Stigma by association: Parent stigma and youth adjustment in inflammatory bowel disease

Objective Examine the indirect association between parents’ experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). Methods During routine clinic visits, 150 youth with well-controlled IBD (ages 10–18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. Results Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents’ experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. Conclusions Parents who face stigma related to their child’s IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths’ illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents’ associative stigma and youths’ illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.

Using Network Analysis to Compare Caregiver and Youth Reports of Youths’ Depressive Symptoms

Objective: Multi-informant assessment is the gold standard for youth depressive symptoms, and discrepancies in symptom reports across caregivers and youths can predict important clinical outcomes. However, discrepancies are typically only evaluated by comparing the means of sum scores across informants. We took a broader approach that involved: 1) evaluating discrepancies at the symptom level and 2) using mean-level and network structure comparisons. Method: Participants were clinically referred youths and their primary caregiver (N = 298 youth- caregiver pairings) ages 7-14. The sample was racially (52.68% Non-Caucasian) and socioeconomically (54.02% family income < $40,000 per year) diverse. We compared whether youths and caregivers differed significantly on their means for each depressive symptom. We then conducted a Network Comparison Test to gauge the extent to which youths and caregivers differed in the associations between pairs of symptoms. Results: Youths and their caregivers differed at the mean level on 12/21 symptoms, with caregivers reporting higher levels on all 12. However, youth-caregiver differences were found on only 3 of the 119 associations between pairs of symptoms (i.e., “edges”). Perfectionism – feels unloved was more strongly associated in the youth network, while won’t talk – secretive and rather be alone – uninvolved were more strongly associated in the caregiver network. Conclusions: A symptom-level, multi-method approach to caregiver and youth discrepancies revealed that our understanding of discrepancies might depend on the type of analysis we use (mean-level vs. network structure). Integrating the mean-level and network approaches may produce a richer, more clinically useful understanding of symptom-level cross-informant discrepancies.

THE IMPACT OF POSITIVE SCHOOL EXPERIENCES AND SCHOOL SES ON DEPRESSIVE SYMPTOMS IN CHINESE CHILDREN: A MULTILEVEL INVESTIGATION

The current study investigates the effects of teacher support, school connectedness, and school socioeconomic status (SES) on youth depressive symptoms. Data were collected from a sample of 881 students in Grade 6 from 10 primary schools in Northwest China. Hierarchical linear modeling indicated that higher levels of teacher support, school connectedness, and school SES were significantly associated with fewer depressive symptoms. Further, the relationships between school-level SES and youth depressive symptoms varied by the participant’s perceived level of teacher support and perceived level of school connectedness. These findings underscore the importance of positive school experiences on child psychological outcomes. Implications for future research on Chinese youth are discussed.