Integrating Etiological Models of Social Anxiety and Depression in Youth: Evidence for a Cumulative Interpersonal Risk Model

Abstract

Models of social anxiety and depression in youth have been developed separately, and they contain similar etiological influences. Given the high comorbidity of social anxiety and depression, we examine whether the posited etiological constructs are a correlate of, or a risk factor for, social anxiety and/or depression at the symptom level and the diagnostic level. We find core risk factors of temperament, genetics, and parent psychopathology (i.e., depression and anxiety) are neither necessary nor sufficient for the development of social anxiety and/or depression. Instead, aspects of children's relationships with parents and/or peers either mediates (i.e., explains) or moderates (i.e., interacts with) these core risks being related to social anxiety and/or depression. We then examine various parent- and peer-related constructs contained in the separate models of social anxiety and depression (i.e., parent-child attachment, parenting, social skill deficits, peer acceptance and rejection, peer victimization, friendships, and loneliness). Throughout our review, we report evidence for a Cumulative Interpersonal Risk model that incorporates both core risk factors and specific interpersonal risk factors. Most studies fail to consider comorbidity, thus little is known about the specificity of these various constructs to depression and/or social anxiety. However, we identify shared, differential, and cumulative risks, correlates, consequences, and protective factors. We then put forth demonstrated pathways for the development of depression, social anxiety, and their comorbidity. Implications for understanding comorbidity are highlighted throughout, as are theoretical and research directions for developing and refining models of social anxiety, depression, and their comorbidity. Prevention and treatment implications are also noted.

Central relaxin-3 receptor (RXFP3) activation reduces elevated, but not basal, anxiety-like behaviour in C57BL/6J mice

“…Anxiety disorders comprise a highly prevalent, heterogeneous group of clinically defined psychiatric conditions [1,2], which stem from a wide range of potential causes [3,4], and are often co-morbid with other psychiatric conditions such as addiction or mood disorders [5,6].…”

What It Means to Be an Adolescent Teacher-And-Peer-Independent Motivation Type

“…There are multiple factors, which have a significant impact on the development of youth depression. The effects of peer relationships have been found to be a mediator as well as a moderator in relation to youth depression (Epkins & Heckler, 2011). Over time, youth depression has been found to have an impact within the academic context (Boulard, Quertemont, Gauthier, & Born, 2012) not least through its association with emotional problems (Comer, 2010;Essau, 2007;Hazell, 2002), such as worry, unhappiness, clinginess, and fear (Goodman, Lamping, & Ploubidis, 2010).…”

Treatment Moderation and Secondary Outcomes: Results from a Randomized Clinical Trial

“…The principle of multifinality is relevant to the present discussion because social anxiety and depression are not only highly comorbid, but also have many similar interpersonal risk factors, such as social skills deficits and problematic peer-youth relationships (e.g., Epkins & Heckler, 2011).…”

“…This is an interesting finding also because it suggests that for boys, variables other than social anxiety mediate changes in depressive symptoms. This possibility indicates that there may be multiple and potentially different pathways that link social anxiety and depressive symptoms for girls versus boys (e.g., Cicchetti & Rogosch 1996;Cicchetti & Toth, 2009;Epkins & Heckler, 2011). …”

“…Anxiety and depressive symptoms, on the one hand, and anxiety symptoms and externalizing problem behaviors, on the other hand, could become linked when a third variables contributes to both anxiety and secondary problems, "creating a spurious effect, the illusion of a causal link in either direction that is actually related to unmeasured variables" (p. 734, Masten et al, 2005). For example, the risk literature for social anxiety and depressive symptoms provides potential common causes that could underlie relations among these symptoms, including social skills deficits, loneliness, and having few or no friends as three relevant risk markers (e.g., Epkins & Heckler, 2011). Similarly, the risk literature for anxiety and externalizing behaviors provides potential common causes that could underlie relations among these problems, including low socioeconomic status, low quality of parenting and parent-youth relationships (e.g., Masten et al, 2005).…”