A comparison between socially anxious and depressive symptomatology in youth: a focus on perceived family environment

Anxiety Disorders 19 (2005) 423–442

A comparison between socially anxious and depressive symptomatology in youth: a focus on perceived family environment Helena S. Johnson*, Heidi M. Inderbitzen-Nolan, Ann M. Schapman Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA Received 2 September 2003; received in revised form 5 December 2003; accepted 16 April 2004

Abstract The current study employed present-oriented self-report measures to compare groups of socially anxious, depressed, mixed socially anxious and depressed, and comparison youth on perceptions of the family environment, as assessed via the Family Environment Questionnaire (FEQ). Results indicated that the mixed and depressed groups rated their parents as being overly concerned with others’ opinions, feeling ashamed of their performance, and restricting family sociability more than the socially anxious and comparison groups. With respect to the latter two groups, the socially anxious group rated their family environment more negatively than the comparison group on each of these variables. Implications of the findings and directions for future research are discussed. # 2004 Elsevier Inc. All rights reserved. Keywords: Social anxiety; Depressive symptomatology; Family environment; Adolescence

One of the most prevalent internalizing disorders in youth is Social Phobia. Research has revealed that 9–15% of children referred to an anxiety disorders clinic (Last, Strauss, & Francis, 1987; Strauss & Francis, 1989) and 20% of * Corresponding author. Tel.: þ1 402 474 0861; fax: þ1 402 472 4637. E-mail address: [email protected] (H.S. Johnson).

0887-6185/$ – see front matter # 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.janxdis.2004.04.004

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children identified as test anxious (Beidel & Turner, 1988) are socially phobic. Furthermore, a recent epidemiological study found lifetime prevalence rates of Social Phobia in a community sample were 9.5 and 4.9% for 14–24-year-old females and males, respectively (Wittchen, Stein, & Kessler, 1999). Lastly, average age of onset of social anxiety is between early and late adolescence (American Psychiatric Association, 1994; Bourdon et al., 1988). Given the early onset and the number of youth affected, the continued study of etiological factors related to social anxiety in youth is of great importance. One potential etiological factor that has gained research attention is parental influence or parental rearing style (Hudson & Rapee, 2000). This finding is supported primarily by the adult literature, which has found differences between individuals with Social Phobia and both normal control groups and other types of anxiety-disordered groups. In general, results have demonstrated that socially phobic adults perceived their parents as having been overprotective during childhood (Bruch & Heimberg, 1994), rejecting and not emotionally supportive (Arrindell, Emmelkamp, Monsma, & Brilman, 1983; Parker, 1979), isolating them from routine social experiences, concerned about others’ opinions, and not emphasizing family sociability (Bruch, 1989; Bruch & Heimberg, 1994; Bruch, Heimberg, Berger, & Collins, 1989). Importantly, however, the above findings have relied upon retrospective reports of adults, which may be inaccurate due to memory deficiencies. Recently, researchers began investigating perceived parental rearing practices of youth with social anxiety using present-oriented methodologies. That is, youth who are currently experiencing social anxiety are asked to report on parental rearing practices. One such study found that a community sample of youth reporting higher levels of social anxiety perceived their parents as being more socially isolating, overly concerned about others’ opinions, ashamed of their shyness and poor performance, and less socially active than youth reporting lower levels of social anxiety (Caster, Inderbitzen, & Hope, 1999). Furthermore, in comparison to normal controls, clinically referred socially anxious youth viewed their parents as more rejecting, displaying less emotional warmth, and promoting less family sociability than normal controls (Boegels, van Oosten, Muris, & Smulders, 2001). Notably, symptoms of social anxiety and depression often co-occur in youth, with approximately 55% of youth diagnosed with Social Anxiety Disorder from a clinical population also meeting criteria for Major Depressive Disorder (Last, Perrin, & Hersen, 1992). Additionally, the importance of studying comorbid social anxiety and depression in youth lies in the findings that children identified with both anxiety and depressive symptoms may be more symptomatic than those with only one disorder (Bernstein, 1991; Katon & Roy-Byrne, 1991). Studies that have incorporated a comorbid group when studying family factors associated with depression and anxiety have provided initial support for

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differential relationships between anxiety and depression. For example, a study of depressed (major depression, dysthymia, or depressive disorder not otherwise specified), anxious (overanxious disorder or anxiety disorder not otherwise specified), both depressed and anxious, and control children (ages 9–14) found that children in the comorbid group reported more family conflict and had lower scores on democratic family style, active/recreational orientation, moral/religious emphasis, and family sociability than children in the anxious group (Stark et al., 1990). Furthermore, the comorbid group scored significantly higher than the depressed group on the democratic family style variable. Another study, utilizing retrospective reports, found that adults with mixed depression/anxiety disorder perceived their childhood as being more traumatic and reported less satisfaction in their relationship with their parents than adults with an anxiety or depressive disorder alone (Alnaes & Torgersen, 1988). Together, these findings suggest that the combination of anxiety and depression may yield more severe symptomatology than anxiety or depression alone (Katon & Roy-Byrne, 1991), leading to greater negative perceptions of the family environment. To date, however, no study of family environment or perceived parental rearing practices for individuals with social anxiety has incorporated a depressed or comorbid depressed/socially anxious group within the same study, although researchers have highlighted the need for a mixed group when studying the comorbidity of depression and anxiety (Brady & Kendall, 1992). Furthermore, Brady and Kendall (1992) suggested that family environment might prove to be a viable research area for ‘‘delineating differences in family psychopathology for depressed, anxious and mixed children’’ (p. 251). The present study, therefore, investigated the perceived parental rearing practices of youth identified via selfreport measures as experiencing social anxiety, depression, or both social anxiety and depression in the same study using one set of parental rearing variables. Thus, the current study contributes to the existing literature examining relations between parental rearing practices and social anxiety in three important ways. First, as described above, this study will utilize parental rearing constructs found to be sensitive in socially anxious populations with youth reporting significant degrees of depressive symptomatology to facilitate the comparison of results across studies. Second, although previous studies have included groups of depressed, anxious, and comorbid youth, these studies did not examine youth with social anxiety specifically. Thus, this is the first study to examine differences in parental rearing styles among youth with socially anxious symptomatology, depressive symptomatology, and mixed symptomatology. Third, much of the previous research examining relations among parental factors and social anxiety have used retrospective reports. Because such reports may be biased due to inaccurate recall, the present study, similar to more recent research, used a present-oriented methodology.

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1. Method 1.1. Participants A total of 3649 students (1828 males and 1821 females) in grades 4 (n ¼ 505; 255 males and 250 females), 6 (n ¼ 437; 210 males and 227 females), 7 (n ¼ 817; 418 males and 399 females), 8 (n ¼ 776; 377 males and 399 females), 9 (n ¼ 602; 303 males and 299 females), and 11 (n ¼ 512; 265 males and 247 females) participated in the present study. Students were recruited from public and private schools in rural and mid-sized Midwestern cities in the same state. Participants ranged in age from 9 to 17 (M ¼ 12.96, S.D. ¼ 2.26). Ethnicity data were obtained from only 2849 participants (78%) due to the fact that some principals in participating schools did not allow students to complete the demographic questionnaire or some items on the demographic questionnaire (which was used to gather information concerning ethnicity and socioeconomic status). Eighty-five percent of the youth who provided ethnicity data identified themselves as Caucasian, whereas the remaining 15% identified themselves as minorities (e.g., African–American, Asian American, Mexican–American, Native American, or Other). Socioeconomic data, obtained from 2291 participants (62%), revealed that the participants came from a wide range of socioeconomic levels (i.e., 10% upper middle class, 17% middle class, 21% lower middle class, 11% upper lower class, 39% lower class, and 2% impoverished). Lastly, eighty-five percent of the youth also provided information regarding their current living situation. Results revealed that 78% of youth were living in two parent households. 1.2. Measures 1.2.1. Demographic questionnaire A demographic questionnaire was used to collect data about the youths’ sex, age, ethnicity, socioeconomic status, and living situation. Students were also asked with whom they lived and the occupations of the adults with whom they resided, which was used to determine the family’s socioeconomic status using the Dunkin Index (Reiss, 1961). 1.2.2. Family Environment Questionnaire The Family Environment Questionnaire (FEQ) is a 19-item self-report measure that was designed for the present investigation by modifying the Parent Attitudes Toward Child-Rearing Scale (PACR; Bruch et al., 1989; Bruch & Heimberg, 1994), which assesses adults’ retrospective reports of their childhood family environment. Bruch and colleagues (1989) adapted items from the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979), the Children’s Report of Parental Behavior (Schaefer, 1965), and the Family Attitude Survey (Bloom, 1985) to create the PACR. For the current study, the PACR was modified in three

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ways. First, to reflect the youths’ current perceptions, item wording was changed from past to present tense. Second, the language was simplified (e.g., ‘‘Before my family would go out, my parents would lecture me on how to act’’ was changed to ‘‘Before my family goes out, my parents tell me how to act’’). Third, students were asked to indicate how true an item was for their mothers and fathers separately (as opposed to ‘‘parents’’ on the PACR). Each item on the FEQ is answered using a 5-point scale ranging from not at all (1) to very much (5). Items are answered by the youth with regard to each parent separately, yielding scores for the youth’s perception of his/her mother and of his/ her father. Items on the FEQ are divided into the same four subscales as on the PACR: (a) isolation, which consists of five items measuring the youth’s perception of how socially isolated his/her parent keeps him/her (e.g., ‘‘My mother (father) doesn’t like me to go out unless it is for something special’’); (b) others’ opinion, which consists of five items assessing the degree to which the youth perceives his/ her mother and father as being overly concerned about other people’s opinions (e.g., ‘‘My mother (father) won’t let me wear the clothes I want because he/she is scared that other people, like family or neighbors, will say something’’); (c) shame, which consists of five items measuring the youth’s perception of how ashamed his/her parent is of his/her shyness or poor performance (e.g., ‘‘If I don’t do well in school, like in class or at sports, my mother (father) gets upset and acts like I embarrassed him/her’’); and (d) family sociability, which consists of four items assessing the youth’s perception of his/her mother and father’s sociability (e.g., ‘‘My mother (father) enjoys taking the family to visit other people’’). The isolation, others’ opinion, and shame subscales are scored so that high scores are negative (i.e., represent greater perception of parent’s social isolation of the youth, greater concern with others’ opinions, and greater shame regarding the youth). The Family sociability subscale, however, is scored in such a way that high scores are positive (i.e., indicative of perceptions of greater sociability of parents). Bruch et al. (1989) reported Cronbach a’s on the PACR subscales ranging from .71 to .86, as well as support for the validity of the measure. Because the PACR was modified for the present study to form the FEQ, item-total correlations and Cronbach a for each subscale were calculated for the current sample. Based on the results of the item-total correlations, two items were eliminated from the FEQ due to low correlations. Cronbach a on the resulting subscales were as follows: (a) maternal isolation, .39; (b) paternal isolation, .37; (c) maternal others’ opinions, .62; (d) paternal others’ opinions, .62; (e) maternal shame, .64; (f) paternal shame, .64; (g) maternal family sociability, .60; and (h) paternal family sociability, .62. Due to the low coefficient a on the Maternal and Paternal Isolation subscales, these were eliminated from the analyses. 1.2.3. The Social Anxiety Scale for Children-Revised (SASC-R; La Greca, 1991) and the Social Anxiety Scale for Adolescents (SAS-A; La Greca, 1998) The SASC-R and the SAS-A both consist of 18 items reflecting fears of negative evaluation and social avoidance and distress and 4 filler items. Students

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are asked to indicate along a 5-point continuum how true an item is for them. The SASC-R is intended for elementary-school aged children, and the SAS-A is to be used with adolescents. The only difference between the two versions is the use of age-appropriate language (e.g., ‘‘other kids’’ on the SASC-R versus ‘‘peers’’ or ‘‘others’’ on the SAS-A and ‘‘playing’’ on the SASC-R versus ‘‘doing things’’ on the SAS-A). The internal consistency (a’s ¼ .67–.86) and temporal stability (r’s ¼ .67– .70) of the measures have been adequately demonstrated (La Greca, 1989, 1991). In addition, La Greca (1989) reports significant relationships between SASC-R scores and peer relations, teacher ratings of withdrawal, and selfreports of social competence, providing evidence of the scale’s concurrent validity. Similarly, adolescents who scored higher on the SAS-A also reported lower self-perceptions of peer acceptance and romantic appeal (La Greca & Lopez, 1998). 1.2.4. Children’s depression inventory The children’s depression inventory (CDI; Kovacs, 1981) is a 27-item questionnaire that asks respondents to endorse statements about themselves reflecting cognitive and somatic symptoms of depression. Each item has three possible alternatives from which participants choose based on experiences in the past 2 weeks. Scores for each item are assigned values of 0, 1, or 2 with higher scores indicating greater depressive symptomatology. This questionnaire was designed for children and adolescents from 7 to 17 years of age. The CDI has been shown to have adequate internal consistency (as ranging from .71 to .94; Saylor, Finch, Spirito, & Bennett, 1984) and to differentiate between children diagnosed as depressed and nondepressed (Carlson & Cantwell, 1979). Although the CDI typically evidences a significant relationship with self-reported anxiety symptoms (e.g., Finch, Lipovsky, & Casat, 1989; Hodges & Craighead, 1990), it was included in the present study because no measure of depressive symptoms has discriminant validity with anxiety symptoms in children and adolescents (Jolly & Dykman, 1994), and the CDI is the most commonly used depression measure among researchers and clinicians (Kazdin, 1981). 1.3. Procedure As part of a larger study, letters describing the research project were mailed to the homes of parents who had children enrolled in the target grades at participating schools. The method used to obtain parental consent varied across schools depending on principals’ preferences. In some schools, passive consent procedures (2637 students; 72% of participants) were used in which the letters mailed to the homes asked parents to notify the primary investigator if they did not wish their child to participate in the study. In other schools, active consent procedures were used, whereby parents

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were required to send a signed consent form back to the school with their child1. Participants were required to provide assent to participate in the study prior to completing any questionnaires in the classroom. Approximately 30 students with parental consent (.8%) did not assent to participate. Research assistants distributed randomized questionnaire packets that included a demographic questionnaire, the FEQ, SASC-R or SAS-A, and CDI, along with other measures that were part of a larger investigation. Most participants took approximately 30 min to complete the questionnaires. Trained graduate and undergraduate research assistants were available to answer questions or to help participants if necessary. Due to confidentiality, students were assured that no one would be told of their responses. For ethical purposes, however, teachers were told the number of students (no names provided) who indicated thoughts of suicide (an item on the CDI), which occurred in only one instance.

2. Results 2.1. Preliminary analyses Correlations among FEQ subscales were examined. As can be seen in Table 1, correlations ranged from .04 to .56, suggesting the different subscales measured distinct components of the family environment. Additional analyses were conducted to examine relationships among all the study variables. As can be seen in Table 1, correlations between demographic variables (i.e., SES and age) were minimally associated (r’s ¼ .00 to .24) with study variables (i.e., CDI, SAS, and FEQ scales), accounting for no more than 4% of the variance2. 2.1.1. Relationship among study variables Table 1 also shows the relationship between FEQ subscales and both CDI and SASC-R/SAS-A total scores for the entire sample. As can be seen, in general, it 1 At the time this study was conducted, the use of passive consent procedures was approved by the authors’ institutional review board and NIMH. A goal of the larger study was to investigate the relationship between social anxiety and peer relations using sociometric methods (Inderbitzen, Walters, & Bukowski, 1997). The accurate classification of students using sociometric methods is dependent upon having at least an 80% participation rate. Given that most studies using active consent procedures yield participation rates below 50% and that most parents fail to sign and return consent forms due to apathy, in conjunction with the director of program evaluation for the local public school system, it was decided to use passive consent procedures. Parental consent rate averaged across schools using passive consent procedures was 96%, and parental consent rate averaged across schools using active consent procedures was 34%. Statistical analyses indicated no differences between students recruited using passive consent procedures and those using active consent procedures on any measures in this study. 2 Correlations were first computed for males and females separately. No differences emerged between males and females. Thus, data was collapsed across gender.

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Table 1 Correlational analyses among study variables for the total sample Variable (1) Age (2) SES (3) CDI (4) SASCR/SAS-A (5) Shame (M) (6) Shame (F) (7) Others’ opinion (M) (8) Others’opinion (F) (9) Family Soc (M) (10) Family Soc (F)

1 –

2 .01 –

3

4 **

.13 .04 –

5

6 *

7 **

8 *

9 *

.06 .10 .14 .10 .11 .12** .05 .01 .11* .10* .34** .30** .38** .33** .28** – .17** .18** .24** .19** – .80** .56** .44** – .46** .51** – .78** –

10 **

.18 .05 .36** .16** .15 .09* .10* .01 –

.22** .05 .36** .15** .14* .11** .08 .04 .80** –

Note: M: mother; F: father; Family Soc: family sociability score. N ¼ 530. * P < .05. ** P < .01.

appears that CDI scores are more strongly associated with FEQ subscales (this pattern holds true for both males and females). Hotelling’s t-tests were performed to determine whether there was a significant difference in the strength of the relationships between the CDI scores and the FEQ variables and the SASC-R/ SAS-A scores and the FEQ variables. These analyses indicated that perceived concern for other’s opinions by mothers, t (769) ¼ 2.28, P ¼ .05, and fathers, t (769) ¼ 2.23, P ¼ .05, shame by mothers, t (769) ¼ 3.23, P ¼ .05, and fathers, t(769) ¼ 5.12, P ¼ .05, and family sociability by mothers, t(769) ¼ 5.07, P ¼ .05, and fathers, t (769) ¼ 5.32, P ¼ .05, were more strongly correlated with CDI total scores than with SASC-R/SAS-A total scores. 2.2. Formation of groups To determine whether the associations among the family environment variables and self-reported depressive and anxious symptomatology differed when using symptomatic groups, the participants were classified into the following four mutually exclusive groups: (a) socially anxious, (b) depressed, (c) mixed, and (d) comparison. In order to form groups that were clinically significant and distinct, both clinical cut-offs and sample means were utilized. Thus, those classified as socially anxious had a total score above or equal to 50 or 54, depending on age and gender, on either the SASC-R or SAS-A (see La Greca, 1998, for suggested clinical cut-off scores) and a total score on the CDI less than or equal to the mean (M ¼ 8.39, S.D. ¼ 7.31) for the study sample. These criteria resulted in 317 youth (163 males; 154 females; mean age ¼ 12.62) classified as socially anxious (8.7% of total sample). Those participants classified as depressed had scores greater than or equal to the clinical cutoff for the CDI total score (i.e., 20; Kovacs, 1992) and scores that were less than or equal to the SASC-R or SAS-A total score mean (M ¼ 43.03, S.D. ¼ 12.75) for the study sample. These criteria resulted in 91 youth (50 males; 41 females; mean age ¼ 13.36) classified as depressed (2.5% of total sample).

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Participants classified as being both socially anxious and depressed (i.e., mixed group) had CDI total scores greater than or equal to the clinical cutoff (i.e., 20) and a SASC-R or SAS-A total score greater than or equal to the clinical cut-off depending on age and gender (i.e., 50 or 54). These criteria resulted in 180 youth (64 males; 116 females; Mean age ¼ 13.09) classified as having both depressed and socially anxious symptomatology (4.9% of total sample). Youth in the comparison group had SASC-R or SAS-A total scores that were less than or equal to the study sample mean and CDI total scores less than or equal to the study sample mean. To make groups reasonably comparable in size, a random 30% of the comparison participants were selected, resulting in a group of 325 youth (166 males; 159 females; Mean age ¼ 13.01). See Table 2 for CDI and SASC-R/SAS-A means, standard deviations, and ranges for the four groups. 2.3. Between group analyses 2.3.1. Equivalence of groups on age Given the large age range of the youth in the present sample, the four groups were compared statistically on age once the groups were formed. Results indicated that the groups differed significantly with regard to age, F (3, 822) ¼ 3.41, P ¼ .017. Tukey’s post-hoc analyses revealed that the socially anxious group was significantly younger than the depressed group (P ¼ .055). As a result, age was used as a covariate in the following between-groups analyses to statistically control for the effects of age.

Table 2 Means, standard deviations, and ranges for CDI and SASC-R/SAS-A total scores across groups Group

CDI total score

SASC-R/SAS-A total score

Comparison (n ¼ 325) Mean S.D. Range

3.30 2.50 0–8

32.88 7.16 1–43

Socially anxious (n ¼ 317) Mean S.D. Range

4.89 2.36 0–8

57.76 6.45 50–89

Depressed (n ¼ 91) Mean S.D. Range

25.18 5.85 20–48

32.37 7.58 7–43

Mixed (n ¼ 180) Mean S.D. Range

24.98 4.68 20–43

63.64 8.75 51–89

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Table 3 Between group analyses: means and standard deviations on FEQ subscales by group Variable

Comparison (n ¼ 325) M (S.D.)

Others’ opinion (F) 6.86 (2.47)a Others’ opinion (M) 6.96 (2.58)a Shame (F) 7.33 (2.46)a Shame (M) 7.36 (2.36)a Family Soc (F) 10.37 (2.72)a Family Soc (M) 10.56 (2.52)a

SocAnxious (n ¼ 317) M (S.D.) 7.92 8.36 8.05 8.16 9.79 10.02

(3.40)b (3.59)b (3.07)b (3.13)b (2.44)b (2.39)b

Depressed (n ¼ 91) M (S.D.) 8.93 9.89 10.75 10.98 8.48 8.81

Mixed (n ¼ 180) M (S.D.)

(4.17)b,c 9.47 (3.94)c (4.10)c 9.95 (3.91)c (5.32)c 10.68 (4.35)c (5.54)c 10.88 (4.57)c (3.05)c 8.20 (2.74)c (2.94)c 8.26 (2.74)c

df 3, 3, 3, 3, 3, 3,

Z2

F 715 780 721 784 724 786



23.00 32.33 36.83 35.90 24.15 32.60

09 .11 .12 .12 .09 .11

Note: FEQ: Family Environment Questionnaire; SocAnxious: socially anxious group; M: mother; F: father; Family Soc: family sociability score. Means within rows with differing letters are significantly different at P < .008. Degrees of freedom differ across analyses due to missing data.

To investigate whether youth in the four groups perceived their family environments differently, a series of analyses of covariance (ANCOVAs) with group (socially anxious, depressed, mixed, and comparison) and gender as between-subjects’ independent variables, the six subscales of the FEQ as dependent variables, and age as a covariate were performed. To control for the increased risk of Type 1 errors as a result of this approach, a Bonferroni correction was applied. Each ANCOVA was followed by pairwise comparisons among the four groups. See Table 3 for means and standard deviations of FEQ variables by group. Effect sizes for analyses are also presented in Table 3. Results of analyses indicated there were no significant gender by group interactions for any of the six FEQ variables. In addition, results indicated a group main effect for all six of the FEQ variables. Specifically, for maternal opinion of others, paternal and maternal shame, and paternal and maternal family sociability variables, youth with depressive and mixed symptomatology did not differ from one another and scored higher than the socially anxious and comparison youth. The socially anxious group also scored higher than the comparison group for each of these variables. For paternal opinion of others, youth with depressed and mixed symptomatology did not differ from one another and scored higher than the comparison youth, although the socially anxious and depressed groups also did not differ from one another. Additionally, the mixed group scored higher than the socially anxious group on the paternal opinion of others variable. Lastly, results also revealed main effects for gender on the following variables: paternal opinion of others, F (1, 715) ¼ 29.15, P ¼ .001, maternal opinion of others, F (1, 780) ¼ 16.00, P ¼ .001, and paternal shame, F (1, 721) ¼ 16.09, P ¼ .001. Males scored higher than females on each of these variables. 2.4. Multiple regression analyses Given that the depressed and mixed groups did not differ from one another, and because correlational results indicated FEQ subscales were more highly

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Table 4 Regressions predicting maternal family environment from CDI scores, SASCR/SAS-A scores, and their interaction Shame (M) 2

R Variables Block 1 Age Gender

2

RD

Others’ opinion (M) Final b

.01**

2

R

2

RD

.03**

.10**

Block 3 SASCR/SAS-A

.11**

Block 4 Interaction

.11**

.08**

.13**

.10**

.14**

.11**

.07**

.01**

.54** .12**

.01**

.03** .14**

.00

Final b

.23** .19

.84**

.00** .00

R2D

.12** 1.02**

.01** .01**

R2 .04**

.00** .00

Block 2 CDI

Final b

Family sociability (M)

.02** .12**

.00 .00

.00 .00

Note: M: maternal. N ¼ 2655. ** P < .001.

associated with depression than with social anxiety scores, a series of multiple regression analyses (one for each FEQ subscale) was performed to determine whether socially anxious symptomatology was uniquely related to perceptions of family environment. More specifically, for each FEQ subscale, a multiple regression with age and gender entered on block one, depression scores entered on block two, social anxiety scores entered on block three, and the interaction of depression and social anxiety scores entered on the fourth block was conducted. As can be seen in Tables 4 and 5, the addition of depression scores in block two produced a significant R2 change for each FEQ subscale. When social anxiety scores were added to the model in block three, there was a significant increase in the R2 for each subscale, although the magnitude of the change was very small. Overall, these regression analyses suggested that the variance within the FEQ subscale scores is better predicted by depressive than socially anxious symptomatology. 2.5. Exploratory analyses Given that the youth included in the present study spanned a wide range of grades in school, ad hoc, exploratory analyses were conducted to examine whether differential patterns of responding by grade existed. A series of oneway analyses of variance (ANOVAs) with grades (4, 6, 7, 8, 9, and 11) as the independent variable and the six FEQ subscales as the dependent variables was performed to investigate whether youth in the varying grades perceived their family environments differently. To control for increased risk of Type 1 errors as a result of performing multiple ANOVAs, a Bonferroni correction was applied.

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Table 5 Regressions predicting paternal family environment from CDI scores, SASCR/SAS-A scores, and their interaction Shame (P) 2

R Variables Block 1 Age Gender Block 2 CDI

RD

Others’ opinion (P) Final b

.02**

R

2

2

RD

.11**

.09*

.12**

.01*

R2D

.08**

.11**

.06**

.01**

.51** .12**

.01**

.03** .13**

Final b

.26** .00

.73** .13**

.00

R2 .05**

.00** .00

Family sociability (P)

.14** 1.05**

.00**

.12**

Final b

.03** .00** .01*

Block 3 .12** SASCR/SAS-A Block 4 Interaction

2

.02** .12**

.00 .00

.00* .01*

Note: P: paternal. N ¼ 2655. * P < .05. ** P < .001.

Post-hoc comparisons were also examined. Table 6 provides means and standard deviations of FEQ variables by grade. Results indicated a main effect of grade for three of the FEQ variables. Specifically, youth in the lower grades reported higher levels of maternal concern for others’ opinions than youth in the 11th grade. Regarding maternal family sociability, youth in the higher grades reported lower levels than youth in the fourth grade. Finally, younger youth in grades four and six tended to report higher levels of paternal family sociability than youth in the higher grades, although youth in sixth and seventh grades did not differ with respect to paternal family sociability.

3. Discussion The present study investigated the differential patterns of perceived family environment across groups of symptomatic (i.e., depressed, socially anxious, mixed depressed and socially anxious) and comparison youth. Results showed that although both socially anxious and depressed symptoms were related to family environment variables, associations were stronger for depressive than socially anxious symptoms. Furthermore, the depressed and mixed groups rated their mothers as being overly concerned with other’s opinions and both parents being ashamed of the youth’s difficulties and restricting family sociability more so than the socially anxious and comparison groups, substantiating prior investigations (i.e., Alnaes & Torgersen, 1988; Kashani et al., 1999). Finally, analyses indicated that the socially anxious group perceived greater parental shame and

Variable

4 M (S.D.)

6 M (S.D.)

7 M (S.D.)

8 M (S.D.)

9 M (S.D.)

11 M (S.D.)

df

Others’ opinion (F) Others’ opinion (M) Shame (F) Shame (M) Family Soc (F) Family Soc (M)

8.36 8.92 7.96 8.24 10.48 10.61

8.10 8.46 8.45 8.25 10.36 10.53

8.05 8.36 8.68 8.89 9.39 9.43

8.11 8.48 8.84 9.05 9.07 9.22

8.10 8.69 9.30 9.51 9.22 9.27

7.01 7.12 8.79 8.58 8.78 9.32

5, 5, 5, 5, 5, 5,

(3.72) (3.95)a (3.52) (3.85) (2.56)a (2.38)a

(3.84) (3.95)a (4.00) (3.50) (2.67)a,d (2.60)a

(3.19) (3.51)a (3.79) (4.05) (2.44)b,c,d (2.58)b

(3.21) (3.38)a (3.59) (3.79) (2.89)b,c (2.58)b

(3.34) (3.49)a (4.33) (4.40) (2.84)b,c (2.87)b

(3.40) (3.16)b (3.56) (3.30) (2.94)b,c (2.85)b

802 872 810 879 814 881

F

Z2

2.44 4.26 2.40 2.44 8.64 8.61

.015 .024 .015 .014 .051 .047

Note: FEQ: Family Environment Questionnaire; SocAnxious: socially anxious group; M: mother; F: father, Family Soc: family sociability score. Means within rows with differing letters are significantly different at P < .008. Degrees of freedom differ across analyses due to missing data.

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Table 6 One-way analyses: means and standard deviations on FEQ subscales by grade

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overconcern with others’ opinions, as well as more restriction of family sociability, than the comparison group, again supporting previous literature (i.e., Arrindell et al., 1983; Bruch et al., 1989). And, although effect sizes for these findings were relatively small, 9–12% of the variance was accounted for, which may be clinically significant. As indicated, the depressed group rated its family environments more negatively than the socially anxious group, supporting previous studies that employed groups of depressed and non-specific anxious children and adolescents from school-based and inpatient populations (e.g., Barrera & Garrison-Jones, 1992; Stark et al., 1993). Additionally, correlation and regression analyses suggested that family environment variables were better predicted by depressive symptoms than social anxiety symptoms in this sample of youth. There are several potential explanations for this finding. First, it is possible that the family environments of depressed youth truly are more dysfunctional (as operationally defined by the FEQ scales in the present study) than those of socially anxious youth. Another possibility is that the global negative affect and cognitions associated with depression (see Compas, Ey, & Grant, 1993, for a review) produces more negative perceptions of one’s family environment. With regard to the latter, a negative cognitive bias is more likely to be associated with depression than social anxiety because the dominant emotion in depression is sadness (Brady & Kendall, 1992) with low positive affect (Watson & Kendall, 1989), whereas the dominant emotion in social anxiety is fear of negative evaluation (Hope & Heimberg, 1993). Depression, therefore, appears to have a more general, non-specific focus, than social anxiety, which may lend itself to more global negative perceptions. Research utilizing direct observation or methodology that incorporates information obtained from multiple sources (e.g., youth, siblings, parents) is needed to determine whether ratings obtained by youth are accurate observations of their experiences in their families or inaccurate perceptions, potentially due to a negative cognitive bias. As noted, the finding that the socially anxious group rated its parents more negatively than the comparison group on all variables supported, and is consistent with, existing literature in both youth and adult populations. A previous investigation found that youth in a highly symptomatic social anxiety group perceived their parents as more socially isolating, more concerned about others’ opinions, more ashamed of their shyness and poor performance, and less socially active than did youth in a low symptomatic social anxiety group (Caster et al., 1999). Adult retrospective studies have demonstrated similar findings. That is, socially phobic adults reported isolation, an overemphasis on the opinions of others, less emphasis on family sociability (Bruch, 1989; Bruch & Heimberg, 1994; Bruch et al., 1989), overprotection (Bruch & Heimberg, 1994), rejection and lack of emotional support (Arrindell et al., 1983; Parker, 1979) on the part of their parents. Taken together, these findings lend support to the theory that parental admonishments may influence the development of youths’ fear of negative evaluation in social interactions (Buss, 1980, 1986). That is, parents who repeatedly criticize their

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youth’s appearance or behavior and overly emphasize being scrutinized by others may contribute to the development of social anxiety in youth. Nonetheless, as stated previously, future research is needed to determine the accuracy of youths’ perceptions of their family environment. It is possible that a youth’s fears of negative evaluation may bias their interpretations and perceptions of their parents’ behaviors. Perhaps the most interesting results were those indicating that the mixed and depressed groups reported similar perceptions of their family environments. Although inconsistent with prior literature (i.e., Alnaes & Torgersen, 1988) and expectations based on the potential greater psychopathology for the mixed group (Bernstein, 1991; Katon & Roy-Byrne, 1991), these findings were further elucidated by the results of the current regression analyses demonstrating that depression alone (rather than social anxiety or the interaction between depression and social anxiety) was the best predictor of the family environment variables in this sample. Thus, it appears that the FEQ scores of the individuals in the mixed group were primarily driven by their significant depressive symptomatology and the additional social anxiety symptomatology did not significantly alter their perceptions of their family environment. Differences between results of the present study and previous studies with regard to comparisons between mixed and depressed only groups may be explained by methodological factors. First, previous studies employing comorbid groups utilized diagnostic groups, whereas the present investigation used clinical cut-off scores from self-report measures for group formation. This major difference in methodology may account for the findings that the mixed group reported more pathological family environments in previous studies. That is, comorbid diagnostic groups likely experience greater psychopathology than the mixed group from the current study. Second, the current study used a present-oriented design rather than a retrospective approach, which may lead to more accurate perceptions of family environments. Overall, the present findings are more consistent with those of Stark and colleagues (1990), who used a present-oriented design and found that the mixed depressed and anxious groups were similar to the depressed group on two of eight family environment variables (i.e., cohesion and enmeshment), than with those of a study employing retrospective reports of adults (Alnaes & Torgersen, 1988) that found the mixed group perceived their families more negatively than either the depressed or anxious group. Third, the current investigation assessed constructs of perceived parental overconcern with others’ opinions, shame with regard to a youth’s poor performance, and family sociability, whereas prior investigations employing comorbid groups measured variables such as perceived family conflict, democratic parenting styles, and relationship satisfaction. Thus, it may be the case that mixed and depressed groups do not differ on the familial factors employed in the present investigation but do differ on constructs assessed in previous investigations. Finally, in the present study the mixed group was comprised of depression and social anxiety symptomatology, whereas in previous studies the mixed group was comprised of depression and non-specific anxiety. Thus, because social anxiety is a more specific

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form of anxiety than investigated in previous studies, it is possible that it does not significantly contribute to the overall psychopathology of the mixed group. There is substantial literature with depressed youth showing that their family environments are characterized by highly negative experiences (e.g., McCauley et al., 2001). Whereas our results support the conclusion that depressive symptomatology is more closely associated with negative family experiences than social anxiety symptomatology (as assessed in this study), continued research is needed to delineate the relative influence of family environment variables in depressed and socially anxious youth before a determination can be made. Such research may have implications for the distinction between anxiety and depression, as this continues to be a much-debated and studied issue. More importantly, however, continued research in this area can influence the applied realms by broadening the focus of assessment and treatment to include family environment and functioning. Although not main objectives of the current investigation, important results regarding gender, age and grade, and prevalence rates for social anxiety in youth emerged. With respect to gender, results revealed no significant interactions between gender and group in relation to perceived parenting. Males, however, were found to have higher scores than females on perceptions of both maternal and paternal overconcern with others’ opinion and paternal shame with regard to a youth’s poor performance. A possible explanation for this gender difference is offered by McCauley et al. (2001) based on unpublished data with depressed youth. These authors suggest that depressed males and females may have different family interactions, leading males to express anger overtly while females may attempt to prevent conflict and maintain more harmonious family relationships. It is possible that this explanation is true for all youth and results in females rating their family environments less negatively than males, which would be consistent with the current findings on a few of the family environment variables. Alternatively, males in the United States are taught to be independent, whereas dependence and affiliation are encouraged in females (see Kavanagh & Hops, 1994, for a review). Thus, it is possible that males view parental overconcern and shame as more restrictive and negative than do females. It has also been found that females tend to internalize family pathology (Werner, 1990). As a result, females may perceive their family environments similarly to males, but are less comfortable expressing their feelings and, thus, do not rate their parents as negatively as their male counterparts. Nonetheless, these gender differences and speculations should be the subject of future scientific endeavors. Regarding age, current findings revealed that the socially anxious group was younger than the depressed group. This finding is consistent with studies showing that the mean age for children with anxiety disorders is lower than for depressive disorders and that depression typically follows anxiety in children and adolescents, consistent with the temporal hypothesis (Cole, Peeke, Martin, Truglio, & Seroczynski, 1998). Finally, the socially anxious group comprised 8.7% of our sample, a rate that is consistent with recent epidemiological data for Social Phobia (Wittchen et al., 1999), particularly given males and females were combined in

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the current sample. Regarding grade, results revealed that youth in higher grades tended to report less family sociability than youth in lower grades. Additionally, youth in the eleventh grade reported perceiving less maternal concern for others’ opinions than youth in all other lower grades. A review of the relevant literature revealed that there are few studies examining age or grade effects on reports of family environment. One known study of age-related perceptions of family environment in youth found that negative perceptions of the family increased with age (Garnefski, 2000). This investigation, however, utilized youth ages 12– 18 and a 3-item checklist to assess family perceptions. Ages of youth in the present study spanned 9–17 years, and a more comprehensive measure of family environment was employed. Thus, the differing age ranges and measurement make comparisons between the studies difficult. Even so, the present findings are somewhat consistent with the aforementioned literature given that older youth reported lower levels of family sociability than younger youth. It should be noted that the present investigation does not allow for establishment of causality. Results suggest that negative perceptions of family environments are associated with anxious and depressive symptoms, not necessarily implying that negative environments cause psychopathology. On the contrary, the following four mechanisms may account for this relationship: (a) psychopathology in youth elicits negative parenting styles, (b) dysfunctional parenting produces psychopathology in offspring, (c) the relationship between parenting styles and youth psychopathology is mediated by an additional variable, such as locus of control, as suggested by Chorpita, Brown, and Barlow (1998), or (d) a third variable, such as parental psychopathology, contributes to the onset of both negative parenting practices and youth psychopathology. Future studies may attempt to establish causality by employing longitudinal designs or utilizing statistical analyses such as structural equation modeling. A second limitation of the present investigation was the utilization of a relatively new measure of perceived parenting, the Family Environment Questionnaire (FEQ), for which data to support its reliability and validity is lacking. Based on the current sample, a coefficients were moderate for the others’ opinion, shame, and family sociability subscales. Future studies might examine additional psychometric properties of the FEQ, such as test-retest reliability and construct validity, to better establish its merits for the assessment of family environment. Notably, though, the FEQ was a modified version of the Parent Attitudes Toward Child-Rearing Scale (Bruch et al., 1989), which does have data to support its psychometric strength (Bruch et al., 1989). Despite the limitations, the current study contributes to the existing research on family environment and anxious and depressive symptoms in several ways. Specifically, the present study extended previous literature utilizing almost exclusively adult populations to a youth population. In addition, the current study addressed concerns regarding memory bias in retrospective reports by employing a present-oriented methodology. Incorporation of family environment constructs that have been found to relate to social anxiety in previous literature

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(i.e., Bruch, 1989; Caster et al., 1999), thereby facilitating comparisons among studies in the literature, is also a strength of the present investigation. Furthermore, the exploration of gender differences was a unique contribution to this study, as few studies have studied gender with regard to perceived family environment. Lastly, a chief contribution of the present study was the inclusion of a comorbid socially anxious and depressed group that allowed for the delineation of family processes associated with social anxiety, depression, and comorbid psychopathology. In addition to the contributions the current study makes to the research literature, present results also have implications for the work of clinical or counseling psychologists. In particular, results suggest an association between aspects of the family environment and negative affectivity, particularly depression, in youth. Thus, it might benefit clinicians to spend time assessing the family environment of youth with internalizing problems. Clinicians may want to observe parent-youth interactions and consider the potential importance of incorporating a family therapy component into the treatment of youth experiencing socially anxious and/or depressive symptomatology. Acknowledgments The completion of this research project was supported by a National Institute of Mental Health Small Grant no. 5 R03 MH52638 02, awarded to the second author. References Alnaes, R., & Torgersen, S. (1988). Major depression, anxiety disorders and mixed conditions: Childhood and precipitating events. Acta Psychiatrica Scandinavia, 78, 632–638. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: Author. Arrindell, W. A., Emmelkamp, P. M. G., Monsma, A., & Brilman, E. (1983). The role of perceived parental rearing practices in the aetiology of phobic disorders: A controlled study. British Journal of Psychiatry, 143, 183–187. Barrera, M., Jr., & Garrison-Jones, C. (1992). Family and peer social support as specific correlates of adolescent depressive symptoms. Journal of Abnormal Child Psychology, 20, 1–16. Beidel, D. C., & Turner, S. M. (1988). Comorbidity of test anxiety and other anxiety disorders in children. Journal of Abnormal Child Psychology, 16, 275–287. Bernstein, G. A. (1991). Comorbidity and severity of anxiety and depressive disorders in a clinic sample. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 43–50. Bloom, B. L. (1985). A factor analysis of self-report measures of family functioning. Family Process, 24, 225–240. Boegels, S. M., van Oosten, A., Muris, P., & Smulders, D. (2001). Familial correlates of social anxiety in children and adolescents. Behaviour Research and Therapy, 39, 273–287. Bourdon, K. H., Boyd, J. H., Rae, D. S., Burns, B. J., Thompson, J. W., & Locke, B. Z. (1988). Gender differences in phobias: Results of the ECA community survey. Journal of Anxiety Disorders, 2, 227–241.

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