, Jennifer Bonds-Raacke CyberPsychology & Behavior. Apr 2008, Vol. 11, No. 2: 169-174 Abstract | Full Text PDF | Reprints & Permissions
NEXT:

Croat PMCID: Med J. PMC2205974 2007 Octob er; 48(5): 691 700. Copyright 2007 by the

Croatian Medical Journal. All rights reserved.

Discontent with Financial Situation, Selfrated Health, and Well-being of Adolescents in Bosnia and Herzegovina: Cross-sectional Study in Tuzla Canton
Nurka Pranji,1 Aida Brkovi,2 and Azijada Beganli2
1

Department of Occupational Medicine, Tuzla University School of Medicine, Tuzla, Bosnia and Herzegovina 2 Department of Family Medicine, Tuzla University School of Medicine, Tuzla, Bosnia and Herzegovina Correspondence to: Nurka Pranji Department of Occupational Medicine Univerzitetska 1 75000 Tuzla, Bosnia and Herzegovina pranicnurka@hotmail.com Received July 3, 2007; Accepted August 23, 2007.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the

original work is properly cited.

Top Abstract Participants and methods Results Discussion References

Abstract
Aim To examine the relationship between quality of life, selfrated health, and well-being and to establish the relationship between discontent with familial financial situation and health in adolescents living in the Tuzla Canton. Method The study comprised a random sample of 356 high school students aged 16, coming from 15 different classes of 16 high schools in the Tuzla municipality. Data were obtained using a validated self-reporting questionnaire on demographic and socioeconomic background, structure, and dynamics of the adolescents family, life-style, perception, and satisfaction with the financial situation and current health status, as well as social relationships and health care provided in school settings. Results In 11% (n = 40) of students households several poverty indicators were present. Twenty three percent (n = 82) of the examinees were dissatisfied with the financial situation in their families, and 73% of them came from local, non-refugee families. They presented with progressive symptoms of unhappiness and expressed discontent with their health condition, and even self-hate in comparison with adolescents who were satisfied with the financial situation in their families (2 = 21.5; P = 0.001). The prevalence of self-rated mental symptoms was significantly lower among adolescents who were satisfied with their financial situation than in those who were dissatisfied (symptoms of depression 57/274 vs 40/82, P = 0.001; sadness 73/274 vs 45/82, P = 0.001; moroseness 34/274 vs 19/82, P = 0.001; under-sedation 29/274 vs 18/82, P = 0.001; bad marks and school failures 31/274 vs 20/82, P = 0.001; suicidal attempts 11/274 vs 7/82, P = 0.001, respectively). Using linear regression analysis we found that adolescents satisfaction with the

financial situation was a major factor predicting depression (OR, 1.57; 95% CI, 1.158-1.855), loss of appetite (OR, 0.82; 95% CI, 0.561-1.235), distraction (OR, 1.19; 95% CI, 0.837-1.154), unhappiness (OR, 1.05; 95% CI, 0.686-1.405), and inability to perform at school as expected (OR, 1.24; 95% CI, 0.903-1.581). Conclusion Discontent with the financial situation significantly reduces the quality of mental health, leads to inappropriate patterns of behavior, and endangers future perspectives and well-being of adolescents. Home and family are of the outmost importance for emotional, cognitive, and behavioral development during adolescence. The family structure evolved throughout history as a result of social, cultural, and economic development. Concerning the importance of family for the health of adolescents, many risk factors have to be taken into account. Single-parent families carry a higher risk of poverty, which often means a worse health situation as single-parent structures and stepfamilies predispose for developmental problems (1). The influence of traditional and patriarchal family pattern on the health and development of adolescents widely varies (2), depending on factors such as parents unemployment or overwork and relations with members of the extended family. The quality of the relationship with the mother may be a very important protective factor (1-3). On the other hand, adolescence has traditionally been viewed as a period of optimal health, characterized by low morbidity and chronic disease rates. However, some studies demonstrated that adolescents in Western countries have worse health than their parents at the same age. The increasing trend in the number of suicides, depression cases, and other symptoms of mental diseases is currently the prevailing one (3-5). In the years that went by, physical, cognitive, and social changes undergone by adolescents forced the traditional family system to adapt to the novel circumstances (5-7). During

adolescence, unstable family environment causes acute stress and may lead to adolescents insecurity and the impression that he or she is unable to cope with prospective life challenges. Given that a normal adolescents growth and progress are characterized by dramatic changes in physical status, social relations, identity, sexuality, and behavioral patterns, a high level of family instability may lead to difficulties during this transition period and result in poorer adolescent outcomes across a variety of developmental domains. Health-related quality of adolescents lives represent rather unexplored field of research (8,9). The 1992-1995 war transformed Bosnia and Herzegovina from a country with an average gross national income into a poor country (10). Both the collapse of the former socialist system and war led to physical and socioeconomic devastation and unemployment. Despite the success of post-war reconstruction, the economy has never managed to recover. Acutely-induced and widespread poverty, and a high level of unemployment, represent fairly recent phenomena in everyday life of Bosnia and Herzegovina. In spite of the fact that a large number of Bosnians are well educated (10,11), at present about 19.5% of the population are below poverty limit and suffer serious shortages in almost all aspects of their lives. Poverty is defined as a pronounced deprivation in well-being, where the latter stands for an individual possession of income, health, nutrition, education, assets, housing, and a number of rights in the society (12,13). In this study, we analyzed the relationships between the quality of life, self-rated health, and well-being of Bosnian adolescents who lived in the largest Canton of Bosnia and Herzegovina. We hypothesized that poverty and qualitylife factors were the central causes of social differences encountered among adolescents, capable of greatly influencing their health. Inequalities in social standards, encountered among adolescents, may lead to their poor health and influence their social and psychological wellbeing and mental health.

Participants and methods

Research data were collected through a cross-sectional study carried out in April 2006 in 16 second grade classes of the secondary school in the Tuzla municipality. The study was performed with the permission of the Tuzla Canton Ministry of Culture, Sport, and Education. The ethical approval for the research was obtained from the Ethical Research Committee at the Tuzla University School of Medicine. During the interview, the interviewer (one of the authors) was alone with the examinees. Subjects Our study included all high schools in the municipality of Tuzla, comprising students attending the second grade (ie, students born in 1989). We did not include schools for students with special needs. Our population numbered a total of 2705 adolescents (1304 girls and 1401 boys). About 26% of adolescents born in 1989 (n = 703) did not attend school at all (10,11). We used a cluster sample for practical reasons, with class rather than individual as the main unit. According to the type of education they offer, high schools in the municipality of Tuzla are divided as follows: technical schools (50 second grade classes), vocational schools (28 second grade classes), and grammar schools (18 second grade classes). The sample was targeted at the age of 16, and all types of schools were included. We estimated that our sample needed to comprise 15 out 96 classes, randomly selected, because we wanted to have equal number of girls and boys. We expected that the whole sample to comprise 389 adolescents, but only 356 out 389 completed the questionnaire in an appropriate manner (about 16% of the total population; response rate 91.5%). There were 172 participants (48%) from 7 classes of technical schools (mostly boys), 116 participants (33%) from 5 classes of vocational schools (boys and girls), and 68 participants (19%) from 3 classes of grammar schools (mostly girls). Out of whole study sample of 356 participants, 163 (46%) were boys and 193 (54%) were girls (Table 1

). This distribution was in accordance with that of the whole population. The participation in the study was voluntary (12).
Table 1 Demographical structure of high-school respondents from the Tuzla Canton

Questionnaire The questionnaire was designed in accordance with the World Health Organization Questionnaire of life assessment (WHOQOL), which is commonly used in studies dealing with adolescent life quality (14-17). The part of the questionnaire on quality of life, environmental factors, family structure, perceived adolescent aspects about environment and lifestyle (cultural and sports activities), relationships, and emotional support from parents and friends was in form of a Likert-type scale. Answers were given on a seven point scale (from 1 no to 7 yes; 1 never to 7 almost every day; or 1 a great deal better to 7 a great deal worse). Selfrated mental health, sense of self-esteem, and success in performing school tasks were measured with binomial scale (yes or no) (web-extra material). Cronbach alpha coefficient, reflecting the inner consistency of the questionnaire (18), was 0.79, which indicates the satisfactory inner consistency of the questionnaire. Statistical analysis Differences between the examinees gender, various aspects of quality of life and lifestyle, relationship with parents and friends, financial situation in the family, and mental health symptoms and signs were assessed by means of 2 test. In order to identify the relationship between quality-life environmental factors, familial structure, and adolescents self-reported satisfaction with the financial situation, non-parametric correlation analysis (Spearman coefficient) was applied. In order to test the inter-relations between independent variables (emotional support from the mother; satisfaction with

their relations with friends) and dependent variables (depression/no depression, excellent/bad marks in school, felt sad/no sad (sadness), loss of appetite/no loss of appetite, lack of concentration/no lack of concentration, under a lot of pressure regarding the things that have to be done/not under a lot of pressure regarding the things that have to be done, unable to perform tasks, multivariate analysis of variance (ANOVA; logistic regression model) was used. The independent variables utilized the factors reflecting the quality-life environmental factors. Logistic regression analyses were used to identify relevant predictors/protectors of mental health symptoms and signs on the basis of predictors calculated odd ratios (OR) and confidence intervals (CI). All statistical analyses were performed with Statistical Package for Social Sciences, version 7.5 (SPSS Inc., Chicago, IL, USA) and P<0.05 was regarded as significant.

Results

Characteristics of quality of life The average age standard deviation of the examinees was 16.3 0.19 years. Most of them (40%) lived with both parents, 15% lived with a stepfather and mother, and 7% lived with a stepmother and father. Thirty five students (10%) lost their fathers and 6 (2%) lost their mothers during the war or due to illness. Seventeen percent of fathers (n = 62) and 48% of mothers (n = 171) were unemployed. In 40 households (11%), more than one poverty indicator was present. Parents of adolescents who were dissatisfied with their financial situation were more often local, non refugees habitants, fairly high-educated, unemployed and extremely poor than parents of adolescents who were satisfied with their financial situation (Table 2 ). The majority of adolescents (n = 222, 62.4%) spent only 0.5-5 per week, and 16 (4.5%) could not afford any expenses whatsoever (Table 3 ).
Table 2 Quality of family life indicators among adolescents satisfied

or dissatisfied with their financial situation

Table 3 Self-reported relationships with parents and friends among adolescents who were satisfied and those who were not satisfied with their financial situation

The majority of respondents (87%) reported that they did not participate in any sports, 77% (n = 274) did not drive motorcycles, and 83% (n = 294) did not go out in the evenings. However, the survey revealed that adolescents who lived in poverty participated in sports and cultural activities in much higher percentage than the adolescents who were satisfied with their financial situation (Table 4 ). In 75 out of 356 (22%) adolescents, the parents seldom set definite rules on general behavior at home, and in 90 (25%) adolescents the parents seldom or almost never set definite rules on general behavior outside the house (Table 3 ).
Table 4 Self-reported differences in the perceived environment regarding life styles and thinking about own self among adolescents who were satisfied and those who were not satisfied with their financial situation

Seventeen percent of examinees were dissatisfied with themselves, 15% reported a lack of emotional support from their mothers, 7% were dissatisfied with the emotional support from friends, and 13% were dissatisfied with their health (Table 4 ). There was a significant correlation between the selfrated health and level of self-satisfaction (r = 0.504; P = 0.001), symptoms of sadness (r = 0.189; P = 0.001), symptoms of depression (r = 0.331; P = 0.001), and discontent with familial financial situation (r = 0.369; P =

0.001). Out of 356 adolescents, 82 (23%) were usually dissatisfied with their financial situation. Self-esteem related to discontent with the overall financial situation positively correlated with the employment status of the father (r = 0.28; P = 0.001), mother (r = 0.27; P = 0.001), and family socioeconomic state (r = 0.28; P = 0.001). There was a significant correlation between the family socioeconomic state and the residential status of the examinees (locals, refugees, or immigrants) (r = 0.15; P = 0.001), as well as with living with stepparents (Table 5 ).
Table 5 Correlation between scores on the socioeconomic state subscales and the satisfaction with the family financial situation, obtained among 356 adolescents

Mental health and related symptoms The average score obtained in the assessment of the health status in the study sample as a whole was 1.67 0.93, ranked on a 1-4 scale. Out of 356 adolescents, 97 (27%) reported symptoms of depression and 118 (33%) reported sadness. Except for the symptoms of distraction (P = 0.125), mental health symptoms were most frequent among adolescents who were dissatisfied with their financial situation they were two times more prone to attempt suicide. Out of 82 adolescents who were dissatisfied with their financial situation, 20 (25%) reported poor school marks and failure in school, 18 (22%) consumed tranquillizers or sedatives, 25 (31%) skipped classes, and 47 (57%) needed to use substantial effort in order to complete the required tasks (Table 6 ).
Table 6 Prevalence of the symptoms and signs related to the wellbeing and mental health of 356 adolescents who were either satisfied or not satisfied with their financial situation

Logistic regression analysis showed that symptoms of

depression were significantly associated with poor emotional support provided by the mother in the following conditions: decreased educational level of the father (OR, 1.738; 95% CI, 1.499-1.978), the degree to which parents know where the adolescent hangs out (OR, 2.339; 95% CI, 2.004-2.673), refugee or immigrant status (OR, 1.772; 95% CI, 2.001-2.638), and parental setting of rules at home (OR, 2.320; 95% CI, 1.31-2.282). The problem of bad marks in school was quite often associated with domicile or immigrant status (67.7% were refugees and immigrants; OR, 2.606; 95% CI, 2.0323.180), employment status of the father (OR, 1.424; 95% CI 1.110-1.561), and educational level of mother (OR, 0.924, 95% CI, 0.183- 1.666) (Table 7 ). The symptom of sadness was often negatively associated with the educational level (OR, 1.938; 95% CI, 1.680-2.196) or the employment status of the father and (OR, 1.165; 95% CI, 0.996-1.333). On the other hand, excellent marks in school were often negatively associated with hobbies like playing an instrument or singing (OR, 1.245; 95% CI, 1.083-1.407), reading with the purpose of relaxation (OR, 1.123; 95% CI, 0.9851.261), or the habit of going out in the evening (OR, 2.120; 95% CI, 1.647-2.593).
Table 7 The most frequent factors affecting the quality of life (independent variables) associated with mental health symptoms as dependent variables (depression, inability to perform tasks, bad marks in school); observed among 303 of 350 adolescents who receive (more ...)

In selected cases of adolescents who were receiving emotional support from their friends, we applied the multivariate logistic regression analysis and discovered that adolescents satisfaction with their financial situation positively correlated with absence of various disease symptoms (P = 0.001) (Table 8 ).
Table 8 Health symptoms associated with satisfaction with the family

financial situation (independent variable) among 319 of 356 adolescents satisfied with the relationships they had with their friends

Discussion
Our study showed that almost a half of the adolescents from the Tuzla Canton in Bosnia and Herzegovina live in poverty. Over two-thirds of adolescents spent the maximum of 0.5-5 per week. Twenty three percent of examinees were usually dissatisfied with the financial situation in their family. Six percent of families lived on low income or pensions. This finding is in agreement with the previous assessment of poverty in Bosnia and Herzegovina (10,11). The population health, particularly that in childhood and youth, is profoundly affected by the environment (1,6,1921). Several studies have dealt with the relationships between specific aspects of poverty, deprivation, and adolescents health (3,5,19-21). Our students, who lived in poverty or were dissatisfied with their financial situation, reported a lower quality of life than those living on a satisfactory income. Nevertheless, we found the first ones to be much more involved in sports and cultural activities. The mechanism underlying such a finding is not well understood (2,22). Seventeen percent of students reported a low level of self-esteem, which was positively correlated with the unemployment of parents and poor socio-economic situation of the family. Similar results have also been reported by other authors (6,19-23). The most pronounced factors in this regard are economic hardships, family discord, disruption, and dysfunction, parental mental health problems, and difficulties in coping with day-to-day demands of the family life (1,5,6,19-23). Psychological, emotional, and developmental well-being are also closely associated with the socioeconomic status (1-5). The rate of depression rate encountered among the studied adolescents was 27%. Results of some studies

indicated that depressed adolescents reported significantly less parental attachment (21,22). Students with a history of suicidal attempts expressed the least secure attachment and the lowest degree of individualization in their current relationship with their parents (9). Poor relationship with the mother and the lack of her emotional support, as well as poor relationship with friends, were the predictors of depressive symptoms and poor self-rated health in the logistic regression model. A more recent study reported that 20% of adolescent suffered from depression (21-23). The results of our study indicated that depression during adolescence was strongly associated with poverty and life with stepparents, ie, life in an insecure environment. Gender was associated with the prevalence of depression too, so that the girls were at more risk. The risk of having a negative self-perception resulting from depressive experiences, observed in our adolescents, was mainly based on the unemployment of parents and a poor familial socioeconomic state. Other authors found that such feelings were usually associated with the sense of being abandoned (5,7,9,20,23). A possible explanation of our results could be that relationships with friends are of the high importance for the perception of adolescents financial situation. Adolescents who were dissatisfied with their financial situation had the impression of being abandoned by others. Some authors in our country suggest that adolescents develop strong attachments to their parents, which become even stronger in adverse situations (24). Bad marks, failure in school, and depression, found in our study, were strongly associated with the level of parental control (my parents set definite rules of what I can do at home and my parents set definite rules on what I can do outside) and parental education. Entertainment activities (reading, going out, and riding a motorcycle or a moped) were rarely present (10%-17%). These values and perspectives are culturally based and, as such, resistant to changes (24,25).

Almost a half of the adolescents reported discontent with their health. The relationship between poverty and adolescent health is extensive, strong, and pervasive. In this respect, undoubtedly important contribution comes from a social support provided by the mother. Emotional support provided by the mother can have an important influence on the quality of life of adolescents who live in poverty. The satisfaction with the relationship with the mother (friendship, giving advice, and having someone to talk to) results in better adolescent health (5,26-31). This effect is the strongest in families living in poverty (32-34). There are several limitations to our study. First, the collected data were self-reported, and depended on the reliability of adolescents self-perception. On other hand, the impact of poverty on health my be similar to that from traumatic post-war factors or acculturation in most households in the Tuzla Canton (25,29). This study was also limited by the age of the respondents, which were all aged 16, so that our results may not be relevant to the whole adolescent population. The study did not include adolescents who were not part of regular schooling system. Therefore, the important goal of our future investigations will be to focused on the differences between healthy adolescents and adolescents with acute or chronic health conditions who both live in poverty. In conclusion, poverty in adolescents is associated with undesirable psychological and social consequences, including poor psychological well-being. Depressive symptoms, self-perceived health status, and contextual variables are important correlates of poverty. Perceived quality of life should be a barometer of opportunities and a useful social indicator in the surveillance studies on adolescents. Reasons why poor adolescents have worse health are the same as the reasons why families remain in poverty conditions. These reasons may be unemployment, post-war poverty in Bosnia and Herzegovina, educational level, and cultural determinative aspects of lifestyle.

Acknowledgments

We express our gratitude to all secondary schools in the Tuzla Municipality, and the students that took part in this study.

References

1. Judge K, Benzeval M. Health inequalities: new concerns about the children of single mothers. BMJ. 1993;306:67780. [PubMed] 2. Raphael D, Rukholm E, Brown I, Hill-Bailey P, Donato E. The Quality of Life Profile Adolescent Version: background, description, and initial validation. J Adolesc Health. 1996;19:36675. [PubMed] 3. West P. Inequalities? Social class differentials in health in British youth. Soc Sci Med. 1988;27:2916. [PubMed] 4. Terrell TR, Mascie-Taylor CG. Biosocial correlates of stature in a 16year-old British cohort. J Biosoc Sci. 1991;23:4018. [PubMed] 5. Reading R. Poverty and the health of children and adolescents. Arch Dis Child. 1997;76:4637. [PubMed] 6. Maclure A, Stewart GT. Admission of children to hospitals in Glasgow: relation to unemployment and other deprivation variables. Lancet. 1984;2:6825. [PubMed] 7. Graham PJ. Childhood epidemiology. Behavioural and intellectual development. Br Med Bull. 1986;42:15562. [PubMed] 8. Najman JM, Bor W, Morrison J, Andersen M, Williams G. Child developmental delay and socio-economic disadvantage in Australia: a longitudinal study. Soc Sci Med. 1992;34:82935. [PubMed] 9. Oakley A, Hickey D, Rigby AS. Love or money? Social support, class inequality and the health of women and children. Eur J Public Health. 1994;4:26573. 10.

Tioungsou ER, Yemstov RG. Poverty and the labor market in Bosnia and Herzegovina 2001 to 2004. Washington (DC): The World Bank; 2005. 11. World Bank. Bosnia and Herzegovina country economic memorandum, report no. 29 500-BA. Washington (DC): The World Bank; 2005. 12. Ungurean C, Csiki IE. Poverty. In: Georgieva L, Burazeri G, editors. Health determinants in the scope of new public health. A handbook for teachers, researchers, and health professionals. Sofia: Hans Jacobs Publishing Co; 2005. p. 74-96. 13. Pranji N. Child labor. In: Georgieva L, Burazeri G, editors. Health determinants in the scope of new public health. A handbook for teachers, researchers, and health professionals. Sofia: Hans Jacobs Publishing Co; 2005. p. 132-51. 14. World Medical Association Declaration of Helsinki. Recommendations guiding medical doctors in biomedical research involving human subjects. Helsinki: WHO; 1989. Available from: http://www.fda.gov/oc/health/helsinki89.html Accessed: September 4, 2007. 15. WHOQOL group. The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. 1995;41:14039. [PubMed] 16. Patrick DL, Edwards TC, Topolski TD. Adolescent quality of life, part II: Initial validation of a new instrument. J Adolesc. 2002;25:287 300. [PubMed] 17. Hibell B, Andersson B, Bjornason T, Ahlstrom S, Balakireva O, Kokklevi A, et al. The ESPAD report. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs; 2003. 18. Goldberg D, Williams P. A users guide to the general health

questionnaire. Windsor (UK): NFER-Nelson; 1988. 19. Nunnally JC, Bernstien IH. Psychometric theory, 3rd edition. New York (NY): McGraw-Hill; 1994. 20. Golding J. Child health and the environment. Br Med Bull. 1986;42:20411. [PubMed] 21. Kliegman RM. Perpetual poverty: child health and the underclass. Pediatrics. 1992;89:7103. [PubMed] 22. Sund AM, Larsson B, Wichstrm L. Psychosocial correlates of depressive symptoms among 12-14-year-old Norwegian adolescents. J Child Psychol Psychiatry. 2003;44:58897. [PubMed] 23. Goldney RD, Fisher LJ, Wilson DH, Cheok F. Major depression and its associated morbidity and quality of life in a random, representative Australian community sample. Aust N Z J Psychiatry. 2000;34:10229. [PubMed] 24. Afifi M, Al Riyami A, Morsi M, Al Kharusi H. Depressive symptoms among high school adolescents in Oman. East Mediterr Health J. 2006;12:1930. 25. Hasanovic M, Sinanovic O, Selimbasic Z, Pajevic I, Avdibegovic E. Psychological disturbances of war-traumatized children from different foster and family settings in Bosnia and Herzegovina. Croat Med J. 2006;47:8594. [PubMed] 26. Ge X, Conger RD, Elder GH., Jr Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms. Dev Psychol. 2001;37:40417. [PubMed] 27. Meuleners LB, Lee AH. Adolescent quality of life: a school-based cohort study in Western Australia. Pediatr Int. 2003;45:70611. [PubMed] 28.

Pearce J. Psychosocial disturbances in young people: challenges for prevention. BMJ. 1996;312:453. 29. Hasanovic M, Sinanovic O, Pavlovic S. Acculturation and psychological problems of adolescents from Bosnia and Herzegovina during exile and repatriation. Croat Med J. 2005;46:10515. [PubMed] 30. Edwards TC, Huebner CE, Connell FA, Patrick DL. Adolescent quality of life, part I: conceptual and measurement model. J Adolesc. 2002;25:27586. [PubMed] 31. Ljubotina D, Galic J, Jukic V. Prevalence and risk factors of substance use among urban adolescents: questionnaire study. Croat Med J. 2004;45:8898. [PubMed] 32. Vingilis E, Wade TJ, Adlaf E. What factors predict student self-rated physical health? J Adolesc. 1998;21:8397. [PubMed] 33. Edwards TC, Patrick DL, Topolski TD. Quality of life of adolescents with perceived disabilities. J Pediatr Psychol. 2003;28:23341. [PubMed] 34. Berg-Nielsen TS, Vika A, Dahl AA. When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem. Child Care Health Dev. 2003;29:20713. [PubMed]
NEXT:

Mental Illness and Mental Health in Adolescence

by Janis Whitlock and Karen Schantz As any parent, youth worker, or young adult can verify, mental health in adolescence may be characterized by a roller coaster of emotional and psychological highs and lows. Intense feelings are a normal and healthy part of the psychological landscape of youth, but it is also true that many mental health disorders of adulthood begin in childhood or adolescence. While the mental health field offers essential options for treating disorders, the profession is only beginning to explore ways to build optimum health. This fact sheet provides a very brief introduction to mental health with a

focus on definition, assessment, and mental health disorders, then offers perspective on the role youth development approaches may play in promoting positive mental health and protecting against mental health disorders.

Defining and Assessing Adolescent Mental Health

The term mental health generally refers to a psychological and emotional state. Like the states of mind and being it reflects, the term is fluid and is used to to discuss a) a positive state of psychological and emotional well-being and the conditions that foster it, b) the absence of mental illness, or c) the presence of mental imbalances that affect overall psychological well-being. Assessing mental health may be equally ambiguous and context-dependent. How do we know if an individual is psychologically and emotionally thriving, thus enjoying positive mental health? How do we know if a person is struggling with a mental health disorder? The task of evaluating whether a young person is experiencing chronically negative trends in psychological and emotional wellbeing is complicated by the fact that fluctuations in mood and behavior are normal in adolescence. Because of this, and because of the need to ensure that youth at risk for mental illness or disorders receive the attention they need, it is most common to assess mental health as either the absence or presence of mental illness rather than through a more positive lens.

Mental Health Disorders

Mental health problems affect one in every five young people at any given time (U.S. Department of Health and Human Services, 1999) although severity varies greatly. Individuals are regarded as possessing a serious emotional disturbance when a mental disorder disrupts daily functioning in home, school, or community. If a child or adolescent is able to function well in at least two of those three areas, it is unlikely that he or she has a serious mental health disorder. It is estimated that one in ten young people in the United States experiences a serious emotional disturbance at some point in their childhood or adolescence. Recognition of the signs and symptoms of mental health disorders is important because early intervention may be critical to restoring health. Mental health disorders are typically marked by disruption of emotional, social, and cognitive functioning. Those disorders that most commonly affect adolescence are anxiety disorders, which manifest through phobias, excessive worry and fear, and nervous conditions; and depression disorders, characterized by states of hopelessness or helplessness that are disruptive to day-to-day life. Other mental health conditions affecting youth include bipolar disorder, conduct disorder, attention-deficit/hyperactivity disorder, learning disorders, eating disorders, autism, and childhood-onset schizophrenia. Causes of Mental Illness Although it is often possible to identify triggers for particular episodes of mental illness, identifying the underlying etiology is often more difficult. In many cases, mental illness emerges as a consequence of biological and environmental interactions. For example, the predisposition for disorders such as schizophrenia, bipolar disorder, and depression are genetically heritable and may be activated by particular environments (Pickler, 2005). Environmental factors that lead to chemical imbalances in the body or damage to the central nervous system may also create biological vulnerabilities. When these vulnerabilities are coupled with environmental conditions high in chaos and low in security and safety (such as exposure to violence, including witnessing or being the victim of abuse; stress related to chronic poverty, discrimination, or other serious hardship; and the loss of important people through death, divorce, or broken relationships), mental disorders may result (Perry, 2002).

However, it is important to note that while research on the etiology of mental illness has been fruitful, not all individuals at risk for mental illness develop it and many individuals with no apparent risk do. Also, having a genetic predisposition does not mean that developing a mental illness is predetermined or that parents with a similar condition are to blame. Much remains to be learned in this area. Signs of Disorder

Mental health disorders seldom simply appear in full bloom. Instead, they are often preceded by symptoms of deteriorating health and functioning. The primary differences between developmentally common behavior and nascent mental health disorders are in
symptom severity and duration, and the extent to which the behavior causes disruption to daily life. Early onset mental disorders may be episodic at first, but tend to increase in severity, duration, and level of disruption over time. Family members and friends are often the first to notice early symptoms. It is important to recognize that perceptions of what constitutes good or poor mental health will vary from culture to culture. Such variation may affect how serious disorders are expressed, detected, and interpreted. Sensitivity to cultural difference is critical to effective detection, intervention, prevention, and treatment.

Treatment Psychotherapeutic interventions such as cognitive behavior therapy and family systems therapy are currently the most widely used and effective treatments for most mental illnesses. While they may be added to these interventions, medications typically should not be used as the sole treatment; however, selective serotonin reuptake inhibitors (SSRIs) are widely used and generally considered safe. Fortunately, widespread and growing awareness of the prevalence of mental health disorders in children and adolescents has spurred the search for therapeutic and pharmacological approaches that are safe and effective for youth. Internet resources such as those offered by the American Academy of Child and Adolescent Psychiatry (see http://www.aacap.org/cs/root/facts_for_families/facts_for_families) provide valuable resources for families and others seeking updated information on mental health disorders and treatment.

Beyond Mental Illness: Promoting Mental Health and Well-Being

Understanding signs and symptoms of mental health disorders is important for early detection and intervention. It is also important, however, to define and research mental health in positive terms (rather than merely the absence of illness) and to promote well-being through affirming, strengthbased approaches. Positive Psychology: Developing Mental Health in Young People

With so much emphasis on disorder, we might well wonder if freedom from illness is the best we can hope for. The emerging field of positive psychology seeks to bring balance to mental health research through the study and promotion of psychological strengths. Linking youth development to the positive psychology framework, the Commission on Positive Youth
Development (2006) summarizes positive psychological characteristics in five broad categories: Positive emotions, including joy, contentment, and love Flow, defined as the psychological state that accompanies highly engaging activities Life satisfaction; the sense that ones own life is good, which correlates with characteristics such as self-esteem, resiliency, optimism, self-reliance, healthy habits, and prosocial behavior Character strengths such as curiosity, kindness, gratitude, humor, and optimism

Competencies in the social, emotional, cognitive, behavioral, and moral realms These characteristics gesture toward a much more vibrant vision of mental health, and are suggestive of ways concerned communities might create supports, opportunities, and services to promote optimum health. Along these same lines, positive psychology inquires into the role institutions play in facilitating the development of positive traits: how organizations, naturally occurring socializing systems, and communities help young people produce positive outcomes (Commission on Positive Youth Development, 2006). Youth Development and Community In calling for a focus on strengths over deficits, and community responsibility in balance with individual responsibility, positive psychologists join the growing movement toward youth development as a public health strategy. As part of the national public health initiative Healthy People 2010, the National Initiative to Improve Adolescent Health by 2010 (NIIAH) has identified 21 Critical Health Objectives for adolescents and young adults, including objectives within the category of mental health and substance abuse. NIIAH recommendations move away from a categorical focus on specific problems toward an ecological, positive youth development approach that involves community collaborationincluding young people themselvesto create solutions (Centers for Disease Control and Prevention et al., 2004).

Relying on research that demonstrates the protective effects of youth development approaches, NIIAH explicitly endorses youth development strategies that involve all community sectors to address health and safety. Rather than saying to a young person the problem is with you, this approach engages youth together with families, schools, health care providers, youth- serving agencies, faith communities, media, colleges and universities,
employers, and government agencies to build strengths and reduce risks at the environmental as well as individual level. Emphasis falls on community responsibility, community solutions, and community connectedness: the problem is with us; the answers are with all of us. This commitment to supporting health through community-level change grew out of research that demonstrates the importance of social context to individual health. Although some individuals are physiologically vulnerable to development of mental illness and disorders, studies consistently show that environment matters a great deal in mental health functioning. Relationships with caring adults, development of positive life goals, and belief in a positive future have all been consistently linked to healthy social and emotional functioning in youth and adults (Eccles and Gootman, 2002). Similarly, history of trauma and abuse as well as high environmental instability is consistently linked with poor mental function (Perry, 2002; Karr-Morse & Wiley, 1997). This suggests that environments that foster connection with others and provide opportunities for meaning and mastery serve as buffers against mental disorders and promote positive mental health. Environments that cultivate both positive emotional relationships and the ability to understand and articulate emotional states may prove particularly useful in supporting positive mental functioning. Initiatives such as those promoted by the Collaborative for Academic, Social, and Emotional Learning and by proponents of emotional literacy are examples of such environmentally-focused frameworks. A commitment to making a difference for mental health in youth also requires us to reduce the major risk factors that lead to health crises. As Bernat and Resnick propose (2006), promoting strengths is critical to health, but this effort does not negate the urgency of addressing fundamental threats to health, such as poverty. Poverty is one such threat; entrenched, negative adult attitudes toward youth is another. Building healthy communities for youth means partnering with youth to take on the attitudes, policies, and practices that exclude young people from making a meaningful

contribution to social change.

References
Bernat, D. H., & Resnick, M. D. (2006). Healthy Youth Development: Science and Strategies. Journal of Public Health Management and Practice (Suppl. November), S10-S16. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health; Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Adolescent Health; & National Adolescent Health Information Center, University of California, San Francisco. (2004). Improving the health of adolescents & young adults: A guide for states and communities. Retrieved December 15, 2008, from http://nahic.ucsf.edu/index.php/companion/index/#chapters Commission on Positive Youth Development. (2006). The positive perspective on youth development. In D. L. Evans, E. B. Foa, R. E. Gur, H. Hendin, C. P. OBrien, M. E. P. Seligman, & T. B. Walsh, Treating and preventing adolescent mental health disorders: What we know and what we dont know. Retrieved December 15, 2008, from http://amhitreatingpreventing.oup.com/anbrg/private/content/mentalhealth/9780195173642/p127.html#ac prof-9780195173642-part-7 Eccles, J. S., & Gootman, J. A. (2002). Community programs to promote youth development. Washington, DC: National Academy Press. Karr-Morse, R., & Wiley, M. S. (1997). Ghosts from the nursery: Tracing the roots of violence. New York: Atlantic Monthly Press. Matarese, M., McGinnis, L., & Mora, M. (2005). Youth involvement in systems of care: A guide to empowerment. Retrieved December 15, 2008, from http://www.tapartnership.org/youth/youthguide.asp Perry, B. D. (2002). Childhood experience and the expression of genetic potential: What childhood neglect tells us about nurture and nature. Brain and Mind, 3, 79-100. Pickler, J. (2005). The role of genetic and environmental factors in the development of schizophrenia. Psychiatric Times 22(9). U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Retrieved December 15, 2008, from http://www.surgeongeneral.gov/library/mentalhealth/home.html Next:

Boys have greater psychological well-being than girls, due to a better physical self-concept
February 3rd, 2009

Self-concept may be defined as the totality of perceptions that each person has of themselves, and this self identity plays an important role in the psychological functioning of everyone. To date, however, there has been no investigation into the relationship that physical self-concept has with

psychological well-being or psychological unwellness. Ads by Google

American Nuclear Society - www.ans.org ANS Meeting -- Advancing Nuclear Technology for a Greater Tomorrow
The author of the thesis is Ms Arantzazu Rodrguez Fernndez, who presented her work under the title, El autoconcepto fsico y el bienestar/malestar psicolgico en la adolescencia (Physical self-concept and psychological well-being/unwellness during adolescence). Ms Rodrguez is a graduate in Psychology and carried out her PhD under the direction of doctors Alfredo Goi Grandmontagne and Igor Esnaola Etxaniz, of the Department of Evolutionary Psychology and the University School of Education at the UPV/EHU. She currently works as a research worker at the university. This research had three fundamental objectives: to study the relationship between physical self-concept and psychological well-being, to identify the relationship between physical self-concept and anxiety and depression and, finally, to analyse the relationship between physical self-concept and Eating Behaviour Disorders (EBDs) amongst both the non-clinical population in general as well as amongst patients previously diagnosed with anorexia or bulimia nerviosa. A study on adolescents To undertake the research, a total of 1,959 young people between the ages of 12 and 23 from the Basque Country, Burgos and Rioja were studied. 48 of these were patients diagnosed with some form of EBD. The data obtained indicated that physical self-concept is related in a positive manner with the psychological well-being of the individual and in a negative manner to psychological unwellness, in such a way that the more one is happy with one's physique, the more psychological well-being one has, with less levels of anxiety and depression and less risk of suffering from an EBD. This relationships have also been analysed as a function of age, gender and physical activity. As a general rule, it is seen that, taking into account physical self identity, male adolescents present higher scoring for psychological well-being than their female peers. This same relationship is established between12-14 year old adolescents on the one hand and 15+ adolescents on the other, and between those who do physical activity and those who do not. But, considering all the variables at the same time, it was seen that adolescents with more positive physical self-concept and who are, at the same time, between 12 and 14 or carry out physical activity, score higher for psychological well-being, without any significant difference between the sexes being observed. This research also showed young people experienced psychological unwellness in relation to their physical appearance throughout their adolescence, whether their perception of their physique is low, average or high. Nevertheless, undertaking sporting activity appears to be a good way to minimise any psychological unwellness, probably because it enhances physical self-concept. It is only when physical self-concept is low that doing physical exercise gives rise to the potential risk of suffering EBD. As a rule, however, sport can be defended as a way of increasing personal well-being and reducing psychological unwellness. Stages of greater risk As regards disorders associated with physical appearance, the greatest risk of developing an anxiety disorder is after the age of 15; for a depressive disorder the risk stage is between 12 and 17; and for anorexia or

bulimia nerviosa the risk period is between 18 and 23. Finally, of all the elements conditioning physical self-concept, the outstanding one is that of an attractive physical appearance, because the self-perception of this is strongly related to anxiety, depression and psychological well-being. All this, of course, is a reflection of how society favours relationships between what is attractive as perceived by one and how anxious, how depressed or how happy one feels with oneself. Source: Elhuyar Fundazioa

Ads by Google Social Media Research - Read Free Techology Research On Social Media - Research.Aberdeen.com Biokinesiology MS & PhD - Involve in Cutting-Edge Research Meet World-Renowned Researchers pt.usc.edu/Biokinesiology MSc Sports Physiotherapy - Part-time online distance education CSP endorsed, meets IFSP standards www.bath.ac.uk/health

A Complexity Approach to Psychological Well-Being in Adolescence: Major Strengths and Methodological Issues
Authors: Gonzlez, Mnica1; Casas, Ferran; Coenders, Germ Source: Social Indicators Research, Volume 80, Number 2, January 2007 , pp. 267-295(29) Publisher: Springer Abstract:
Psychological well-being in adolescence is an increasing field of study. Deepening in its knowledge during this period of life can be of a lot of help to the designing of more adjusted prevention programs aimed to avoid or reduce the problems adolescents might be experiencing. Complexity theories can be a productive alternative to the important limitations explanations about psychological well-being in adolescence have nowadays. Answers to a questionnaire have been obtained from a sample of 968 Catalan adolescents from 12 to 16 years old including 29 psychological well-being indicators measuring 8 dimensions related to satisfaction with specific life domains, self-esteem, perceived social support, perception of control and values.A structural equation modelling approach to complexity that focuses on the non-linearity property has been followed. Given the large number of dimensions, the model has been estimated in two steps. First, a confirmatory factor analysis model has been fitted to the 29 indicators and appropriate factor scores have been saved. Then all possible

products and squared terms of the factor scores have been computed and have been used as predictors of the dependent variable using an ordered logit model.The results show that a non-linear model including interaction effects among the 8 dimensions, age and gender, has a higher explanatory power to predict satisfaction with life as a whole, compared to a linear model estimated from those same indicators.This work must be understood as a first step, basically a methodological one, to the future elaboration of new models of psychological well-being in adolescence to be based on the principles defended by complexity theories.

Keywords: adolescence; complexity theories; non-linearity; quality of life; subjective well-being Document Type: Research article DOI: 10.1007/s11205-005-5073-y Affiliations: 1: Email: monica.gonzalez@udg.es