Melbourne School of Psychological Sciences - Theses
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ItemWellbeing and functioning in emerging adulthood: A longitudinal study of determinants and mechanisms( 2018)During the key periods of adolescence and emerging adulthood, individuals can be particularly vulnerable to experiencing suboptimal wellbeing and functioning. With potential long-term impacts on adult trajectories, early wellbeing promotion is critical. This study aimed to further understand wellbeing development across adolescence and into emerging adulthood, by examining the role of a range of individual and environmental characteristics. The individual characteristics examined included temperament, anxiety symptoms, and depression symptoms. Environmental characteristics included parental responses to emotion expression, parental mental health, stressful life events, and maltreatment. The role of emotion regulation strategies were also explored in relation to the characteristics and wellbeing. The study utilised a longitudinal community cohort from the Adolescent Development Study, recruited from schools across Melbourne, Australia. The sample included 245 families who completed questionnaires across three time points. At time 1 (mean age = 12.45), measures of temperament, depression symptoms, anxiety symptoms, parental depression symptoms, parental anxiety symptoms, and parental responses to offspring emotion expression were completed. At time 2 (mean age = 15.01), adolescents completed measures of stressful life events and maltreatment. They completed emotion regulation and wellbeing measures at the final time point (mean age = 18.83). Predictor variables were factor analysed within each domain in order to provide sufficient representation of the structure of the data. A series of path analyses, controlling for gender and SES revealed that temperament traits, neglect, and abuse predicted wellbeing and functioning outcomes. Bootstrap path analyses (using 95% confidence intervals for the indirect effect) revealed significant associations between the emotion regulation strategies of rumination, distraction, mindfulness, cognitive reappraisal, and expressive suppression with the individual and environmental characteristics, and wellbeing and functioning outcomes. Findings suggest that wellbeing development across adolescence and emerging adulthood is associated with individual characteristics (e.g., temperament), as well as environmental experiences that deviate from adaptive ranges (e.g., neglect). The various patterns found in the study reinforce the salience of examining wellbeing as a multifaceted construct, with aspects of wellbeing potentially having different developmental pathways. Furthermore, emotion regulation strategies may be important for wellbeing pathways, with maladaptive strategies (e.g., rumination) being associated with lower wellbeing and adaptive strategies (e.g. mindfulness) associated with higher wellbeing. Therefore, emotion regulation may be a suitable target for optimising youth wellbeing.
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ItemThe role of biological stress and inflammation in sleep and mental health: a longitudinal perspective among at-risk adolescents( 2018)Objective: A healthy functioning body relies in part on a delicate balance between the immune and neuroendocrine (or immuno-endocrine) systems. Sleep disturbance, anxiety, and depression have each been associated with disruptions to the immuno-endocrine system. Recent literature also suggests that dysregulations of the immuno-endocrine system may precipitate sleep disturbance and mental health issues, suggesting a bi-directional role for immuno-endocrine functioning in sleep and mental health. Poor sleep, mental ill-health, and disturbed immuno-endocrine functioning have each been linked to a range of psychosocial, psychiatric, and medical comorbidities including risk for stroke, diabetes, and cardiovascular disease, greater medical expenses, increased substance use, disruptions to interpersonal relationships, poorer vocational outcomes, increased family violence, and more chronic mental and physical health conditions throughout the lifespan. While associations between sleep, mental health, and immuno-endocrine functioning are well- established in adults, less is known about immuno-endocrine functioning in the context of adolescent sleep and mental health, despite high prevalence rates of poor sleep, anxiety, and depression among youth. Further, targeted, preventative treatment interventions for adolescents at-risk of poor sleep, anxiety, and depression may buffer against the progression of mental health issues, as well as immuno-endocrine system dysregulation. However, no study to date has investigated the longitudinal impact of an early-intervention, psychological treatment intervention on biomarkers of immuno-endocrine health in a sample of at-risk-for- depression adolescents. Further, no study with youth has investigated the potential mechanistic role of immuno-endocrine dysregulation in common disease progressions from anxiety issues to depression onset, poor sleep issues to anxiety onset, or poor sleep issues to depression onset. Therefore, the aims of the current thesis were to investigate these gaps in the literature. Method: As part of a larger, multi-center and comprehensive ‘Sleep and Education: learning New Skills Early’ (SENSE) Study, the current thesis investigated the immuno-endocrine functioning of at-risk adolescent participants (n=122, 73 female) in the SENSE Study. The SENSE Study was a two-year, early intervention, randomized-control trial (RCT) researching the impact of a seven-week cognitive-behavioral and mindfulness-based intervention for adolescents who endorsed sleep disturbances and/or anxiety symptoms, known risk factors for the development of depression. The overarching aim of the SENSE Study was to investigate whether a multicomponent sleep intervention, which combined operant conditioning, stimulus control, sleep hygiene psychoeducation, cognitive therapy, and mindfulness-based techniques, would serve as a preventative measure for at-risk adolescents against the development of depression two years post-intervention. Participants were recruited from schools within the Melbourne metropolitan area and invited to participate if they endorsed elevated anxiety and/or poor sleep symptoms, and had no prior history of major depression. At baseline (Time 1; T1) participants (aged 12 to 16 years, mean aged 12.71 years) provided saliva samples across two consecutive days and completed a range of sleep and mood assessments including semi- structured mental health clinical diagnostic interviews, self-report questionnaires, and wrist- actigraphy (an objective measurement of sleep). Participants were randomized into either a seven-week sleep treatment intervention (n=63) or an active study skills control intervention (n=59). Participants completed the same assessments (excepting saliva sample collection) at post-intervention (Time 2; T2), and were assessed again (including saliva sample collection) at two-years post-intervention (Time 3; T3) when participants were aged between 14 and 18 years (mean aged 16.82 years). Thus, immuno-endocrine data was collected at T1 and T3. The current thesis investigated several cross-sectional and longitudinal associations among measures of sleep and mental health with diurnal levels of salivary C-reactive protein (CRP) and cortisol, biomarkers representative of overall systemic functioning of the immune system (CRP) and the neuroendocrine system (cortisol). This project was also the first to use the cortisol to CRP ratio as a measure of inter-system immuno-endocrine organization in the context of sleep and mental health among a sample of youth and in a longitudinal setting. First, for cross-sectional analyses, it was predicted that greater sleep disturbance and mental health issues would be associated with greater disruptions to the immuno-endocrine system (as indexed by higher morning and evening levels of CRP, lower morning and higher evening levels of cortisol, and less homeostatic cortisol to CRP ratio levels). Second, it was predicted that compared to participants in the control intervention, participants in the treatment intervention would display healthier immuno-endocrine functioning at two-year follow-up. Third, it was predicted that dysregulated immuno-endocrine functioning would aid in the progression of 1) anxiety issues to depression onset, 2) poor sleep issues to anxiety onset, and 3) poor sleep issues to depression onset. Finally, it was predicted that sex would be a moderator in all analyses. Results: First, cross-sectional multivariate regression analyses indicated that participants who self-reported longer sleep onset latency (the period of time attempting to fall asleep) at T1 had more blunted morning cortisol levels at T1, even when controlling for common covariates used in the literature. Sex did not moderate this relationship. Second, one-way analyses of covariance (ANCOVA) were conducted to investigate treatment effects on salivary levels of CRP and cortisol, which revealed no statistically significant effects of treatment conditions on biomarkers measured at T3. Two-way ANCOVAs investigating the effect of treatment and sex were also not significant. Third, longitudinal analyses revealed that participants with greater bedtime variability at T1 were less likely to experience depressive symptoms at T2, and more likely to experience a clinical anxiety episode by T3, although levels of CRP and cortisol did not mediate these paths. Finally, participants with an anxiety disorder at T1 were 4.58 times at risk of developing a depressive disorder by T3, although levels of CRP and cortisol did not mediate this path. Sex did not moderate any longitudinal analysis. However, a higher T1 cortisol to CRP ratio (indicative of elevated levels of cortisol relative to attenuated levels of CRP) significantly predicted the onset of a first-ever depressive disorder by T3, even when controlling for T1 depressive symptoms. Conclusion: The current study adds to the literature on links between sleep, mental health, and immuno-endocrine functioning in youth, a relatively new area of research. Results highlight important methodological considerations that future treatment studies should incorporate, considerations which may encourage benefits to the adolescent immuno-endocrine system. The continuation of immuno-endocrine biomarker assessment among youth populations will advance the knowledge of the potential biological underpinnings of sleep disturbance and poor mental health. Refinement of treatment interventions may pave the way for such underlying mechanisms to be harnessed and recruited along the path to treatment outcome goals. Moreover, that perceived sleep onset latency but not objective sleep onset latency was associated with more blunted cortisol levels suggests that interventions designed to target negative or inaccurate assessments of sleep may buffer against neuroendocrine health consequences. Lastly, the finding that adolescents with a more disorganized immuno- endocrine system (i.e., a higher cortisol to CRP ratio) were more at risk of developing depression is novel, and suggests that the cortisol to CRP ratio could serve as a disease risk biomarker for first-onset depression. Early identification of individuals at high risk of depression may prevent medical and psychiatric comorbidities throughout the lifespan.
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ItemThe psychological significance of different adolescent perfectionist profiles( 2018)Perfectionism has historically been regarded as a significant risk factor in the development and maintenance of psychological disorders. However, perfectionism is not always associated with poor psychological outcomes. Indeed, contemporary multidimensional perfectionism questionnaires include both adaptive and maladaptive dimensions, and recent research suggests a better understanding of perfectionism is achieved by focusing on combinations of these dimensions (rather than individual dimensions) to identify adaptive and maladaptive perfectionist subgroups/profiles. The purpose of the research reported herein was to investigate the nature of these subgroups in adolescents. Study 1 (n = 105, 17-year-olds) (Sironic & Reeve, 2012) examined perfectionist subgroups based on the Almost Perfect Scale-Revised (APS-R: Slaney, Rice, Mobley, Trippi, & Ashby, 2001), as well as the Depression Anxiety Stress Scales (DASS: Lovibond & Lovibond, 1995) and Motivated Strategies for Learning Questionnaire (Pintrich, Smith, Garcia, & McKeachie, 1991). It was hypothesised that four meaningful perfectionist subgroups could be derived from the APS-R’s High Standards and Discrepancy dimensions, and that each subgroup would rate their anxiety, depression, stress, and learning metacognitive beliefs differently. As predicted, cluster analysis of High Standards and Discrepancy dimension responses yielded four subgroup profiles: (1) high High Standards/low Discrepancy; (2) high High Standards/high Discrepancy; (3) low High Standards/high Discrepancy, and; (4) low High Standards/low Discrepancy). Subgroups were related to psychopathological symptoms and learning metacognitions in predictable ways. The low High Standards/high Discrepancy subgroup claimed to use metacognitive self-regulation significantly less often than the high High Standards/low Discrepancy and high High Standards/High Discrepancy subgroups; and the two high Discrepancy subgroups exhibited significantly higher depression ratings than the high High Standards/low Discrepancy subgroup. These findings support a four-subgroup account of perfectionism. The findings were interpreted as suggesting that the low High Standards/high Discrepancy subgroup might lack insight into (or deny) their perfectionistic tendencies—a tendency often associated with psychological disorders. Some suggest that perfectionism may be either externally and/or internally motivated. Insofar as this is correct, it is possible that students in this fourth subgroup are not seeking their own high standards but adopting the standards of significant others. Study 2 was designed to investigate this possibility. In Study 2 (n = 938, 14- to 17-year-olds) (Sironic & Reeve, 2015), high school students completed three commonly used perfectionism questionnaires (i.e., the Frost Multidimensional Perfectionism Scale, FMPS: Frost, Marten, Lahart, & Rosenblate, 1990; Child and Adolescent Perfectionism Scale, CAPS: Flett, Hewitt, Boucher, Davidson Munro, 2000; and APS-R), as well as the DASS. Preliminary analyses revealed commonly observed factor structures for each perfectionism questionnaire. Exploratory factor analysis of item responses from the three questionnaires (combined) yielded a four-factor solution (factors were labelled High Personal Standards, Concerns, Doubts and Discrepancy, Externally Motivated Perfectionism, and Organisation and Order). A latent class analysis of individuals’ mean ratings on each of the four factors yielded a six-class solution. Three of the six classes represented perfectionist subgroups (labelled adaptive perfectionist, externally motivated maladaptive perfectionist, and mixed maladaptive perfectionist) and three non-perfectionist subgroups (labelled non-perfectionist A, non-perfectionist B, and order and organisation non-perfectionist). Each subgroup was meaningfully associated with depression, anxiety, and stress symptoms. The mixed maladaptive perfectionist and externally motivated maladaptive perfectionist subgroups reported significantly higher levels of self-reported depression, anxiety, and stress compared with the adaptive perfectionist and non-perfectionist subgroups. The mixed maladaptive perfectionist and externally motivated maladaptive perfectionist subgroups did not differ in their depression and anxiety ratings, but the mixed maladaptive perfectionist subgroup reported significantly greater levels of stress than the externally motivated maladaptive perfectionist subgroup. The same three perfectionism questionnaires used in Study 2 were used in Study 3 (n = 299, 19-year-olds) (Sironic, Paul, & Reeve, under review at the time of thesis submission). Study 3 sought to establish whether externally motivated perfectionism was also an important aspect in a university undergraduate sample, and whether perfectionists’ beliefs about thinking (their clinical metacognitive beliefs, as measured by the Meta-Cognitions Questionniare-30 Shortened Version (MCQ-30: Wells & Cartwright-Hatton, 2004)) may differentiate perfectionist subgroups and help better explain their DASS depression, anxiety, and stress symptoms. Study 2’s four-factor solution was confirmed by factor analysis of items from the three perfectionism questionnaires, and the same three perfectionist subgroups were identified using latent class analysis of individuals’ average ratings on each factor. Clinical metacognitive beliefs and depression, anxiety, and stress ratings varied in expected ways in the different subgroups, with the externally motivated maladaptive perfectionists at greatest risk of poor psychological outcomes. Overall, the findings of the three studies offer new insights into the conceptualisation of adolescent perfectionism. Support was found for the existence of three perfectionist subgroups (one adaptive, two maladaptive) in adolescence. Findings showed that three out of 10 students were classified as maladaptive perfectionists, and that maladaptive perfectionists were more prevalent than adaptive perfectionists. Notably, the externally motivated maladaptive perfectionist subgroup seemed to possess the poorest metacognitive skills and be most at risk of experiencing psychopathology symptoms. These findings have implications for the treatment of perfectionists. They suggest that intervention strategies are needed to address issues associated with externally motivated perfectionism (i.e., the impact of parents, teachers or significant others); and that enhancing metacognitive skills could be included as part of an intervention strategy.