ADOLESCENT MENTAL HEALTH: PARENTAL ATTACHMENT RELATIONSHIPS AND NEGATIVE AUTOMATIC THOUGHTS AS VULNERABILITY FACTORS
Nor Sheereen Zulkefly1*, Amira Najiha Yahya2
1Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor
2Department of Psychology, Faculty of Social Sciences and Liberal Arts, UCSI University, Cheras, Kuala Lumpur
*Corresponding Author: sheereen@upm.edu.my
Accepted: 1 June 2019 | Published: 15 June 2019
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Abstract: Attachment and cognitive theories have been independently used to understand the development of maladaptive working models of self and others and the role it plays on the mental health of adolescents. Few studies have however, considered the interplay of both theories in a single study. This study fills the gap by examining the relationship between parental attachment relationships (maternal and paternal), negative automatic thoughts and mental health (i.e., depression, anxiety, and stress) of adolescents. Additionally, the study examines the indirect effect of maternal and paternal attachment relationships on mental health via negative automatic thoughts of adolescents. A total of 1018 school-going adolescents across four regions of Malaysia and aged between 14 and 17 years (mean =15, Sd. =1.01) were recruited using proportional to size cluster sampling. Results of structural equation modelling analysis indicated a direct link between maternal and paternal attachment relationships to anxiety. Only maternal attachment was found to have a direct relationship to depression, whereas paternal attachment had an indirect link via negative automatic thoughts. Both maternal and paternal attachment relationships were found to have indirect relationships to stress via negative automatic thoughts. The study concludes that parental attachment and negative automatic thoughts play significant role in the development of adolescent’s mental health. Including aspects related to secure parent-adolescent attachment relationships and positive automatic thoughts in any prevention and intervention efforts for promoting better mental health of adolescents is ostensibly essential.
Keywords: Maternal Attachment, Paternal Attachment, Negative Automatic Thoughts, Mental Health, Adolescents
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1. Introduction
Depressive symptoms in adolescents have been alarmingly increasing (Jun, Baharudin, & Jo- Pei, 2013; Kaur et al., 2014; Mason, Chmelka, Trudeau, & Spoth, 2016; Wan Salwina et al., 2014) and they are expected to be a major cause of mental health illness by 2020 (Guan, 2014). Findings from the National Health and Morbidity Survey 2015 (NHMS, 2015) reported that almost 4.2 million (29.2%) adolescents aged 16 and above, and 0.6 million (12.1%) children aged five to 16 were suspected to have mental health problems (NHMS, 2015). Additionally, the NHMS 2015 reported that mental health problems were generally higher amongst adolescents aged 16 to 19 years old (34.7%). Since depressive symptoms are
recognized as one of the major public health issues involving adolescents’ later development (Jun et al., 2013; Kaur et al., 2014), findings from the NHMS 2015 are becoming a concern at both the national and society levels. Therefore, considerable attention should be directed towards understanding the prevalence of and factors related to depressive symptoms in Malaysian adolescents. Specifically, a study needs to be conducted in order to understand factors that might influence depressive symptoms in adolescents.
Recently, researchers have started to emphasize the significant role that fathers play in adolescents’ depressive symptoms (Agerup et al., 2015; Demidenko et al., 2015; Duchesne &
Ratelle, 2014; Jun et al., 2013). Past studies have highlighted the importance of fathers’
presence and involvement that should go beyond than instrumental in adolescents’ lives (Jafari, Baharudin, & Archer, 2016; Jun et al., 2013; Yap, Baharudin, Yaacob, & Osman, 2013). Specifically, the studies have underlined the unique contributions that fathers can offer for being active and emotionally responsive towards adolescents. An interactive emotional bond between fathers and adolescents commonly establishes and sustains good attachment (Ainsworth, 1989; Bowlby, 1969). Attachment can offer significant functions in the beginning of infancy stage and extends until the child moves into the adolescence period (Ruhl, Dolan, & Buhrmester, 2015). For example, secure attachment from fathers will provide adolescents with positive experiences and engenders the development of better psychological outcomes, such as low depressive symptoms (Agerup, Lydersen, Wallander, &
Sund, 2015).
On top of the influence of father attachment on depressive symptoms, the connection between adolescents’ self-esteem and depressive symptoms has been widely documented. Self-esteem was highlighted as one of the vital elements in determining depressive symptoms. Various studies (Babore, Trumello, Candelori, Paciello, & Cerniglia, 2016; Moksnes, Bradley Eilertsen, & Lazarewicz, 2016; Wang et al., 2016) have underlined significant associations between the two variables in adolescents. For example, low self-esteem may be associated to a higher likelihood of having depressive symptoms (Babore et al., 2016). On the other hand, adolescents who reported high self-esteem will value their abilities and others’ support which in turn inhibit the development of depressive symptoms (Wang et al., 2016).
Up until now, empirical evidence has consistently supported the contention that both father attachment and self-esteem may affect the development of depressive symptoms in adolescents. However, there is only limited research that has simultaneously investigated father attachment and self-esteem as predictors of depressive symptoms. Needless to say, exploring father attachment and self-esteem together, will epitomize an important next step toward understanding adolescent depressive symptoms. In light of previous research, the main purpose of this study was to evaluate the role of father attachment and self-esteem as predictors of depressive symptoms in adolescents. In addition, the study explored the potential mediating role of self-esteem on the relationship between father attachment and depressive symptoms. This study desired to advance understanding on the influence of father attachment and self-esteem in adolescents’ development, particularly on how to alleviate the deleterious effect of depressive symptoms.
2. Literature review
While much research has focused on maternal attachment during infancy or childhood, father attachment and its role on the development of depressive symptoms in adolescents have received an increasing attention in recent years (Demidenko, Manion, & Lee, 2015).
Attachment theory (Bowlby, 1988) hypothesizes that adolescents who experience secure attachment which is characterized by responsiveness, and adequate satisfaction of physical and emotional needs will develop internal representations of their attachment figure (i.e.
fathers) as safe and available all the time. This will subsequently become a prototype for adolescents’ future relationships and influence their later psychological development, including depressive symptoms (Agerup et al., 2015; Demidenko et al., 2015; Duchesne &
Ratelle, 2014).
Apart from father attachment, self-esteem is also considered as an important factor that may foment the development of depressive symptoms in adolescents (Chen, Yu, Wu, & Zhang, 2015; Shapero et al., 2014; Young & Dietrich, 2015; Yue, Dajun, Yinghao, & Tianqiang, 2016). Past research has revealed that low self-esteem might contribute to depressive symptoms. For example, adolescents with low self-esteem tend to feel disappointed, sad, lonely and more depressed (Brausch & Decker, 2014; Hu & Ai, 2014; Hunter, Barber, &
Stolz, 2014; Orth & Robins, 2013; Smokowski, Evans, Cotter, & Guo, 2014). The relation between self-esteem and depressive symptoms has been explained in a vulnerability model.
The model described self-esteem as a causal factor for depressive symptoms. Low self- esteem is conceptualized as a stable factor that predisposes an individual to experience depression. In contradiction to high self-esteem, individuals with low self-esteem are more likely to have diminish positive affect and feel unworthy of positive outcomes, which in turn lead to depressive symptoms (Wood, Heimpel, Manwell, & Whittington, 2009).
Generally, past studies support the contention that father attachment and self-esteem have significant influence on adolescents’ depressive symptoms (Agerup et al., 2015; Barrera, Gaga-a, & Pabayos, 2016; Demidenko et al., 2015; Kullik & Petermann, 2013; Peng et al., 2012; Yue et al., 2016). However, empirical research related to depressive symptoms in adolescents commonly focus on one predictor, either father attachment or self-esteem at a time. Limited research was found that combined and analysed the unique effect of these predictors simultaneously in a study. Since these two variables are almost certainly correlated, perhaps a combination of father attachment and self-esteem will provide a better framework in understanding the emergence of depressive symptoms in adolescents.
3. Methodology
Participants
Participants in this cross-sectional study were adolescents recruited from daily government secondary schools in Johor, Kelantan, Pulau Pinang and Kuala Lumpur (N=1018, 60.7%
female). The age range was 14 to 17 years (M=15.00, SD= 1.01). Approximately 83.5%
participants identified themselves as Malay, 10.6% as Chinese, 5.3% as Indian and 0.6% as others.
Measurements
Depressive Symptoms
Depressive symptoms were assessed using Depression, Anxiety and Stress Scale (DASS) (Lovibond & Lovibond, 1995). The DASS consists of 21-items designed to measure the emotional states of depression, anxiety and stress. Each question measured the prevalence of symptoms of depression, anxiety, or stress over the prior week. Seven items for depression were used from DASS to measure depressive symptoms of the participants. Answers were reported on a 4-point Likert scale from 0 (did not apply to me at all) to 3 (applied to me very
much). It includes items for depression such as, “I felt that I had nothing to look forward to”
and “I was unable to become enthusiastic about anything”. The scale was found to be highly reliable with a Cronbrach’s alpha value of 0.77.
Father Attachment
Father attachment in the present study was measured using the Domains of Adolescent Attachment Scale-Malay (DAAS-Malay; Zulkefly, 2013). This 23 items DAAS-Malay was used to assess adolescents’ attachment relationship with their fathers. This scale comprises four specific dimensions which are secure, anxious fearful, approachability and responsiveness. Four items from secure and seven items from responsiveness were used to measure father attachment in the study. Higher summation scores of these items indicating a higher level of attachment with fathers. The participants expressed their agreement on a 5- point Likert scale from 1 (not at all) to 5 (very much). The scale was found to have good levels of reliability with a Cronbach’s alpha value of 0.89.
Self-Esteem
The Rosenberg Self-Esteem Scale (RSES) (Rosenberg, 1965) was used for measuring the adolescents’ self-esteem. The RSES included 10 items and was rated on a five-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree) with the total score ranging between 10 and 40. The items explore the individual’s satisfaction with him/herself and positive feelings. Higher summation scores indicated that the respondent possess a positive self-esteem. The RSES is a well-known scale with good reliability (alpha coefficient of 0.70) with test-retest reliability correlations of 0.85 and 0.88 (Rosenberg, 1965). Examples of items that are measured in the RSES include “On the whole, I am satisfied with myself” and “At times I think I am no good at all”.
Analytical Procedure
Preliminary analyses were conducted to examine descriptive statistics and correlations among the study variables. Structural equation modeling procedure using AMOS 20.0 was used to investigate the relationships between father attachment, self-esteem and depressive symptoms. The model fit was assessed using a set of indices recommended by Hu and Bentler (1999): Normed chi square statistics (χ2/df) < 5; Root-Mean-Square Error of Approximation (RMSEA) of .06 or less; Comparative Fit Index (CFI) and Goodness of Fit Index (GFI), best if above .95. Three item parcels for each of the self-esteem and depressive symptoms and two item parcels for father attachment were formed to control inflated measurement errors caused by multiple items for the latent factor (Little, Cunningham, Shahar, & Widaman, 2002). Finally, the present study conducted mediation analyses using bootstrapping estimation procedure to investigate whether self-esteem was the mechanism through which father attachment associated with depressive symptoms. An indirect effect will be considered as significant when zero is not included in the lower and upper limits of the 95% confidence intervals (Preacher & Hayes, 2008).
4. Results
Means, standard deviations, and bivariate correlations of all study variables are as presented in Table 1. Prior to conducting structural model testing, correlation analysis on all of the study variables was conducted. Generally, correlations results revealed that father attachment and self-esteem were significantly correlated with depressive symptoms and in the expected direction.
Table 1: Means, standard deviations and bivariate correlations between study variables
Variables 1 2 3
1 Father Attachment 1
2 Self-Esteem .351** 1
3 Depression -.296*** -.545*** 1
Mean 42.67 18.30 8.77
Standard Deviation 8.25 3.97 6.46
Note. ***p<0.001
A full path hypothesized structural model which included father attachment, self-esteem and depressive symptoms variables was examined using structural equation modeling procedure to determine whether the model fits the study data using the recommended indices. Figure 1 shows the hypothesized model with estimated standardized regression coefficients. The indices indicated that the hypothesized structural model showed excellent fit to the data (χ2=74.32, df =16, χ2/ df =4.645, p <0.001; CFI = 0.973; GFI = 0.962; RMSEA = 0.06). The overall model explained 16% of the variance in self-esteem and 60% of the variance for depressive symptoms. An examination of the model revealed that self-esteem (-.76) was found to have a direct and negative influence on depressive symptoms, but not for father attachment (-.04). Results of bootstrapping analysis revealed that the indirect effect of self- esteem was significant (SIE = -.303, SE = .040, p<0.001, bootstrap 95% CI [-.391,-.231]) for the relationship between father attachment and depressive symptoms.
Figure 1: Full path hypothesized structural model
5. Discussion
Generally, the present study aimed to determine the direct relationships of father attachment and self-esteem on depressive symptoms. The study found that self-esteem had a significant and direct relationship to depressive symptoms. The results are consistent with previous research (Brausch & Decker, 2014; Du, Chi, Li, Zhao, & Zhao, 2014; Hu & Ai, 2014;
Smokowski et al., 2014; Yip, 2015) which indicated that individuals with high levels of self- esteem are likely to engage in less depressive symptoms. This finding implies that adolescents’ positive evaluations of themselves could motivate them towards healthy
psychological being. Smokowski et al. (2014) noted that the cognitions about oneself are not only significant in developing the foundation of pride and confidence, but also could provide a dramatic influence on psychological development in adolescents. However, father attachment was found to have no direct association to depressive symptoms. Results of the present study were inconsistent with past studies (Agerup et al., 2015; Allen et al., 2007;
Demidenko et al., 2015) which highlighted that better attachment relationship with fathers could reduce the risk of having depressive symptoms in adolescents.
Findings that emerged from this study on the indirect effect of self-esteem on the relationship between father attachment and depressive symptoms in adolescents warrant additional attention. The obtained results of the bootstrap analyses contributed to the growing body of research on adolescents’ self-esteem as a mediator. Theoretically, the findings were in keeping with components of Beck’s (1967; 1983) cognitive theory of depression, which indicated that severity of depressive symptoms in individuals can be differentiated on the basis of their underlying cognitions about themselves. The findings are in accordance with results from past research which signified that self-esteem served as an underlying mechanism that acted as one of the protective factors for depressive symptoms in adolescents (Babore et al., 2016; Moksnes et al., 2016; Bajaj, Robins, & Pande, 2016). As such, self- esteem can be interpreted as a cushion for adolescents against depressive symptoms. Thus, adolescents with better attachment with fathers may have higher self-esteem, which in turn makes them less likely to experience depressive symptoms.
There are number of shortcomings in this study. The cross sectional design does not allow us to draw conclusions regarding the directionality of the relationships. Future researchers may consider longitudinal studies to elucidate the directionality of the relationships. Additionally, data of the present study relied exclusively on self-report measures. In future, multiple assessment method (i.e. father reports) may be used to further strengthen the validity of the findings.
6. Conclusion
The current research advances literature in several important ways. First, this study has provided valuable empirical evidence on the unique combination of father attachment and self-esteem in the prediction of depressive symptoms in Malaysian adolescents. Previous studies have mostly examined the effects of these factors separately; thus results of the study filled the related gaps in literature topic and provided a better framework for understanding the etiology of depressive symptoms. Additionally, the mediation role of self-esteem has provided valuable insight on the underlying factor that connected father attachment to depressive symptoms. The study demonstrated the importance of this factor in promoting better adolescent development. Therefore, the present study can contribute to the prevention of depressive symptoms in adolescents. For instance, empirical information from the current research may be used to organize programs and activities for adolescents to foster healthy psychological development. The present study can likewise provide policy makers with a better understanding of the importance of fathers in relation to adolescents’ development.
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