Quality of Interpersonal Relationships and Depression in Adolescence: Psychosocial Functioning Moderating Effect

Abstract

Adolescent depression has a devastating nature and affects different areas of functioning resulting in significant psychosocial limitations. Poor interpersonal relations have been increasingly associated with depressive symptoms. Negative familial interactions are a vulnerability factor to depression but more research is needed. This study aimed to test the moderating effect of psychosocial functioning in the relationship between the quality of interpersonal relationships and depressive symptoms. The sample consisted of 433 adolescents and the following instruments were used: Children’s Depression Inventory ( CDI - Kovacs, 1985 ; Portuguse version: Marujo, 1994), Quality of Relationships Inventory (QRI - versions father and mother - Pierce, Sarason & Sarason, 1991; Portuguese version: Neves & Pinheiro, 2006 ) and the semi-structured interview Adolescent-Longitudinal Interval Follow-up ( A-LIFE - Keller et al., 1993 ; Portuguese version: Matos & Costa, 2011 ). A relation between poor relationships with parents and depressive symptomatology was found. The dimension of father support/depth was found as a protective factor against the development of depression in adolescence but the conflict with the mother was associated with higher levels of depressive symptoms. Lower levels of psychosocial functioning were predictive of depressive symptoms in the domains of academic achievement and relationships with family and friends. The results also showed a moderating effect of school performance and satisfaction with functioning on the relationship between the perception of conflict with the father and depressive symptoms. These findings suggest that intervention programs designed to improve the quality of familial relationships will be beneficial to adolescents’ psychosocial functioning and to the prevention of depressive symptoms.

Keywords: Psychosocial functioningquality of interpersonal relationshipsdepressionadolescencemoderation

1.Introduction

Depression has been associated with adverse situations, deficits in social skills and psychosocial malfunction, such as low school performance, little involvement in recreational activities and with poor interpersonal relationships (Lewinsohn, Gotlib & Seeley, 1995; Nilsen, Karevold, RØysamb, Gustavson, & Mathiesen, 2013; Singh, Bassi, Junnarkar & Negri 2015). In a longitudinal study that took place during a period of about 10 years, in which patients’ functioning was evaluated and variations in levels of symptomatology were considered, it was concluded that increasing levels of severity of depressive symptoms were significantly associated with an increase in restrictions in general functioning and in the work and interpersonal relationship domains (Judd, Akiskal, Zeller et al., 2000).

The emergence and persistence of depressive symptoms (Moos & Cronkite, 1999), their association with other disturbances in associated commorbility (Lewinsohn, Gotlib & Seeley, 1995), poor response to treatment (Hirschfeld, Russell, Delgado, Fawcett, Friedman & Harrison, 1998), as well as relapses and frequent recurrences (Vittengl, Clark & Jarrett, 2009), affect individuals’ performance, interpersonal relationships and leisure activities (e.g. Dunn & Jarrett, 2009; Ro & Clark, 2009), consequently limiting psychosocial functioning of patients. It is also recognized by several authors that relations among peers in adolescence have a very important contribution to psychosocial functioning (La Greca & Harrison, 2005).

Studies have suggested that formation and maintenance of stable interpersonal relationships are fundamental to adolescents’ quality of life (Baumeister & Leary, 1995). On the contrary, poor quality relationships and low levels of support from family and friends have been associated with negative results in adolescents’ mental health (Allen, Porter, McFarland, McElhaney, & Marsh, 2007; Branje, Hale, Frijns, & Meeus, 2010; Jenkins, Goodness, & Buhrmester, 2002; La Greca & Harrison, 2005; Sheeber, Davis, Leve, Hops, & Tildesley, 2007; Stice, Ragan & Randall, 2004), also being predictors of an increase in depressive symptoms in adolescence (Bogard, 2005; Hankin, 2006; Hauenstein, 2003; Kendler, Kuhn, Vittum, Prescott & Riley, 2005; Nilsen, Karevold, RØysamb, Gustavson & Mathiesen, 2013). The existence of occasional conflicts in the family environment is normative during adolescence (Levpušček, 2006), but prolonged, intense and repeated conflict has been associated with poor psychological adjustment (Kenny, Dooley & Fitzgerald, 2013). It has been found that negative family interactions may be relatively stable over time and can make children and adolescents more vulnerable to depression (Hauenstein, 2003).

Although adolescence is a time when young people distance themselves from their parents, the parent-child relationship is essential to their psychological health (Kenny, 2013; Schochet et al., 2015). Positive and satisfactory relations between adolescents and parents are associated with high levels of support, warmth, approval, and low emotional stress, contributing to the well-being of the relationship with the father and the mother and to less depressive symptomatology (Kenny, Dooley & Fitzgerald, 2013). A robust parental support can protect the onset of depressive symptomatology (Bogard, 2005; Duchesne & Ratelle, 2014). However, a bad relationship between parents and their

children, poor quality of family environment, high levels of family conflict and low levels of family support, may predict the appearance and development of depressive episodes (Duchesne & Ratelle, 2014; Hankin, 2006; McCauley, Myers, Mitchell, Calderon, Schloredt & Treder, 1993; Queen, Stewart, Ehrenreich-May & Pincus, 2012).

In addition to addressing the importance of the relationships established with parents in adolescence, authors have also investigated about friendship, stressing the role of adaptive variables like intimacy and support. These variables have been studied in relation to parents, friends and dating relationships (Marques, 2013; Matos, Pinheiro & Marques, 2013; Pinheiro, Matos & Marques, 2013; Neves & Pinheiro, 2006; Neves & Pinheiro, 2009; Pierce, Sarason & Sarason, 1991). Research points out that friendship throughout adolescence becomes more intimate and loving (Levpušček, 2006; Liu, 2006) and that the quality of friendships is associated with high levels of intimacy and support, positively influencing self-esteem and psychosocial adjustment in adolescents (Bogard, 2005). Thus, we can predict that friendships may have a protective function of mental health (Kenny, Dooley & Fitzgerald, 2013). However, despite the benefits that they undoubtedly entail, friendships may have negative features, such as: low levels of perceived intimacy, less support and companionship, increased levels of conflict, pressure and exclusion (La Greca & Harrison, 2005). Negative characteristics are associated with higher levels of depressive symptomatology, problems of self-esteem, low school performance, less social participation and more interpersonal issues (Kenny, Dooley & Fitzgerald, 2013; La Greca & Harrison, 2005).

According to some authors, the key to decreasing the risk of depression is the existence of significant sources of social support for the adolescent (in the family, group of friends and school context), since there is a strong association between poor social relationships (parents, colleagues and romantic partners) and the development of depressive symptoms in adolescence (Schenfelder, Sandler, Wolchik & MacKinnon, 2011). It should also be noted that, in adolescents with depressive symptomatology, the occurrence of positive events (e.g. recognition of school merit) and planning rewarding activities allow the improvement of depressive symptoms, self-esteem, interpersonal relations and, consequently, of psychosocial functioning (e.g. Gledhill & Garralda, 2010).

2.Material and methods

3.Results

3.4. Moderating analyses

Hierarchical multiple linear regressions were performed to explore the possibility of a moderating effect of psychosocial functioning (total note and respective domains) and of satisfaction with functioning on the relationship between the quality of interpersonal relationships and depressive symptomatology. Only statistically significant results of the moderations will be presented.

3.4.1. Study of the moderating effect of school performance on the relationship between quality

of interpersonal relationships and depressive symptoms

With regard to school performance , analysis of the regression coefficients for school performance (SP) , for perception of support/depthin relation to both parents and perception of conflict with the mother , revealed no moderating effects. However, the interaction of the factor conflict with the father with school performance showed a significant effect (β = -.127, p = .007). Both variables are, individually, predictors of depressive symptomatology ( conflict factor : β = .242, p <.01; school performance : β = .137, p = .003) (cf. Table 2 ).

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Variables conflict with the father and school performance were inserted into distinct steps in the

regression model, producing a statistically significant model [step 1: R2 = .242; F (1) = 26.808, p < .01; step 2: R2 = .278, F (2) = 17.990, p < .01]. In the third step, the interaction term was inserted and a statistically significant was also obtained, with a slight increase in R2 , that is, an increase in the variability explained with regard to depressive symptomatology [ R2 = .093, F (3) = 14.654, p <.01]. The interaction term suggests that there is a moderating effect of school performance on the relationship between the perception of conflict with the father and depressive symptoms. In this way, it was found that the interaction term is a significant predictor, explaining 9.3% of variance (cf. Table 3 ).

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To better understand the moderation effect, a graphic of the results was obtained (cf. figure 1 ). Two levels were considered for the factor conflict (below and above average) and also for school performance (if we tried to put 3 levels for school performance with the criterion of the low level to be up to M - 1 SD , we would influence the interpretation of the chart, since the data was not likely to meet in the previously mentioned level). Having into account the main effects, it is possible to verify that lower levels of conflict and higher levels of school performance are related to less depressive symptoms.

With regard to interaction, we can say that a low perception of conflict in relation to the father and a high school performance , predict lower levels of depressive symptoms compared to a poor school performance . However, when the perception of conflict in relation to the father is high, besides the existence of a tendency towards higher levels of depressive symptoms regardless of school performance , these two levels of school performance tend not to differentiate in the

prediction of depressive symptomatology. Therefore, when perception of conflict is high, this is the predominant factor in determining greater depressive symptomatology, with school performance values (low or high) tending to have relatively similar effects at the level of these symptoms. It can also be observed that lower values of conflict with the father and good school performance can serve as a protective factor of depressive symptomatology.

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3.4.2. Study of the moderating effect of satisfaction with functioning on the relationship between

quality of interpersonal relationships and depressive symptomatology

Regarding satisfaction with functioning , analysis of regression coefficients, for the perception of support/depthin relation to both parents and perception of conflict with the mother, showed that there were no moderating effects. However, the factor conflictwith the father in interaction with satisfaction with functioning revealed a significant effect (β = -.095, p = .030). Both variables independently are equally predictors of depressive symptomatology ( factorconflict : β = .242, p < .01; satisfaction: β = .381, p <.01) (cf. tabel 4).

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The factor conflictwith the father and satisfaction were included in the regression model in

distinct steps, producing a statistically significant model [step 1: R2 = .242; F (1) = 26.808, p < .01; step 2: R2 = .447, F (2) = 53.450, p < .01]. In the next step, the interaction term was inserted, obtaining a statistically significant model, with a slight increase in R2 [ R2 = .456, F(3) = 37.521, p < .01], that is, there was an increase in the variability explained in regard to depressive symptomatology. The analysis of the interaction term suggested the existence of a moderating effect of satisfaction with functioning on the relationship between the perception of conflict with the father and depressive symptomatology. In this way, it was found that the interaction term is a

significant predictor, explaining 20.3% of the variance (cf. Table 5 ).

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To better understand the effect of moderation, a graphic of the results was computed (cf. figure 2 ). Two levels were considered for the factor conflict (below and above average) and three levels for the satisfaction (low: till M – 1 SD ; medium: between M – 1 SD and M + 1 SD ; and high: above M + 1 SD ). Having into account the main effects, it is possible to verify that lower levels of conflict with the father and higher and medium levels of satisfaction with functioning , are related to lower levels of depressive symptomatology. With regard to the interaction, we can say that when perception of conflict with the father is low, medium and high levels of satisfaction with functioning tend not to differentiate, leading to lower levels of depressive symptoms, compared with low levels of satisfaction . However, when perception of conflict is higher, depressive symptomatology tends to be similar when satisfaction is low or medium. Low scores on factor conflict with father , as well as high levels of satisfaction , can function as a protective factor of depressive symptomatology. The same is not true when perception of conflict is high, where low and middle levels of satisfaction , boost depressive symptomatology. When perception of conflict with the father is high, satisfaction with functioning assumes great importance in the prediction of depressive symptomatology, since low and middle levels of satisfaction tend to be similar in predicting high scores of depressive symptoms in adolescents.

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on the relationship between the factor conflict with the father and depressive symptomatology

4.Discussion

Literature has shown that lack of quality in interpersonal relationships (IQRI) can contribute to deficit conditions on adolescents’ mental health (Kenny et al., 2013), limiting psychosocial functioning at the level of school performance , relations with family and friends , as well as at the level of satisfaction with life (Greer, Kurian & Trivedi, 2010). Social support and psychosocial

functioning have been indicated as significant predictors of depression (Costello et al., 2001; Nilsen et al., 2013; Singh et al., 2015). Most research on depression considers gender as an important variable to be measured, since there are significant differences between genders in relation to the prevalence and manifestation of this disruption (Nolen-Hoeksema & Girgus, 1994; Twenge & Nolen-Hoesksema, 2002).

The present research aimed to study the moderating effect of psychosocial functioning on the relationship between quality of interpersonal relationships and depressive symptomatology, in a sample of Portuguese adolescents.

It should be noted that, with regard to gender differences, it was found that girls show higher levels of depressive symptoms in relation to boys. This conclusion goes accordingly to literature findings (Nolen-Hoeksema & Girgus, 1994; Twenge & Nolen-Hoesksema, 2002). With regard to IQRI factors, it was found that girls’ perception of support/depth in relation to the mother is higher than boys’ perception, which corroborates the results of another study (Pinheiro et al., 2013). For the remaining factors of the IQRI in relation to the father and the mother, no statistically significant differences were found, which does not corroborate the results of other studies indicating that boys reveal greater conflict relationships with the father and the mother (Matos et al., 2013; Pinheiro et al., 2013). With regard to PF domains, it was found that girls have worse relationships with family members and friends than boys, which confirms the results of other studies (e.g. Singh et al., 2015). Regarding satisfaction with functioning , the total score of PF and its domains, no statistically significant differences between genders were found. To the best of our knowledge, there are no investigations with which we can compare these results.

Results of regression analyses revealed that perception of support/depth in relation to the father and perception of conflict with the mother are independent and significant predictors of depressive symptoms, having found that support/depth is associated to less depressive symptomatology, while high levels of conflict are predictors of more depressive symptoms. These results meet the results found in previous studies (Marques, Matos & Pinheiro, 2014; Marques, Pinheiro, Matos & Marques, 2015; Matos, Pinheiro & Marques, 2013; Pinheiro, Matos & Marques, 2013). Regarding the association between PF and depressive symptomatology we can conclude that better relations with family and friends , as well as better school performance , are predictors of less depressive symptomatology. These results corroborate results found in previous studies (Greer et al., 2010; Judd, Akiskal, Zeller et al., 2000; Lewinsohn et al., 1995). It would be expected that participation in recreational activities was also related to depressive symptoms, since studies have shown that a greater number of pleasurable activities are associated with less depressive symptomatology in adolescents (Gledhill & Garralda, 2010), but that was not the case. Concerning the total score of PF and satisfaction with functioning , results showed that both variables significantly and independently predict depressive symptomatology. Therefore, worst PF and poorer satisfaction with functioning are related to higher levels of depressive symptomatology, corroborating previous studies results (Costello et al., 2001; Greer et al., 2010; Nilsen et al., 2013; Singh et al., 2015).

It was subsequently examined the moderating effect of PF and of satisfaction with functioning , in the relationship between quality of interpersonal relationships and depressive symptomatology. Results revealed, by the analysis of the interaction term, a non-statistically significant moderation effect of PF total score. Before this result, it was important to conduct more tests to check if there was a moderating effect of the multiple domains of PF . With regard to PF domains, relationships with family and friends and recreational activities , analysis of the interaction term suggested that there was no moderating effect.

With regard to the interaction between the factor conflict with the father and school performance , there was a significant moderating effect of school performance . A low perception of conflict with the father and a high school performance predict lower levels of depressive symptoms,

compared with poor school performance . When perception of conflict in relation to the father is high, this is the predominant factor in determining greater depressive symptomatology, with school performance values (low or high) tending to have relatively similar effects at the level of these symptoms. Thus, lower values of conflict with the father when associated with high levels of school performance , can serve as a protective factor of depressive symptomatology. With regard to the other factors of the IQRI (father and mother versions), no moderating effect of school performance was found.

Finally, we analyzed satisfaction with functioning (evaluated by the adolescent) as a moderator variable in the relationship between the various factors of the IQRI (father and mother versions) and depressive symptomatology. A moderating effect was found in the sense that when perception of conflict with the father is low, medium and high levels of satisfaction tend not to differentiate, leading to lower levels of depressive symptoms, compared with low levels of satisfaction . However, when perception of conflict is high, depressive symptomatology tends to be similar regardless of satisfaction values. We can see that low scores on the factor conflict with the father , as well as high levels of satisfaction , can function as a protective factor of depressive symptomatology. The same is not true when the factor conflict is high, where medium and low levels of satisfaction can boost depressive symptoms. When perception of conflict with the father is high, satisfaction with functioning assumes great importance in the prediction of depressive symptoms, since low and middle levels of satisfaction tend to be similar in the prediction of higher scores of depressive symptoms in adolescents. Regarding the other factors of the IQRI (father and mother versions), a moderating effect of satisfaction with functioning was not found. After an extensive literature search, it was found that no other studies relate to the moderating effect of PF and satisfaction with functioning in the relationship between the IQRI and depressive symptomatology. Thus, this research becomes fundamental as it can serve as a driving force for future studies.

The present study presents some limitations that should be taken into account in the interpretation of the results. Since the investigation followed a transversal design , it does not allow to draw causality conclusions. We suggest that future research carry out a longitudinal design. In addition to this fact, the sample was collected only in certain geographical areas of the country (North and Center) and involved only non-clinical population not allowing the generalization of results for all adolescents and for clinical population. The absence of significant results may be due to the fact that this is a sample of the community, in which adolescents tend to have low depressive symptomatology and good indicators of quality of interpersonal relationships and psychosocial functioning, taking into account the range of possible scores. The time of completion of the research protocol was also long (about 45 minutes), which may influence adolescents’ responses, since there is a likelihood of loss of concentration and motivation. Time of completion happens because the evaluation protocol of the broader research project in which the present study is inserted is constituted by various scales besides the ones used in this study.

It is important to note that results obtained in this study could be crucial to the development and improvement of programs of prevention of depression in adolescents, because they enhance the importance of implementing a parental component in this kind of programs.

Acknowledgements

We would like to express our gratitude to all the participants that made this study possible and to FCT that funded the study. This work is funded by ERDF – European Regional Development Fund through the COMPETE Program (operational program for competitiveness) and by National Funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project “Prevention of depression in Portuguese adolescents: efficacy study of an intervention with adolescents and parents” (PTDC/MHC-PCL/4824/2012).

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