We have previously demonstrated that calcium plus vitamin D supplementation during adolescent pregnancy reduces the magnitude of transient postpartum bone mass loss. In the present post hoc analysis, we further investigated the effect of calcium plus vitamin D supplementation during pregnancy in hip geometry throughout one year postpartum in Brazilian adolescents with low daily calcium intake (∼600 mg/d). Pregnant adolescents (14–19 years) were randomly assigned to receive calcium (600 mg/d) plus vitamin D3 (200 μg/d) or a placebo from 26 weeks of gestation until parturition. Dual-energy X-ray absorptiometry images were obtained at 5 (n 30 and 26 for calcium plus vitamin D and placebo, respectively), 20 (n 26 and 21) and 56 (n 18 and 12) weeks postpartum, and hip geometry parameters were analysed by Advanced Hip Assessment software. The effects of the intervention, time point and their interaction were assessed using repeated-measures mixed-effects models. No significant intervention effects or intervention × time interactions were observed on hip geometry parameters (P > 0·05). Time effects were observed in cross-sectional area, cross-sectional moment of inertia and section modulus parameters with decreases from the 5th to the 20th week postpartum followed by recovery from the 20th to the 56th week (P < 0·05). Our findings indicate that the postpartum period is associated with transient changes in the hip geometry of lactating adolescent mothers, regardless of the low calcium intake and the supplementation offered during pregnancy, suggesting that a physiological adaptation of these adolescents to low calcium intake is at play.

This study aimed to assess feasibility, acceptability and potential for impact of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA), a co-designed intervention for pregnant adolescents in Malawi. We used a mixed-methods interventional pre-post cohort design. We recruited pregnant adolescents from a rural health centre in Zomba district, Malawi, all of whom were offered a five-session psychosocial intervention delivered by community healthcare workers. Quantitative feasibility indicators related to participant enrolment, session attendance and intervention completion. Feasibility of intervention delivery was explored using in-depth semi-structured interviews with healthcare workers. Acceptability was investigated through in-depth semi-structured interviews with intervention participants and a service user satisfaction questionnaire. Intervention outcomes were assessed using standardised measures of common mental disorders, financial distress and poor mental health and perceived social support. 19 adolescents aged 15–19 years (mean=17.21, SD=1.18) started the intervention, with 18 (94.7%) completing the programme. Significant improvements (p<0.05) were reported across all outcome measures, with moderate to high pre-post effect sizes. Intervention participants reported high levels of service satisfaction, although healthcare workers (n = 6) reported that some feasibility challenges emerged during recruitment and delivery. The FOR MAMA intervention proved to be an acceptable and feasible psychosocial intervention for pregnant adolescents in Malawi.

Early life adversity (ELA) and youth chronic health conditions have been examined as separate contributors to psychopathology. However, little work has specifically examined early life health adversity (ELHA) and its association with risk for internalizing disorders. This study seeks to examine the relationship between ELHA and internalizing disorders across adolescence. A sample of 705 Australian mother–youth dyads participated in a prospective longitudinal study. Mothers reported child health indicators at youth ages three-to-four days, six months, and five years and completed a psychiatric interview at 15 years. Youth completed a psychiatric interview, as well as measures of current health status, at age 20. ELHA was positively associated with both youth anxiety and depressive disorders from ages 15 to 20. When independently accounting for the role of (a) current health status and (b) exposure to traditionally conceptualized forms of ELA, these findings remained statistically significant for anxiety but not depressive disorders. ELHA interacted with maternal depression, such that ELHA was only associated with youth depressive disorders in cases where mothers themselves had experienced depression. Routine mental health screenings may be warranted for youth who experience ELHA and their mothers. Pediatric primary care may be an ideal setting for implementing prevention and intervention efforts.

This study applies a comprehensive bioecological perspective to address a significant gap in the childhood adversity literature by employing latent profile analysis to examine the impact of diverse combinations of early childhood adversities and protective factors on adolescent psychosocial and behavioral outcomes. Drawing from the United Kingdom’s Millennium Cohort Study (N = 19,444), we identified eight unique profiles of early childhood adversity and protective factors. These profiles provide a nuanced understanding of adversity combinations and allow for differentiation between groups with similar profiles. Latent profile membership was a significant predictor of all adolescent outcome variables, indicating that profiles differed significantly from one another on psychosocial and behavioral outcomes (Wald values ranged from 10.10–623.22; p < .001). Some findings support the cumulative risk model, indicating that exposure to multiple early adversities increases the likelihood of adverse outcomes. However, we also found that specific adversities, such as parental psychopathology, parental alcohol use, and neighborhood deprivation, uniquely impact adolescent outcomes. This study highlights the necessity for tailored interventions and policies to support children with distinct early life experiences, emphasizing the importance of addressing both cumulative and specific adversities at multiple levels to prevent psychosocial and behavioral problems in adolescence.

The rates of anxiety and depression increase across adolescence, many experience recurrence after treatment, yet longitudinal studies examining promotive factors are scarce. We prospectively examined the role of the promotive factors structured style, personal and social competencies, family functioning, and social resources in homotypic and heterotypic continuity and discontinuity of anxiety and depression across three years in a clinical sample. Participants were adolescents with anxiety or depressive disorders aged 13–18 years at T1 (N = 717, 44% initial participation rate) and aged 16–21 years at T2 (N = 549, 80% follow-up participation rate). At T1, diagnoses were collected from medical records and participants responded to questionnaires. At T2, semi-structured diagnostic interviews were conducted. Higher levels of all promotive factors were associated with reduced probability of anxiety or depression three years later. The promotive factors were not associated with homotypic continuity of anxiety, whereas personal competence beliefs, social competence, and, less strongly, family functioning were associated with reduced homotypic continuity of depression and heterotypic continuity from depression to anxiety. Analyses with interaction terms did not indicate moderation by the promotive factors. Our findings suggest that bolstering promotive factors may be vital for increasing treatment success and preventing recurrence of anxiety and depression in the transition toward adulthood.

Rising rates of suicide fatality, attempts, and ideations among adolescents aged 10–19 over the past two decades represent a national public health priority. Theories that seek to understand suicidal ideation overwhelmingly focus on the transition from ideation to attempt and on a sole cognition: active suicidal ideation – the serious consideration of killing one’s self, with less attention to non-suicidal cognitions that emerge during adolescence that may have implications for suicidal behavior. A large body of research exists that characterizes adolescence not only as a period of heightened onset and prevalence of active suicidal ideation and the desire to no longer be alive (i.e., passive suicidal ideation), but also for non-suicidal cognitions about life and death. Our review synthesizes extant literature in the content, timing and mental imagery of thoughts adolescents have about their (1) life; and (2) mortality that may co-occur with active and passive suicidal ideation that have received limited attention in adolescent suicidology. Our “cognition-to-action framework for adolescent suicide prevention” builds on existing ideation-to-action theories to identify life and non-suicidal mortality cognitions during adolescence that represent potential leverage points for the prevention of attempted suicide and premature death during this period and across the life span.

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (Mage = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Dante Cicchetti propelled forward the field of developmental psychopathology by advancing this framework and championing new methods, including emphasizing the central role that multilevel analysis holds for explicating pathways of risk and resilience. His work continues to change the face of existing science. It has also paved the way for the formation of new projects, like the Research Domain Criteria initiative. This paper uses our laboratory’s work on multilevel approaches to studying adolescent depression, non-suicidal self-injury, and suicidal thoughts and behaviors to shine a spotlight on Dr Cicchetti’s contributions. In addition, we review recent developments, ongoing challenges, and promising future directions within developmental psychopathology as we endeavor to carry on the tradition of growth in the field.

Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals’ vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.

This study examined the predictors and sequelae of exposure to peer pressure from close friends in adolescence. Adolescents (99 female; 85 male) were followed from age 13 to 24 utilizing peer, parent, and romantic partner reports and observational data. Participants who were exposed to high levels of peer pressure as teens were more likely to experience higher levels of coercive behavior from romantic partners (as reported by those partners), as well as lower levels of parent-reported functional independence. All findings held even after accounting for baseline levels of teen assertiveness. Adolescents at risk for increasing exposure to peer pressure were characterized by poor-quality parent and peer relationships, as well as baseline deficits in ability to assert autonomy. Results suggest that exposure to peer pressure, aside from its potential effects on deviant or risky behavior, may reflect a powerful threat to the autonomy development process as adolescents transition from parents to peers as primary sources of support and interaction.

Adolescence is a period of substantial maturation in brain regions underlying Executive Functioning (EF). Adolescence is also associated with initiation and escalation of Alcohol Use (AU), and adolescent AU has been proposed to produce physiological and neurobiological events that derail healthy EF development. However, support has been mixed, which may be due to (1) failure to consider co-occurring externalizing symptoms (including other drug use) and poor social adaptation, and (2) heterogeneity and psychometric limitations in EF measures. We aimed to clarify the AU-EF association by: (1) distinguishing general externalizing symptoms from specific symptoms (AU, aggression, drug use) using bifactor modeling, (2) testing prospective associations between general externalizing symptoms and specific symptoms, and task-general EF, as indexed by a well-validated computational modeling framework (diffusion decision model), and (3) examining indirect pathways from externalizing symptoms to deficits in task-general EF through poor social adaptation. A high-risk longitudinal sample (N = 919) from the Michigan Longitudinal Study was assessed at four time-points spanning early adolescence (10–13 years) to young adulthood (22–25). Results suggested a critical role of social adaptation within peer and school contexts in promoting healthy EF. There was no evidence that specific, neurotoxic effects of alcohol or drug use derailed task-general EF development.

This study provides insights into the roles played by perceived stress and social support in the relationship between cumulative risk exposure (CRE) and adolescent emotional distress. Preregistered longitudinal moderated mediation analyses were used to test hypotheses relating to the association between CRE and later emotional distress; the mediating role of perceived stress in the relationship between CRE and later emotional distress; and, the moderating effects of peer and adult-level family support on the relationship between CRE and later perceived stress, among N = 19,159 adolescents over three annual waves (at ages 11/12, 12/13, 13/14). Analyses revealed that CRE significantly predicted later adolescent emotional distress. This relationship was partially mediated by perceived stress. Both peer and adult-level family support significantly moderated the impact of CRE on later perceived stress (i.e., adolescents reporting higher levels of support perceived significantly lower levels of stress resulting from CRE compared to those reporting lower levels of support). These findings provide critical empirical evidence of the roles played by perceived stress and social support in the relationship between CRE and adolescent emotional distress, with consequent implications for intervention.

Childhood adversities have been linked to psychosocial outcomes, but it remains uncertain whether subtypes of adversity exert different effects on outcomes. Research is also needed to explore the dynamic interplay between adversity and psychosocial outcomes from childhood to mid-adolescence. This study aimed to investigate these relationships and their role in shaping adolescent wellbeing. Data were extracted from three timepoints of the UK Household Longitudinal Survey when participants (n = 646) were aged 10–15. Cross-lagged panel models were used to explore the relationship between cumulative adversities, and separately non-household (i.e., bullying victimization and adverse neighborhood) and household (i.e., sibling victimization, quarrelsome relationship with parents, financial struggles, and maternal psychological distress) adversities, and psychosocial outcomes (i.e., internalizing and externalizing problems, delinquency, and life satisfaction). Our results revealed that heightened cumulative adversity predicted psychosocial outcomes from childhood to mid-adolescence. Increased levels of household adversity predicted psychosocial outcomes throughout early to mid-adolescence, while non-household adversity only predicted psychosocial outcomes in early adolescence. Furthermore, worse psychosocial outcomes predicted higher levels of adversities during adolescence, highlighting bidirectionality between adversity and psychosocial outcomes. These findings underscore the varying impacts of adversity subtypes and the mutually reinforcing effects of adversities and psychosocial functioning from childhood to mid-adolescence.