Anxiety, Depression and Coping Strategies: Improving the Evaluation and the Understanding of These Dimensions during Pre-Adolescence and Adolescence

Article excerpt

Abstract

The aim of this study is to investigate and refine three different scales which measure depression, anxiety and coping strategies. The relation between these scales is also verified in a non-clinical school population of pre-adolescents and adolescents. Lastly, the moderating effects of age, gender, grade failure and family type are tested. This study used depression, anxiety and coping strategy scales to check moderating effects. The sample consisted of 916 Portuguese pupils, 54.3% females, aged 10 to 22 (M = 14, 44). The participants were randomly selected from the 5th to the 12th grades of public schools. The CDI (Kovacs, 1981), the MASC (March, 1997) and the CRY-Y (Moos, 1993) were used. Scales revealed a good internal consistency and suggested that girls are more anxious than boys are and that older students are more depressed, but use more coping strategies than younger learners. A set of exploratory factorial analyses (EFA) was then carried out with the objective of getting the most representative factor from the anxiety (MASC), the depression /CDI) and the coping (CRY-Y) scales. Reduced scales were identified and they strongly correlated with the previous measures, but better differentiate between a set of moderators. A confirmatory model (CPA) was carried out. Also, adjustment indexes suggested a good fit for the model, but consider both genders separately and the two age groups independently. An analysis of the items retained provided suggestions for school based interventions.

Keywords: anxiety, depression, coping, adolescents, schools

There is an increase in the prevalence of different psychological disorders in childhood and adolescence, which affects children and adolescents' academic performance, as well as their behavior as individuals, members of a family and of a particular social environment (Maag & Irvin, 2005; Windle & Davies, 1999). These emotional disorders are often related with the use of negative or maladaptive coping strategies under stressful situations. Furthermore, they have an impact on the psychosocial adjustment of children and adolescents (Hussong & Chassin, 2004).

Several studies are unanimous in considering depression as a very common pathology in childhood and in adolescence. In addition, they consider that the heterogeneity of depressive symptoms is related to different periods of childhood/adolescence - when comorbidity appears (Harrington, Rutter, & Trombone, 1996; Mash & Wolfe, 2002).

In general, studies suggest that depression symptoms appear before children are 12 years of age, and that by that age boys present higher values of depression (McGee, Feehan, Williams, & Anderson, 1992). Moreover, as age increases, there is a substantial increase of the number of depression symptoms. According to some researchers, the differences increase between the ages of 13 and 15 and drastically increase between the ages of 15 and 18, where there's a higher prevalence among the feminine gender (Duggal, Carlson, Srouf, & Egeland, 2001; Scraedly, Gotlib, & Hayward, 1999).

Depression can also affect school performance. Atienza, Cuesta and Galán (2002) carried out a cross-sectional study related to this issue, with 264 adolescents aged 12 to 16, from public and private schools. In this study, they observed that depressed adolescents present low interest in school matters, as well as attention and concentration difficulties.

Anxiety appears as a common, functional and transitory experience and its nature and intensity can vary largely depending on the individuals' developmental stage. Considering these characteristics, anxiety allows children and adolescents to engage in new, unexpected or dangerous situations (Rosen & Schulkin, 1998). However, the intensity of anxiety can increase and often become chronic and dysfunctional from a social and emotional point of view (Fonseca, 1998). To corroborate this assertion, Essau, Conradt and Petermann (2000) found that from a sample of adolescents between the ages of 12 and 17 females present more anxiety symptoms than males and that this symptom tends to increase with age - generally between the ages of 12 and 15.

According to Ballone (2003), low academic performance can also interfere with children's development and mental well being, thereby increasing anguish and feelings of concern. Similarly, Byrne (2000) showed that adolescents, who have higher anxiety levels, have a greater number of disruptive behaviours, lower self-concept and lower school performance.

Some studies have demonstrated that there is a relation between anxiety and depression in adolescents and adults (Kovacs & Devlin, 1998; Pine, Cohen, Gurley, Brookm, & Yuju Me, 1998). In order to analyse this association, Matos, Barrett, Dadds and Short (2003) carried out a cross-sectional study with Portuguese children and adolescents, aged 10 to 17, attending 6th, 8th and 10th grade in public schools. The subjects were evenly distributed in terms of gender. Researchers observed a significant association between depression and anxiety and superior frequency levels of anxiety and/or depression symptoms in females. It is thus important to examine the strategies that children and adolescents use in order to deal with stress, considering that coping can be a key issue in understanding successful performances under stressful events (Hussong & Chassin, 2004).

Children and adolescents use a great diversity of coping strategies in different domains (in their school performance, family-life and social environment). They differ nonetheless, in stress situation evaluation and in coping strategy assessment. The effect and type of answer to a situation that causes stress depend on personal characteristics and abilities (Wenger, Sharrer, & Wynd, 2000), as well as on family support, school support and home-school links (Matos, Dadds, & Barrett, 2006).

Coping can have several functions, which can be summarized in two great categories: problem-focused and emotion-focused (Rijavec & Brdar, 2002). The first category reflects cognitive and behavioural efforts which are made to dominate or solve a stressful situation, whereas the second category includes cognitive and behaviour efforts made to avoid thinking about the stressful situation or to manage the emotional discomfort caused by stress (Moos, 1993).

Gender differences in the use of coping strategies have been reported in several studies, suggesting that females tend to use emotion-focused passive strategies in order to achieve emotional stability, such as relaxation, relationship investment, emotional expression and social support. Males use more problemfocused coping strategies and are less prone to accept or wait passively, but rather confront the stressor agent or situation (Myers & Thompson, 2000; Rijavec & Brdar, 1997).

Some studies report that there is a positive relation between maladaptive coping strategies and different psychological disorders (Endler & Parker, 1990; Holahan, Moos, & Schaefer, 1996). Selffge-Krenke (2000) observed that children and adolescents with pathological behaviours use maladaptive coping strategies, which in the future can increase their pathological behaviours, resulting in a vicious cycle. Depressed adolescents show a higher number of stressful life events and a higher use of maladaptive coping strategies before the onset of these events (Selffge-Krenke, 2000). Wilson, Pritchard and Revalee (2005) pointed out in a study with adolescent participants (ages 10 to 19), that females present more psychological symptoms, such as anxiety and depression, and use more emotionfocused coping strategies.

Byrne (2000) analysed the relations between anxiety, fear, self-esteem and coping strategies on a sample of 224 adolescents attending 7th, 9th and 12th grade. Results suggested that 12th grade males present a significant decrease of anxiety and fear, and that by the 12th grade, males and females use different coping strategies in order to deal with their fear and anxiety.

In line with the above studies, the aim of this research was to investigate and refine three different scales which measure depression, anxiety and coping strategies. It is also our intent to analyse the relation between these scales, in a non-clinical school population of pre-adolescents and adolescents, as well as to check the moderating effects of age, gender, grade failure and family type.

Method

Participants

The study followed strict international ethical and privacy norms by obtaining the faculty's scientific board's approval, school authorizations and parental consent, and by following anonymity guidelines and by working to voluntary-based participation. To be more precise, we selected the participants from Portuguese public schools nation-wide, and chose two classes from the fifth to the 12th grade randomly. The final sample consisted of 916 adolescents, 54.3% of which were females, aged 10 to 22 (M = 14.44; SD = 2.62). Additionally, 37.2% of the students had failed a subject in their past academic career and therefore, had been retained one or more years. As for family type, 72.5% of the subjects had been living in a nuclear family. Also, two age groups were considered - that is, 48% of the students were considered to be less than 15 (10 to 15 years old) and 52% more than 15 (16 to 22 years old). Lastly, we contracted psychologists to administer questionnaires in the classroom which took an average of 50 minutes to fill in.

Measures

The questionnaire records demographic characteristics such as, age, gender, school grade and academic situation (grade retention). This instrument was followed by three different measures - the Children `s Depression Inventory - CDI (Kovacs, 1981), the Multidimensional Anxiety Scale for Children - MASC (March, 1997) and the Coping Responses Inventory - Youth Form - CRI-Y (Moos, 1993).

The CDI is a self-report inventory of 27 items, coded on a three-point scale (1. Absence of symptoms; 2. Moderate symptoms; 3. Severe symptoms). The total score varies between 27 and 81 points. A higher score reflects higher levels of depression. The author reports satisfactory levels of internal consistency with alpha coefficients varying between .71 and .89 for the total scale.

The MASC is a 39-item self-report scale, with items coded on a fourpoint scale (1. Never or almost never true; 2. Rarely true; 3. Sometimes true; 4. Frequently true). The total score ranges between 39 and 156. Higher scores reflect higher levels of anxiety. The author of the scale reports satisfactory levels of internal consistency, with alpha coefficients varying between .88 and .89 for the total scale.

The CRI-Y is a self-report inventory consisting of two parts. In the first section, participants are asked to describe a problem or stressful situation. The answers are grouped in different categories. In the present study for example, the stressful events were recoded in five groups: physical health, family, school, friends and "other".

The second part of the CRI includes 48 items, which evaluate coping strategies. Participants select how they usually deal with the situation described in the first part of the four point scale (1. No, never; 2. One or two times; 3. Yes, sometimes; 4. Frequent). In the original version, the author of the scale considered two dimensions (active/confronting coping and passive/avoidance coping). In the present study, data did not allow us to assume two separate factors therefore we only considered one coping dimension (CRI). Accordingly, results vary between 48 and 192 for each dimension and a higher score corresponds to a more frequent use of coping strategies. The author reported satisfactory levels of internal consistency, with alpha coefficients between .68 and .79 for active/confronting coping and between .59 and .72 for passive/avoidance coping (Moos, 1993). No alpha coefficients were available for the total CRI scale. In the present study, we have only used the total score of the CDI, MASC and CRI.

Results

Preliminary descriptive and univariated analysis

For descriptive and univariated analysis we used the SPSS 16.0 software.

In a first step, we considered Total Depression (CDI) Anxiety ( MASC) and Coping (CRI) scales. Table 1 summarizes the descriptive data and the consistency results.

The Coping (CRI) scale was based on a previously identified problem. Content analysis of these problems revealed that 46.2% of the pupils referred to family problems ; 19.9% mentioned health problems ; 18.2% brought up peer related problems ; 13.2% made reference to school problems and a residual 2.4% revealed other problems.

We carried out ANOVAs by using the CDI, the MASC and the CRI as dependent variables and gender, age group, grade failure and type of family (nuclear to other situations) as moderators.

Regarding gender, the only significant difference was in anxiety (MASC). Girls were considered to be more anxious than boys (X=84.4 vs. X=77.4 respectively), [F (1,913) = 54.72, p < .01]. As for age group, pupils in the younger group were significantly more depressed (CDI) than those in the older group (X=46.39 vs. X=39.89 respectively), [F (1,914) = 158.37, p < .01] and reported significantly less frequent coping strategies (CRI) than the older group (X=103.9 vs. X=111.9 respectively), [F (1,312) = 12.27, p <.01]. In addition, adolescents living in nuclear families were less depressed (CDI) than those having other types of families (X=42.29 vs. X=44.88 respectively), [F (1,914) = 17.43, p <.01].

Neither of these scales was able to significantly differentiate pupils who had failed one or more grades in the past.

Pearson correlations confirmed a significantly positive correlation between the CRI and age (r =.165; p <.05) and a significantly negative correlation between the CDI and age (r =-.439; p <.01). The CRI was positive and significantly correlated with the MASC (r =.224; p <.01) and the MASC was positively correlated with the CDI (r =.206; p <.01). However, there was no significant correlation between the CRI and the CDI.

Exploratory factorial analysis

In a second step, we used the SPSS 16.0 software to carry out a set of exploratory factorial analysis (EFA) and get the most representative factor from the anxiety (MASC), depression /CDI) and coping (CRI) scales.

The principal component analysis with Kaiser Criteria was then conducted to extract one component (in each scale) with eigenvalues greater than one. Some factors loaded in only one or two items and, according to Hakstian, Rogers and Cattell (1982), those components were then deleted. According to Ford, MacCallum and Tait (1986), we also deleted items with loadings greater than .40 in two or more factors. This statistical procedure allowed us to develop three uni-factorial scales that measure depression, anxiety and coping strategy. The scales consist of those items that have higher loadings in the first EFA component.

Additionally, we measured the reduced depression construct (CDI-R) by items 2, 5, 7, 8, 10, 11, 13, 18, 21 and 25 (10 items), the reduced anxiety construct (MASC-R) was measured by items 5, 8, 12, 18, 20, 24, 27, 31 and 35 (9 items) and, the reduced coping strategy construct (CRI-R) by items 1, 4, 12, 17, 20, 25 and 28 (7 items).

Descriptive and univariate analysis (reduced scales)

Descriptive analysis and Cronbach's alpha coefficients of the reduced CDI, MASC and CRI are shown on Table 3. According to Nunnaly (1978), reliabilities of .70 or grater are sufficient. All three reduced scales showed high reliability (CDI-R: .92; MASC-R: .80; and CRI-R: .81). The item/total correlation ranged from .548 to .886 for the CDI-R, .552 to .670 for the MASC-R, and .625 to .710 for the CRI-R.

In a third step we used the CDI-R, the MASC-R and the CRI-R in ANOVAs' as dependent variables, and gender, age group, grade failure and type of family (nuclear or other situation) as moderators. For the gender variable, we found significant differences for anxiety (MASC-R). More specifically, girls were more anxious than boys (X=15.7 vs. X=14.2 respectively), [F (1,863) = 20.36, p < .01]. As for coping (CRI-R), girls reported employing more coping strategies than boys (X=17.4 vs. X=16.3 respectively), [F (1,660) = 7.08, p <.05].

With regard to age group, pupils in the younger group were significantly more depressed (CDI-R) than those in the older group (X=20.78 vs. X=14.39 respectively), [F (1,891) = 340.05, p < .01] and reported significantly less frequent coping strategies (CRI-R) than the older participants (X=15.9 vs. X=17.8 respectively), [F (1,660) = 23.68, p< .01]. On the other hand, they reported significantly less anxiety than the older pupils (X=14.69 vs. X=15.41 respectively), [F (1,863) = 4.66, p <.05]. Moreover, adolescents living in nuclear families were found to be less depressed (CDI-R), than those having other types of families (X=16.68 vs. X=17.61 respectively), [F (1,891) = 7.29, p < .05.

The reduced version of the MASC-R (i.e., anxiety) significantly differentiated pupils who had failed one or more subjects in the past from those who had not. Those who had failed tended to be more anxious than the other students (X=15.54 vs. X=14.81 respectively), [F (1,859) = 4.36, p <.05]. Moreover, a significant positive correlation was observed between the CRI-R and age (r =.18; p < .01), a significantly negative correlation between the CDI-R and age (r =-.62; p =.01), and a significantly positive relation between the MASC-R and age (r =.10; p <.05). A negative significant correlation was found between the CRI-R and CDI-R (r=-.16; p< .01), and no significant relation between the CRI and the MASC-R. Finally, the reduced measures strongly and positively correlated with their corresponding extended scale (CDI and CDI-R, r=.72, p <.01; MASC and MASC-R, r =.67, p < .01; CRI and CRI-R, r =.87, p< .01).

Confirmatory model

In order to test the correlations between the three latent constructs found in the EFA, we constructed a confirmatory model by using the AMOS 6.0 (Arbuckle, 2005) program. We used several indexes to assess goodness of fit according to Hoyle and Panter's (1995) recommendations.

We assessed the overall fit by using the following indices of fit: Chisquare, root mean square error of approximation (RMSEA), comparative fit index (CFI), incremental fit index (IFI) and Akaike's information criterion (AIC). AIC is usually used to compare two or more models with smaller values by representing a better fit of the hypothesized model (Hu & Bentler, 1995). CFI and IFI values close to 1 indicate a very good fit (Bentler, 1990). RMSEA values equal to or less than .10 indicate a good fit (Browne & Cudeck, 1993; Steiger, 1990). Adjustment indexes thus suggest a good fit (÷2=630.017, df =296; RMSEA = .035; AIC = 792.017; CFI = .961, IFI = .961).

The three factors included in the present model explain 7.7% of the variance for the latent construct of depression (CDI-L), 16.8% of the variance for the latent construct of anxiety (MASC-L) and 28.9% of the variance for the latent construct of coping strategies (CRI-L). As for correlations between latent constructs, there was a significant negative association between depression (CDIL) and coping strategies (CRI-L) (r = -.15, p < .01). Associations among the other latent constructs were not significant.

We also tested the invariance of the model relative to gender and age. In terms of gender, the model remains adjusted for both girls (÷2=493.306, df =296; RMSEA = .039; AIC = 655.306; CFI = .954, IFI = .955) and boys (÷2=540.111, df =296; RMSEA = .044; AIC = 702.111; CFI = .940, IFI = .941). As for the age factor, both the younger group (younger than 15) (÷2=480.548, df =296; RMSEA = .038; AIC = 666.10; CFI = .932, IFI = .930) and the older group (÷2=484.145, df =298; RMSEA = .036; AIC = 642.145; CFI = .922, IFI = .924) generated adjusted models.

Discussion

We propose reduced versions of three scales by means of EFA, to evaluate depression (CDI-R), anxiety (MASC-R) and coping strategies (CRI-R) in school settings, targeting pre-adolescent and adolescent non-clinical populations. Our data indicate that the reduced scales strongly correlate with their corresponding extended scales. Also, although shorter, they seem to be more accurate in identifying gender, age and school failure differences, and provide more articulate and comprehensive constructs.

By using the reduced form of the Anxiety, Coping Strategies and Depression Scales, the odd and unusual positive correlation between Anxiety and Coping Strategies seems to fade and a new significantly negative correlation between Coping Strategies and Depression is highlighted. The reduced form of the Anxiety Scale reveals an expected significantly positive correlation between age and anxiety.

In line with the literature, we have also shown that there is a positive relation between maladaptive coping strategies and other psychological disorders (Endler & Parker, 1990; Holahan, Moos & Schaefer, 1996). A significant negative relationship between depression and age was found, as well as a significant positive correlation between coping strategies and age. Moreover, girls appeared significantly more anxious than boys. Coping strategies (CRI-R) were significantly more frequent, only when measured by the short version of the questionnaire.

Similarly, Essau, Conradt and Petermann (2000) found that females presented more anxiety symptoms than males and that these symptoms tended to increase with age. A significant association between depression and anxiety, and a higher frequency of anxiety and/or depression symptoms was also found by Matos et al. (2003) and, more recently, by Matos, Baptista, Simões et al. (2008).

Younger adolescents appeared to be significantly more depressed than the participants in the older group, and presented significantly less frequent coping strategies. On the other hand, anxiety, assessed by the reduced form of the MASC (MASC-R) was significantly higher in the older group.

Adolescents living in nuclear families exhibited significantly lower depression levels. However, only the reduced form of the anxiety scale (MASCR) was able to highlight higher levels of anxiety in the group that had failed subjects in the past. Some authors report (Sanders, 2000; Toumbourou, 2001) that family and internal resources such as cooperation and communication skills, empathy, and self-efficacy (Gore & Eckenrode, 1996; Werner & Smith, 2001) are important assets during adolescence. Vigil and Geary (2008) suggested that the relations between trauma experiences and greater psychological distress may be mediated in part by the family coping strategy.

It is interesting (see Table 4) that depressive items that were retained as the most relevant seem related to negative thoughts about oneself and the environment. Negative life events are also relevant (Lau, 2002; Meyer, Chrousos, & Gold, 2001; Sandberg, Rutter, Pickles, McGuinness, & Angold, 2001), and one of their most important aspect lies in their number, as they have a cumulative effect (Kaplan, 1999; Masten et al., 1988; Simões, Matos, Tomé, & Ferreira, 2008). This is an aspect to be kept in mind in clinical and health promotion interventions in school settings considering the necessity of building a positive self-esteem and of promoting an optimistic view of the world, even in the presence of negative life events.

The content analysis of the items retained after the EFA also shows that all the anxiety items in the MASC-R are related to "physical/emotional/body related sensations". This is also an important issue in clinical and health promotion interventions considering the relevance of helping pupils understand, manage and control their bodies and their emotions. Unfortunately, these aspects are often neglected when the curriculum is developed (Matos et al., 2008).

As for the coping strategy items retained in the reduced version of CRI-R, all of the items are related to problem analysis and solving, that is, to "active coping". It is thus important to analyze the strategies that children and adolescents use to deal with stress, considering that coping can be a key issue in understanding successful performances under stressful events (Hussong & Chassin, 2004). In the present study, a content analysis of the "problem descriptions" of which the CRI is derived, highlighted that the majority of preadolescents and adolescents describe family issues as the most frequent problems affecting their daily lives.

Although the sample used in this study does not have a national significance, it is a broad sample covering all school grades evenly (from the 5th to the 12th). Furthermore, classes and schools were randomly chosen and selected to assure a broad national distribution.

In spite of these limitations, we managed to propose valid, reliable and sensitive reduced forms of scales that can be used to screen three important conditions in non-clinical adolescent populations: depression, anxiety and coping. These reduced forms of the scales also allowed us to analyse the most relevant features of the above conditions, which include "negative thoughts about oneself and the environment", the "physical, emotional and biological related sensations" and the "pro-active problem analysis and solving".

The content of retained items can be used to derive "tips" for clinical and health-promotion interventions in school settings, in order to foster pupils' wellbeing and mental health. It also highlights the need of implementing school-based programs designed to promote self-esteem and self-competence, emotion management and problem-identification and solving. Moreover, the analysis of the initial problems in the Coping Strategy Scale suggests that parents should be involved in school based interventions, because they have stronger effects on adolescents' daily stress. Thus, being able to manage one's own life, becoming autonomous and successfully using autonomous and positive coping skills, is often related to well-being. All of these competencies should be contemplated when considering school curricula, family interventions and home-school links (Matos et al, 2006).

[Reference]

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[Author Affiliation]

Margarida Gaspar de Matos* a

Gina Tomé(a), Ana Inês Borges(a), Dina Manso(a), Paula Ferreira(b),

Aristides Ferreira(ac)

a Technical University of Lisbon, Lisbon, Portugal

b University of Lisbon, Lisbon, Portugal

c Minho University, Minho, Portugal

* Correspondence concerning this article should be addressed to:

E-mail: margaridagaspar@netcabo.pt

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