Chronic Family Economic Hardship, Family …getd.libs.uga.edu/pdfs/lee_tae-kyoung_201108_ms.pdfChronic Family Economic Hardship, Family Processes and Progression of Physical and Mental

Chronic Family Economic Hardship, Family Processes and Progression of Physical and

Mental Health Problems in Adolescent Years

by

TAE KYOUNG LEE

(Under the Direction of K. A. S. Wickrama)

ABSTRACT

The purpose of the present study are to address the unique effects of chronic family

economic hardship as they influence marital conflict, supportive parenting, and adolescents’

anxiety, depressive symptoms, and physical complaints. To find unique pathways, the current

study also added the direct and indirect influence by using an SEM framework. The current study

analyzed data from a longitudinal sample of mothers, fathers, and target adolescents (N= 404-

451) to assess theoretical pathways. Findings generally supported the hypothesized model.

Chronic family economic hardship contributed to mental and physical health of adolescents. This

influence was largely mediated through supportive parenting. Moreover, supportive parenting

buffered marital conflict on depressive symptoms of adolescents. Adolescent females are more

vulnerable to health problems such as anxiety, depressive symptoms, and physical complaints in

several time points. The study demonstrates key mediating pathways based on family stress

model and also highlights the importance of improving health resources for adolescents.

INDEX WORDS: Chronic family economic hardships, Marital conflicts, Supportive parenting,

Adolescents, Anxiety, Depressive Symptoms, Physical Complaints and

Longitudinal data.

Chronic Family Economic Hardship, Family Processes and Progression of Physical and

Mental Health Problems in Adolescent Years

by

TAE KYOUNG LEE

B.S., CATHOLIC UNIVERSITY OF DAEGU, S. KOREA, 2004

M.A., SUNKYUNKWAN UNIVERSITY, S.KOREA, 2006

A Thesis Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment

of the Requirements for the Degree

MASTER OF SCIENCE

ATHENS, GEORGIA

2011

© 2011

Tae Kyoung Lee

All Rights Reserved

Chronic Family Economic Hardship, Family Processes and Progression

of Physical and Mental Health Problems in Adolescent Years

by

TAE KYOUNG LEE

Major Professor: K.A.S. Wickrama

Committee: Lesile Gordon Simons Ronald L Simons Electronic Version Approved: Maureen Grasso Dean of the Graduate School The University of Georgia August 2011

iv

DEDICATION

This is dedicated to my wife who always pushed me to do my best. I am so thankful to

have had such a strong and loving my wife supporting me along the way.

v

ACKNOWLEDGEMENTS

With grateful heart, I would like to express my sincerest thanks to my major professor,

Dr. K. A. S. Wickrama, whose expert guidance, mentorship, inspiration, and encouragement

have given me the utmost support I needed to complete my degree. The experiences of working,

learning, and discussing with him across the years of my master training have made my graduate

education a meaningful and an enjoyable journey. Thank you for the unwavering mentorship,

thoughtful feedbacks, encouragement, and support. I also wish to thank my POS committee

members: Dr. Leslie Gordon Simons, Dr. Ronald Simons, who provided constructive insights

and time for this thesis.

For my friends in Athens, in other part of U.S., and abroad, thank you for listening and

updating me with life outside the academia. Most importantly, none of this would have been

possible without the love, support, patience, and continuous encouragement from my wonderful

wife, Ji-yeong Lee, and parents, Chang-gi Lee and Yeon-hee Kim, to whom I dedicate this

dissertation.

vi

TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS .............................................................................................................v

LIST OF TABLES ......................................................................................................................... ix

LIST OF FIGURES .........................................................................................................................x

CHAPTER

1 INTRODUCTION ........................................................................................................1

Indirect Influence of Chronic Family Economic Hardships on Adolescents’

Mental Health through Marital Conflict ....................................................2

Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Mental

Health Problems through Supportive Parenting .........................................3

Indirect Influence of Marital Conflict on Adolescents’ Mental Health Problems

through Supportive Parenting ....................................................................4

Indirect Influence of Chronic Family Economic Hardship on Adolescents’

Physical Complaints through Marital Conflict ..........................................5

Indirect Influence of Chronic Family Economic Hardship on Adolescents’

Physical Complaints through Supportive Parenting ..................................6

Indirect Influence of Marital Conflict on Adolescents’ Physical Complaints

through Supportive Parenting ....................................................................6

Associations among Adolescents’ Anxiety, Depression, and Physical Complaints

over Time ...................................................................................................7

vii

Moderating Influence of Chronic Family Economic Hardship on Adolescents’

Health Problems through Supportive Parenting .........................................8

Moderating Influence of Supportive Parenting on the Association between Marital

Conflict and Adolescent’s Health Problems ..............................................9

Gender Differences ..........................................................................................................10

Control Variables .............................................................................................................10

Study Objectives ..............................................................................................................11

2 LITERATURE REVIEW ...........................................................................................12

The Theoretical Model ..........................................................................................12

The Association between Chronic Family Economic Hardship and Adolescents’

Health Problems .......................................................................................12

The Associations among Chronic Family Economic Hardship, Marital conflict,

and Adolescents’ Health Problems ..........................................................14

The Associations among Chronic Family Economic Hardship, Supportive

Parenting, and Adolescents’ Health Problems .........................................14

The Associations among Marital Conflicts, Supportive Parenting, and

Adolescents’ Health Problems ................................................................15

The Associations among Anxiety, Depressive Symptom, and Physical Complaints

over Time ................................................................................................16

Moderating Effect of Supportive Parenting on the Association between Chronic

Family Economic Hardship and Adolescents’ Health Problems .............20

Moderating Effect of Supportive Parenting on the Association between Marital

Conflicts and Adolescents’ Health Problems ...........................................20

viii

Gender Moderation on the Associations among Chronic Family Economic

Hardships, Marital Conflicts, Supportive Parenting, and Adolescents’ Health

Problems ................................................................................................................21

Study Control .......................................................................................................23

Specific Study Hypotheses ....................................................................................23

3 METHOD AND MEASUREMENTS ........................................................................25

Sample ...................................................................................................................25

Procedure ..............................................................................................................26

Measures ................................................................................................................27

Analytical Plan ......................................................................................................30

4 RESULTS ...................................................................................................................36

Descriptive Statistics of Study Variables ..............................................................36

Correlations among Study Variables .....................................................................37

Testing Specific Hypotheses ..................................................................................38

5 DISCUSSION ..............................................................................................................51

Summary and Understanding the Research Findings ...........................................51

Implications of the Current Study .........................................................................57

Limitations and Future Works for Current Study .................................................58

REFERENCES ..............................................................................................................................81

ix

LIST OF TABLES

Page

Table 1: Descriptive Statistics of Study Samples ..........................................................................61

Table 2: Mean Differences between Male and Female among Health Problems ..........................62

Table 3: Correlations among Study Variables ..............................................................................63

Table 4: Moderating Effects of Supportive Parenting ..................................................................64

Table 5: Gender Difference of Health Problems ...........................................................................65

Table 6: Gender Difference of the Hypothesized Path Model ......................................................66

Table 7: Univariate Growth Curves Model ..................................................................................67

x

LIST OF FIGURES

Page

Figure 1: Theoretical Model .........................................................................................................68

Figure 2: Operationalized Model ..................................................................................................69

Figure 3: Basic Mediational Structure for Sobel Test ..................................................................70

Figure 4: Direct Influence of Chronic Family Economic Hardship on Adolescents’ Health

Problems .....................................................................................................................71

Figure 5: Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Health

Problems through Marital Conflict ...............................................................................72

Figure 6: Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Health

Problems through Supportive Parenting ......................................................................73

Figure 7: Indirect Influence of Marital Conflict on Adolescents’ Health Problems through

Supportive Parenting ....................................................................................................74

Figure 8: The Operationalized Associations of the Current Study ...............................................75

Figure 9: Supportive Parenting Moderation of Marital Conflict on Adolescents’ Depression .....76

Figure 10: Moderating Effect of Gender Difference on Adolescents’ Health Problems ...............77

Figure 11: Gender Difference on the Associations among Chronic Family Economic Hardship,

Marital Conflicts, Supportive Parenting, and Adolescents’ Health Problems .............78

Figure 12: Gender Difference of Chronic Family Economic Hardship on Depression ................79

Figure 13: Hypothesized Interlocking Model ...............................................................................80

1

CHAPTER 1

INTRODUCTION

Poverty creates enormous challenges for families and living in poverty is associated with

adverse outcomes for adolescents. Living in poverty produces a “conglomeration of stressful

conditions and events” (McLoyd, 1990, p. 314) causing chronic financial hardship. Numerous

studies have been identified that explain the negative effects of economic hardship on children

and adolescents. For example, Adolescents who grow up poor are at heightened risk for a wide

range of psychological problems (e.g., McLoyd, 1998), physical health problems (Wickrama,

Conger, & Abraham, 2005), academic problems (Conger & Donnellan, 2007), alcohol use

(Conger, Lorenz, Elder, Melby, Simons, & Conger, 1991), and vandalism (Moffitt, 1993;

Patterson et al., 1989).

Previous psychological research suggests that anxiety, depression, and physical

complaints are serious health problems among youth (Jacques & Mash, 2004; Simeonsson,

McMillen, & Huntington, 2002; Wittchen, Kessler, Pfister, & Lieb, 2000). In the case of

adolescents’ psychological problems, Beck and Steer (1987) advance depression is associated

with ‘perceived loss’; whereas, anxiety is associated with ‘perceived threat’. However, such

mediating psychological constructs have rarely been used to characterize adolescents’ adverse

family experiences, or to link such experiences specifically with depression and anxiety.

Therefore, this study proposes that adolescents may perceive family economic problems as a loss

in terms of access to material needs, and an ability to develop friendships and close relationships,

which may result in feelings of depression. Also, adolescents may perceive family economic

2

problems as a threat anxiety to successfully transition to adulthood, due to excessive working

hours to earn money, and the possibility of truncating their education. Also, adolescents may

experience threatening family and community events, and circumstances associated with their

family’s adverse economic conditions. Thus, this study suspects that family economic hardship

may directly generate feelings of threat, independent of feelings of depression.

In addition, family economic hardship influences adolescent physical health through a

lack of accessibility and availability of health resources, such as health insurance, medication,

food, and clothing. Also, poor families often live in sub-standard housing and hazardous

environments (Miech, Caspi, Moffit, Wright, & Silva, 1999). In addition, family economic

hardship as a chronic stressor disrupts physiological functions (Lynch, Kaplan, & Shema, 1997).

Thus, consistent with these findings, this study will examine the direct influence of chronic

family economic hardships on adolescents’ health problems (i.e., anxiety, depression, and

physical complaints).

Indirect Influence of Chronic Family Economic Hardships on Adolescents’ Mental Health

through Marital Conflict

Some investigators suggest that socioeconomic factors may impact marital quality

(Piotrkowski, Rapoport, & Rapoport, 1987). For example, Atkinson, Liem, and Liem(1986)

found a significant inverse association between duration of unemployment and marital quality.

Larson (1984) found mean differences between groups of employed and unemployed spouses for

total dyadic adjustment, but not for the satisfaction, affection, or cohesion subscales of the

dyadic adjustment scale. Consistent with these ideas, research evidence continues to accumulate,

suggesting that economic hardship has an adverse influence on the quality of marital

relationships (Brody, Stoneman, Flor, McCrary, Hastings, & Conyers, 1994; Conger et al., 1990).

3

Furthermore, earlier studies have provided evidence for the association between parents’

marital problems and adolescent maladjustment. Exposure to high levels of marital conflict of

parents is associated with the development of a wide variety of difficulties for adolescents’

mental problems, such as anxiety and depressive symptoms (e.g., Cummings & Davies, 1994;

Gottman & Notarius, 2000). Many studies have demonstrated that adolescents’ mental problems

are most likely to occur when a marital relationship is intense and openly hostile (Buehler,

Krishnakumar, Stone, Anthony, Pemberton, & Gerard, 1998; Jenkins, 2000). With these ideas in

mind, the current study examines whether economic hardship influences adolescents’ depressive

symptoms and anxiety indirectly through their parents’ marital conflicts.

Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Mental Health

Problems through Supportive Parenting

Previous research has shown that family economic hardship has a consistent impact on

parenting practices (Conger, Ge, Elder, Lorenz, & Simons, 1994; McLoyd, 1990; Simons,

Lorenz, Conger, & Wu, 1992). In particular, the frustration produced by economic hardship

fosters an irritable, aggressive psychological state in parents that operates to decrease warmth

displayed toward others, including their children (Simon et al., 1990). Also, research reports that

a low level of supportive parenting was judged by their adolescents to be more authoritarian in

their exercise of authority within the home (Buri, Cooper, Ricktsmeier, & Komer, 1991; Simons

et al., 1992).

Several studies have shown that retrospectively reported adverse threatening events and

circumstances associated with family adversity, such as family disruptions, were related to

anxiety disorders (Schwarts, Snidman, & Kagan, 1999; Rapee & Heimberg, 1997). However,

less has been written about the family precursors of anxiety than depression in mental health

4

problems. Specifically, there is a paucity of research on anxiety associated with family adversity.

In addition, most adolescent research on anxiety is also limited by either clinical or cross-

sectional samples. Therefore, this study will examine chronic economic hardship influences

adolescents’ depressive symptoms, as well as anxiety through supportive parenting.

Indirect Influence of Marital Conflict on Adolescents’ Mental Health Problems

through Supportive Parenting

Many studies suggest marital conflict influences adolescent mental problem through

parenting (Conger et al., 1992, 1993; Conger, Ge, Elder, Lorenz, & Simons, 1994; Kitzmann,

2000). For example, Caspi and Elder (1988) found that marital conflict influenced adolescent

mental problems indirectly through its effect on parenting practices. In addition, evidence for the

mediating role of parenting has also been provided by Conger and his colleagues (Conger, Ge,

Elder, Lorenz, & Simons, 1994). In particular, Harold and Conger (1997) found that marital

conflict indirectly predicted increases in adolescents’ internalizing problems through a low level

of supportive parenting.

Most of these previous studies are consistent with the “disrupted discipline hypothesis”

(Emery, 1982), which proposes that conflict and distress in the marital relationship lead to

negative behaviors in parenting, such as inconsistency, rejection, hostility, and harsh discipline.

However, these studies have primarily focused on the negative dimensions of parenting and did

not examine the positive dimensions of parenting behavior. The “loss of love” hypothesis

(Emery & O’Leary, 1982) proposes that parents’ marital problems reduce their warm and

supportive parenting behavior, which, in turn, leads to adjustment problems for children and

adolescents. Therefore, the present study will examine marital conflict influences adolescents’

mental problems through supportive parenting.

5

Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Physical

Complaints through Marital Conflict

Previous studies showed that adolescents who live in families characterized by high

levels of inter-parental conflict have been found at increased risk of adolescents’ negative

adjustment outcomes (see Cummings & Davies, 1994) and physical problems (Nicolotti, El-

Sheikh, &Whitson, 2003). There is evidence that children’s physical health is negatively affected

by marital conflict (Campbell & Lewandowski, 1997; Wadsworth, 1997). Children exposed to

parental problems, such as marital conflict, have more health problems, including mild ailments

and more serious conditions, than children from intact homes (Mauldon, 1990).

Stressful family circumstances, such as parents’ marital conflicts, can contribute to the

physical complaints of adolescents through physiological mechanisms (Bradley & Corwyn,

2002). In detail, Dowd and Goldman (2006) reported that chronic stressors disrupt the body’s

physiological functions because they involve an allostatic load, defined as the cumulative wear

and tear on the body’s systems owing to repeated adaptations to stressors, such as family

economic hardship. This stress-ill health physiological connection may be attributed to hormonal

responses resulting in adverse health outcomes, including high blood pressure, high heart rate,

glucose intolerance, abdominal obesity, elevated low-density lipoprotein (LDL) cholesterol, and

lowered high-density lipoprotein (HDL) cholesterol. These health problems may underlie

adolescents’ physical complaints.

By identifying an association between family economic hardship and physical health

problems, the research focus has shifted to consider the processes underlying this relationship

with particular attention to possible mediating role of parents’ marital conflicts (Frosch &

6

Mangelsdorf, 2001). Thus, this study will examine whether family economic hardship can

influence adolescents’ physical complaints indirectly through marital conflict.

Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Physical

Complaints through Supportive Parenting

Physical complaints are influenced by parenting style (e.g., Eiser & Havermans, 1992;

Hamlett, Pellegrini, & Katz, 1992). In fact, one of the most reliable predictors of adolescents’

adjustment to physical complaints is parenting behaviors (Elliott & Mullins, 2004). Furthermore,

parenting behaviors have been hypothesized to influence physical complaints by the adverse

effects of stressful family events (Wickrama, Conger, & Lorez, 1995).

Although previous developmental studies imply associations among adolescents’

physical complaints, parenting, and family economic hardships, there is very little empirical

research on these associations, including supportive parenting as social support (Vilhjalmsson,

1994). With these ideas in mind, this study examines family economic hardship can influence

adolescents’ physical complaints through supportive parenting.

Indirect Influence of Marital Conflict on Adolescents’ Physical Complaints

through Supportive Parenting

Mechanisms identified as mediating the effects of marital conflict on adolescents’

adjustment include adolescents’ appraisals for parenting (e.g., Harold, & Conger, 1997).

Especially, in the context of marital conflict, previous research found a significant association

between parental support and adolescent reports of physical complaints or well-being. In

particular, parental support reduced physical health problems during adolescence (Wickrama,

Lorenz, Conger, & Elder, 1997; Rogers & Holmbeck, 1997). Moreover, Radovanovic (1993)

7

suggested that positive social support, such as parental support, was negatively related to

adolescent health problems in conflicted families.

Although previous studies imply associations among marital conflict, supportive

parenting, and adolescent’s physical complaints, most of these studies have empirically tended

towards the influence on mental health outcomes (Conger, & Elder, 1994). Although mental

health outcomes may be associated with physical health status (Vilhjalmsson, & Thorlindsson,

1998), there are few empirical studies that focus on physical health over the adolescent years.

Hence, this study examines whether marital conflict influences adolescents’ physical complaints

through supportive parenting.

Associations among Adolescents’ Anxiety, Depression, and Physical Complaints over Time

According to the National Comorbidity Survey (Kessler & Walters, 1998), the lifetime

prevalence rate of depression in adolescents aged 15 to 18 years is 14%, and an estimated 20% of

these adolescents will have had a depressive disorder by the time they are 18 years old. Anxiety

disorders have a lifetime prevalence rate of approximately 20% and exhibit a significant degree

of stability across a lifespan (Costello, Edelbrock, & Costello, 2005). Adolescents with either

major depression or anxiety symptoms are at risk for a variety of negative outcomes, including

academic achievement (Boivin, Hymel, & Hodges 2001; Juvonen, Nishina, & Graham, 2000),

self-esteem (Muris, Schmidt, Lambrichs, & Meesters, 2001), substance abuse (O'Neil, Conner, &

Kendall, 2011), and relationship problems (Cole & Carpentieri, 1993).

Furthermore, adolescent depression and anxiety disorders highly co-occur as well as with

other psychiatric disorders (Angold, Costello, Farmer, Burns, & Erkanli, 1999). Research has

shown the odds ratio of co-occurring anxiety given a depressive disorder are as high as 30.0.

Also, depression and anxiety disorders are more likely to co-occur rather than with other

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8

psychiatric disorders, such as attention-deficit hyperactivity disorder, disruptive behavior

disorders, or substance use disorders (Messer, Angold, Costello, & Burns, 2003).

One of the most important issues in the psychological development of adolescents is

associated with physical health problems (Simeonsson et al., 2002). Conversely, poor physical

health can also involve an array of psychological problems (Lewinsohn, Rohde, Seeley, & Fisher,

1993). Studies conducted over the last few decades have consistently shown that children and

youth with physical health problems are at an increased risk for developing psychological

problems (McDougall, King, de Wit, Miller, Hong, Offord, Laporta, & Meyer, 2004; Newacheck,

McManus, & Fox, 1991). A meta-analytic review of 87 studies revealed that youth with physical

health problems are significantly more likely to exhibit symptoms of psychological problems,

such as depression and anxiety. (Boekaerts & Roeder, 1999).

Given the significantly high prevalence, recurrence, and co-occurrence of depressive

symptoms, as well as anxiety and physical health problems during adolescence, it is important to

understand the inter-related health processes involving the three different health domains in

adolescents over this period. However, most research has focused on a single health domain of

adolescents—depression, physical health problems, but rarely anxiety. Therefore, this study

focuses on how depression, anxiety, and physical complaints mutually influence one another

over time, as an inter-related health process.

Moderating Influence of Chronic Family Economic Hardship on Adolescents’ Health

Problems through Supportive Parenting

The influence of economic hardship on adolescents’ health problems may vary,

depending on the level of supportive parenting. Consistent with the risk-resource perspective,

family economic hardships can be considered a factor that places adolescents at risk for mental

9

and physical health problems, while supportive parenting can be considered a resource factor

which protects and moderates the risk of family economic hardships. Rogers and White (1998)

reported that effective parenting is a buffer for children’s maladjustments, since attentive parents

take the time to reason and help their children develop effective problem-solving skills. Such

moderating effects are deemed important in the developmental literature on adolescents’ health

problems. However, they are still understudied and are infrequently found in the literature on

adolescents’ health problems (Luthar, Cicchetti, & Becker, 2000; Masten, 2001). To address this

need, the moderating effect of supportive parenting on the association between family economic

hardships and adolescents’ health problems (i.e., anxiety, depressive symptom, and physical

complaints) will be examined in this study.

Moderating Influence of Supportive Parenting on the Association between Marital Conflict

and Adolescent’s Health Problems

Prior studies suggest parenting behavior might moderate the association between marital

conflict and adolescents’ health problems. Gordis, Margolin, and John (1997) reported the

interaction between marital problems and parental behavior toward a child accounted for a

significant variance in adolescent’s maladjustment. Frosch and Mangelsdorf (2001) also found

that a mother’s supportive parenting moderated the association between marital conflict and

children’s problems. However, they did not find this moderating effect for adolescent health

problems, such as depressive symptoms, anxiety, and physical complaints. Given these findings

in the literature regarding the moderating effects of supportive parenting, the present study

examines whether the association between marital problems and adolescent health problems is

moderated by supportive parenting.

10

Gender Differences

In addition, Phillips and Diaz (1997) reported that gender difference is an important

marker to understand adolescents’ mental health problems, such as depressive symptoms and

anxiety. In their study, female’s comorbidity of depressive symptoms and anxiety was usually

higher than male’s comorbidity of these mental health problems. Moreover, Silverstein and

Lynch (1998) found evidence the high prevalence of clinical and subclinical depression that

arises among females is of the anxious somatic depression type, involving depression coupled

with anxiety and physical complaints (e.g. coughs, headaches, and fatigue). Therefore, this study

will examine potential gender differences on the association among depressive symptoms,

anxiety, and physical complaints.

Moreover, previous research suggests that economic stress may affect males and females

differently (Bolger, Patterson, & Kupersmidt, 1995; Conger et al., 1993; Elder & Caspi, 1988).

In general, prior work indicates that young males may be more vulnerable to family economic

stress than females (Bolger, Patterson, & Kupersmidt, 1995; Patterson, Vaden, Griesler, &

Kupersmidt, 1991). Therefore, the present study will also examine how gender moderates the

association among family economic hardship, supportive parenting, marital conflict, and

adolescents’ health problems (i.e., depressive symptoms, anxiety, and physical complaints).

Control Variables

Additionally, many previous studies support the view that the parental level of education

can significantly predict adolescents’ mental problems, such as anxiety and depressive symptoms,

as well as physical health problems, such as physical complaints (Donohue, Romero, & Hill,

2006; Wickrama, Conger, Lorenz, & Elder, 1998). Moreover, the research has shown that

parental depression can negatively influence their children’s health problems (Mustillo et al.,

11

2009). Therefore, this study will use parental education and parental depression as a control

variable to assess the uniqueness of the association among depressive symptoms, anxiety,

physical complaints, family economic hardship, and supportive parenting.

Study Objectives

The current study’s objectives are as follows:

1. To investigate the direct influence of family economic hardships on each—depression,

anxiety, and physical complaints.

2. To investigate the indirect influence of chronic family economic hardships on

depression, anxiety, and physical complaints through supportive parenting.

3. To investigate the indirect influence of chronic family economic hardships on

depression, anxiety, and physical complaints through marital conflicts.

4. To investigate the indirect influence of marital conflicts on depression, anxiety, and

physical complaints through supportive parenting.

5. To investigate the longitudinal mutual influences among depression, anxiety, and

physical complaints over the adolescent years.

6. To investigate the moderating effect of supportive parenting on the associations

among family economic hardships and adolescents’ health problems.

7. To investigate the moderating effect of supportive parenting on the associations

among marital conflicts and adolescents’ health problems

8. To investigate the gender difference in associations among adolescents’ health

problems.

9. To investigate the gender difference in pathways among family economic hardship,

marital conflicts, supportive parenting, and adolescents’ health problems.

12

CHAPTER 2

LITERATURE REVIEW

The Theoretical Model

Figure 1 shows the theoretical model for the current study. The theoretical model depicts

family economic hardships directly and indirectly influences adolescents’ anxiety, the levels of

depressive symptoms, and physical health problems through marital conflicts and supportive

parenting. Anxiety, depression, and physical complaints are contemporaneously associated with

each other. Cross-lagged paths depict the influence of early health problems in one domain on

change in health problems in another domain over time. The paragraphs that follow will discuss

all of the constructs and hypothesized associations for this model.

The Association between Chronic Family Economic Hardship

and Adolescents’ Health Problems

Socioeconomic health disparities appear to have increased in recent decades, due to

widening socioeconomic inequalities (Kahn & Fazio, 2005; Pappas, Queen, Hadden, & Fisher,

1993). Hence, the relationship between family-of-origin adversity and youth mental health is

vital to understand the progression of mental and physical health across a lifespan (Repetti,

Taylor, & Seeman, 2002; Wickrama et al., 2008b). Existing research suggests that family

socioeconomic adversity contributes to many domains associated with adolescent’s mental health

problems, such as anxiety and depressive symptoms (Conger et al., 1993). Adolescents become

more susceptible to family disadvantages during adolescence, due to dramatic increases in the

salience of family economic resources (Halpern-Felsher et al., 1997). In addition, adolescents

13

experience normative stressful circumstances during this period, including physical changes (e.g.,

puberty) and changes in social-family relationships (Conger & Ge, 1999). Therefore, a family’s

stressful circumstances may contribute to diminished psychological resources, an increased sense

of continuing entrapment, feelings of anger, hopelessness, frustration, and other negative

emotions among youth. In addition, parents with low-incomes are more likely to experience

mental health problems and chaotic lifestyles, which may transmit directly to their children

(Wickrama, Conger, Wallace, & Elder, 1999; Lempers, Clark-Lempers, & Simons, 1989).

Moreover, Pless and Nolan (1991), in their review of maladjustment for children and youth with

chronic physical health problems, suggest that socioeconomic status may play an important role

in their physical health problems. McDougall et al. (2004) also reported that children and youth

with chronic physical health problems are at increased risk of living in families that receive

welfare income or who are below the poverty level and, at the same time, are also shown to be at

increased risk for emotional problems.

Pless and Nolan (1991), in their review of maladjustment for children and youth with

chronic physical health problems, suggest that socioeconomic status may play an important role

in their physical health problems. Moreover, as I discussed previously in case of marital conflict,

chronic family economic hardship may also disrupt the body’s physiological functions and

results in negative physical health outcomes because it involve allostatic load. McDougall et al.

(2004) also reported that children and youth with chronic physical health problems are at

increased risk of living in families that receive welfare income or who are below the poverty

level and, at the same time, are also shown to be at increased risk for emotional problems.

Therefore, this study proposes that economic hardship would also have a direct effect on

adolescents' mental and physical complaints.

14

The Associations among Chronic Family Economic Hardship, Marital Conflicts, and

Adolescents’ Health Problems

Although there is some evidence that chronic economic stress has a direct impact on

adolescents’ health problems (McLoyd, 1990), adverse financial circumstances could affect

adolescents’ health problems through the quality of family interactions primarily through

emotions and cognitions that reflect their awareness of and responses to economic difficulties.

Considerable research notes that economic factors play an important role in the dynamics of

parents’ marital relationships, and children’s mental and physical problems (Conger & Conger,

2002; Conger et al., 1994, 2002). For example, research suggests the marital dyad is a critical

point of entry for adverse economic influences that eventually affect physical complaints (El-

Sheikh, Harger, & Whitson, 2001) and mental problems (Elder & Caspi, 1988). However, there

is very little empirical research on the relationships among these variables for adolescents.

Therefore, this study proposes that family economic hardships indirectly influence adolescents’

health problems through parents’ marital conflict.

The Associations among Chronic Family Economic Hardship, Supportive Parenting,


Previous research suggests that economic pressure is linked to adolescent adjustment

through parental behavior. For example, Patterson et al. (1989) argued that stressful family

circumstances have their greatest impact on children and adolescents through disruptions in

parent-child relations and effective parenting behaviors. Supportive parenting can have positive

effects on various aspects of adolescents’ health (Amlund, Hagen, Myers, & Mackintosh, 2005;

Leinonen, Solantaus, & Punamaki, 2003). For example, supportive parenting can reduce

adolescents’ mental health (Petersen, Sarigiani, & Kennedy, 1991) and physical health problems

15

(Wicrama, Lorenz, & Conger, 1997). Piko (2000) also reported that a low level of parental

support increased the risk of children’s maladjustment. Moreover, according to Robila and

Krishnakumar (2005), financial strain is associated with lowered social support. Financial

problems, as stated by Ge, Conger, Lorenz, and Simons (1994), are related to disruptive

parenting practices. Parental unemployment, as a possible source of stress and financial strain,

can thus negatively influence the amount of support provided to adolescents by their parents.

Taken together, previous studies provide support for the pathway from family economic

hardships, through supportive parenting to adolescents’ health problems. Thus, this study

proposes that chronic family economic hardships influence adolescents’ health problems

through supportive parenting.

The Associations among Marital Conflicts, Supportive Parenting,


Several researchers have suggested the relationship between marital conflict and youth

maladjustment may be mediated by parenting behaviors (Bray & Hetherington, 1993; Gable,

Belsky, & Crnic, 1992). Research has documented a significant association between parents and

selected parenting behaviors. Parenting behaviors and youth maladjustment are also related

(Gable et al., 1992). Specifically, marital conflict is associated negatively with parental support

(Conger et al., 1993; Fauber et al., 1990). In turn, parental support and responsiveness are

associated with psychological problems (Melby, Conger, Conger, & Lorenz, 1993) and physical

complaints (Katz & Gottman, 1997).

Although there has been some conflicting evidence on this association (Peterson & Zill,

1986), most studies have found that much of the relationship between marital conflict and youth

maladjustment is mediated by parenting behaviors (Bray & Hetherington, 1993; Cole &

16

McPherson, 1993). Therefore, the current study proposes the association between marital

conflict and adolescents’ health problems can be mediated by supportive parenting.

The Associations among Anxiety, Depressive Symptom, and Physical Complaints

over Time

Recently, the existing base of empirical evidence has established that depressive

symptom (Gutman & Sameroff, 2004; Lewinsohn et al., 1993), anxiety (Barnow, Lucht, &

Freyherger, 2005; Moffitt, 1993), and physical complaints (Ajdacic-Gross et al., 2006) show a

significant increase in both prevalence and incidence during adolescence. The time-related

developmental patterning raises questions about the relationships among anxiety, depressive

symptoms, and physical complaints during adolescence (Katon, Elizabeth, Lin, & Kroenke,

2007). Previous research focused on late childhood and adolescence suggests that constructs for

child anxiety and depressive symptoms are distinguishable and covary at dimensional and

categorical levels (Lonigan, Phillips, & Hooe, 2003). Additionally, many studies have reported

heterotypic continuity of psychiatric problems in childhood and adolescence. For example,

Lewinsohn, Klein, and Seeley (1995) found that anxiety symptoms precede and predict

subsequent depressive symptoms. Moreover, other research in the Christchurch Health and

Development Study shows that levels of ‘anxious and withdrawn’ behaviors at age 8 predicted

risk for major depression in late adolescence and early adulthood (Goodwin et al., 2004).

Reinherz et al. (1989) also found that self-reported symptoms of anxiety at age 9 predicted self-

reported symptoms of depression at age 15. Indeed, early symptoms of anxiety more than

doubled the likelihood of later depressive symptoms. Similar results emerged between ages 15

and 18 at a later stage of the same study (Reinherz et al., 1993). Snyder et al. (2009) indicated

that earlier anxiety symptoms facilitate subsequent depressive symptoms. However, other studies

have shown that early depressive symptoms predict changes in anxiety. In a study of consecutive

17

adolescent referrals to psychiatric clinics, Sanford et al. (1995) noted that depression at outcome

(1 year later) was significantly predicted by prior symptoms of anxiety. Conversely, almost half

of the teenagers with major depressive disorder at Time 1 manifested an anxiety disorder 1 year

later. In a review, Wittchen et al. (2000) concluded that anxiety disorders typically precede the

onset of depression when the two co-occur, and the number and type of anxiety disorders present

influence the risk for later depression.

However, research on the developmental ontogeny of depression and anxiety is critical to

this debate. For example, if depressive disorders are nearly always preceded by anxiety, then it is

possible the two symptom groups may be better thought of as a syndrome that begins with

anxiety and emerges as depression or comorbid depression and anxiety. The Dunedin Study is

one of the few studies which the relative predictive utility of anxiety versus depression to later

disorders was tested (Moffitt et al., 2007). Their results demonstrated that anxiety and major

depression had a reciprocal relation such that one preceded the onset of the other relatively

equally from ages 11 to 32 years (Moffitt et al., 2007). Similar findings of reciprocal relations

between anxiety and depression were reported in the Great Smoky Mountains Study, in which

testing of heterotypic and homotypic patterns of stability in anxiety and depression was carried

out using a much narrower age range from 9–16 (Costello, Mustillo, Erkanli, Keeler, & Angold,

2003).

Moreover, consistent with Beck and Streer (1987), I argue that adolescents may perceive

depressive symptoms as a loss in regard of limited resources that can aid school success and

access to material needs, which may precede a late-onset of feeling of anxiety. Also, adolescents

may perceive anxiety as a threat, due to the possibility of truncating their education and

excessive working hours to earn money, which, in turn, may precede late-onset of depressive

18

symptoms. Thus, the current study hypothesizes that anxiety and depression are mutually

influenced over time.

Mental health problems may lead to physical health problems. For instance, mental

disorders, such as depression, may directly lead to physical complaints by weakening and/or

altering the immune response. There is extensive evidence suggesting that stress can lead to

decreased immune functioning (Miller, Chen, & Zhou, 2007) and mental health problems, such

as depression, have been linked to changes in cellular immunity (Cohen & Herbert, 1996), often

resulting in reduced immune response. These changes may lead to an increase in physical

complaints, including fatigue and the common cold (Takkouche, Regueira, & Gestal-Otero,

2001).

In addition, individuals with depressive symptoms may be more likely to engage in

behaviors that lead to physical complaints. For instance, depressive symptoms are associated

with poor self-care (Katon, & Sullivan, 1990), and individuals who are depressed often sleep less

and exercise less than those who are not depressed (Herbert, & Cohen, 1993). Finally, depression

symptoms have been linked to poor eating habits and a lack of exercise, leading to elevated

weight status maintained from childhood into adulthood (Anderson, Cohen, Naumova, & Must,

2006).

While most previous research on the link between mental and physical health has focused

on depression, some evidence suggests that anxiety increases the risk of physical complaints as

well. Several recent studies report that anxiety disorders are associated with back pain and

headaches (Culpepper, 2009; Simon & Fischmann, 2005). Explanations for the association

between anxiety and physical complaints include dysregulation of the stress-response system

(Culpepper, 2009; Roy-Byrne et al., 2008).

19

In contrast, Lavigne and Faier-Routman (1993) reported that physical illness has

influenced psychological problems. They stated the results of their analysis indicated that

children with physical health problems are at an increased risk for psychological symptoms

compared to children without health problems, with internalizing symptoms being more likely

than externalizing symptoms.

Physical health problems may also predict mental health problems in psychosocial

mechanisms. First, internalized problems such as depression and anxiety, may be caused

physiologically by physical illness or through side effects resulting from medications used to

treat a disease (Eiser, 1990; Wallander & Varni, 1998). Second, previous studies suggest that

physical complaints may contribute to mental health problems through unhappiness about having

to heal with the ailment, physical complaints, or body pain or limitations, change in physical

appearance (Lewinshon, et al., 1995), and a limited socioeconomic attainment (Wickrama, et al.,

2005).

For the most part, the many studies that have examined the relationships between

physical health problems and psychological functioning in children and youth have been cross-

sectional or clinic-based, and have involved small, condition-specific samples (Barnett, Manly,

& Cicchetti, 1993). Few studies have followed a sizable cohort prospectively or have used

population-based samples. Moreover, given the paucity of longitudinal studies of comorbid

mental and physical health problems in adolescents from community populations, this study

examines the associations of mental and physical health problems in a sample of youth served in

community settings. Thus, the current study uses community-based longitudinal data. Also, this

study proposes that depression, anxiety, and physical complaints can influence each other over

time.

20

Moderating Effect of Supportive Parenting on the Association between Chronic Family

Economic Hardships, and Adolescents’ Health Problems

Systems theory emphasizes the family context of the adolescent as the critical factor

influencing the processes of coping and long-term adaptation (Mott, James, & Spherac, 1990).

Research has indicated that warm, supportive, and non-coercive parental practices buffer

children’s physical health problems from some of the adverse consequences of economic

hardships (Hanson, McLanahan, & Thomson, 1997). Conversely, Lempers et al. (1989) have

argued that hostile parenting might be expected to amplify adolescents’ mental health problems

against the disruptive threats posed by economic hardships. That is, supportive parenting may

moderate the association between economic hardships and adolescent mental and physical

problems. Thus, this study investigates the moderating influence of supportive parenting on the

association between family economic hardships and adolescents’ health problems.

Moderating Effects of Supportive Parenting on the Association between Marital Conflicts,


Previous research suggests that parent-child relationships may moderate the associations

between marital conflicts and adolescent health, such that relationships characterized by high

affective quality buffer adolescents from the negative consequences of marital conflict. For

instance, in keeping with the family systems theory principle of wholism, Grych and Fincham

(1990) argue that children interpret marital conflicts within the context of parent-child relations.

Therefore, marital conflicts that occur in the context of close, warm, and supportive parenting

will be perceived as less negative and threatening than marital conflicts that occur in the context

of less positive parenting. Similarly, Davies and Cummings (1994) argued that positive and

effective parenting protects and enhances children’s feelings of emotional security, which defend

21

children against the negative consequences of marital conflict exposure. Similar arguments for

the buffering role of parent-child relationships are found in chronic stress and early adversity

literature, in which high quality parent-child relationships are viewed as a mechanism by which

children are protected from negative consequences of early adversity (e.g., Bugental, 2004).

Viewing parenting practices as a moderator suggests that rather than playing a causal role in the

pathway between marital conflicts and child outcomes, there are individual differences in the

levels of parenting; supportive parenting is protective against the negative consequences of

marital conflict exposure. Therefore, consonant with this idea, this study proposes the

association between marital conflicts and adolescents’ health problems is moderated by

supportive parenting.

Gender Moderation on the Associations among Chronic Family Economic Hardships,

Marital Conflicts, Supportive Parenting, and Adolescents’ Health Problems

Gender differences in mental and physical health are well documented. Research on

gender differences in mental health has clearly established that women have higher rates of so-

called “internalizing” disorders, including depression and anxiety disorders (Kessler et al., 2005).

Research on gender differences in physical health has demonstrated that patterns of physical

complaints are gendered as well. The evidence suggests that women are more likely to have

chronic debilitating conditions, such as fatigues and headaches (Bird & Rieker, 2008; Verbrugge,

1985). Furthermore, Furnham and Kirkcaldy (1997) reported significant gender differences in

the frequency of physical ailments of individuals over six months: women reported an average of

3.4 complaints in contrast to 2.6 complaints for males. Females were more likely to report

headaches, general fatigue, and constipation compared to males. Moreover, in the case of adults,

women reported physical complaints consistently more frequently than men in longitudinal

22

research (Ajdacic-Gross et al., 2006). Also, the studies by both Garber et al. (2002) and Ge et al.

(2001) showed that females generally had more depressive symptoms at an earlier onset.

Also, evidence for differences in psychobiological processes between genders was

observed by Egger, Costello, Erkanli, and Angold (1999). They found that among 9-16 year olds,

physical complaints were strongly associated with emotional disorders in females. Also, there is

a study on gender differences on the comorbidity of mental health problems and physical

complaints. In Silverstein and Lynch’s study (1998), for both the genders, musculoskeletal pains

were related to depression. However, it was reported that females more often self-reported

anxious somatic depression, but not pure depression.

Although many studies imply that gender differences in mental and physical health are

widely acknowledged, it is unclear whether there are gender differences in the association

between mental health (i.e., depression and anxiety) and physical complaints. Thus, the current

study is an attempt to explore how the gender difference for adolescents’ health problems occurs

over adolescent years.

In addition to gender issues impacting adolescents’ health problems, some support for

testing gender moderation derives from work showing the mediating path through ineffective

parenting is stronger for sons than daughters (Buehler & Gerard, 2002). Moreover, prior research

proposes that economic stress may also influence males and females differently (Bolger et al.,

1995; Elder & Caspi, 1988). Also, child gender can moderate the association between marital

conflict and their health problems, including emotional problems and physical complaints

(Baviskar, 2010). Thus, this study extends this work by addressing gender differences on the

association between family economic hardships, marital conflicts, supportive parenting, and

adolescent’s health problems (i.e., depression, anxiety, and physical complaints).

23

Study Control

Demographic characteristics may influence contemporaneous and cumulative mental

health, as well as physical health consequences in adolescents. To further isolate the independent

influence of family economic hardships on self-assessed health problems through marital

conflicts and supportive parenting, this study controls for parental education and parental

depression. This is not only because, to a significant degree, adolescent health is an outcome of

the direct investment of parental knowledge and available resources (Becker, 1993), but also

because parental depression can influence their children’s outcome (Goodman & Gotlib, 2002;

Jaser et al., 2005).

Specific Study Hypotheses

This study simultaneously examines factors among individuals, parents, and family

economics for the development of youth’s anxiety, depression, and their physical complaints

during adolescence. The purpose of this study is to begin to address the specific issue of how

family circumstances (i.e., family economic hardships, and marital conflicts, and supportive

parenting) influence adolescents’ depression, anxiety, and physical complaints. Moreover, this

study examines how anxiety, depression, and physical complaints mutually influence one

another over time. Figure 2 depicts the specific hypotheses for this research.

Hypothesis 1. Chronic family adversity (i.e., economic hardships) directly influences

adolescents’ health problems (i.e., anxiety, depressive symptoms, and physical

complaints), controlling for parental education and parental depression.

Hypothesis 2. Chronic family adversity indirectly influences adolescents’ health problems

through marital conflicts, controlling for parental education and parental

depression. (Mediating effect.)

24

Hypothesis 3. Chronic family adversity indirectly influences adolescents’ health problems

through supportive parenting, controlling for parental education and parental

depression. (Mediating effect.)

Hypothesis 4. Marital conflicts indirectly influences adolescents’ health problems through

supportive parenting, controlling for parental education and parental depression.

(Mediating effect.)

Hypothesis 5. Adolescents’ anxiety, depression, and physical complaints mutually influence

one another over time, controlling for parental education and parental depression

(cross-lagged effect).

Hypothesis 6. The association between chronic family economic hardships and adolescents’

health problems is moderated by supportive parenting (moderating effect).

Hypothesis 7. The association between marital conflicts and adolescents’ health problems is

moderated by supportive parenting (moderating effect).

Hypothesis 8. Gender moderates the associations among adolescents’ health problems over the

years.

Hypothesis 9. Gender moderates the associations among family economic hardships,

supportive parenting, marital conflicts, and adolescents’ health problems.

25

CHAPTER 3

METHODS AND MEASUREMENTS

Sample

This study sampled 424 adolescents, who participated in the Iowa Youth Project (IYFP)

and Family Transitions Project (FTP). The IYFP began in 1989 and involved 451 families in 8

counties in Iowa. The site for the research was determined by an interest in rural economic stress

and well-being. Because many of the outcomes and processes considered in the overall study

were concerned with adolescent development, the families selected had at least two adolescents.

Beginning in 1994, the IYFP samples were combined with the FTP.

Data for the current study’s analyses originated from Wave 1 (N= 451), Wave 2 (N= 424),

Wave 3(N= 407), Wave 4(N= 404) of the IYFP, and Wave 6(N= 424) for the FTP longitudinal

study. Predictor variables of chronic family economic hardships were gathered through target

self-reported measures from Wave 1 (1989) to Wave 3 (1991). Supportive parenting was

assessed through parents’ self-report at Wave 2. This variable consisted of perceived father’s

support and mother’s support. The adolescents were in 7th grade and in the age range of 12-14

years of age when information on the predictor variables was collected in 1989. The longitudinal

IYFP study at Wave 3, Wave 4, and Wave 6 produced information on the outcome variables—

anxiety, depression, and physical complaints. At the time of the initial wave in 1989, 34% of the

families lived on a farm, around 12% lived in rural areas but not specifically on a farm, and 54%

of the families lived in rural communities with a population less than 6,500 (Conger et al., 1992).

The median family income of the previous year of the study (1988) was $33,000 and 11% of the

26

families in the IYFP data set had a median income that fell below the federal poverty line

(Conger et al., 1992). The median number of years of education was 13 years for fathers and

mothers, and the median age for fathers was 39 years and 37 years for mothers (Conger et al.,

1992). The average number of family members for the IYFP sample in 1989 was 4.95 children

(Conger et al., 1992). Around 53% of the targeted adolescents were female and 47% were male.

Procedure

Families were contacted prior to participation and information regarding participation

was obtained through letters in the mail and telephone-based interactions. Around 78% of the

participants who were contacted agreed to participate in the current study.

Data for this study originated through home visit methodologies (Conger et al., 1992).

For each wave, families were interviewed two different times. During the first visit, each of the

four family members was asked demographics, family economic circumstances, family

characteristics, and self-reports on behavior and cognitions/attitudes through surveys (Conger et

al., 1992). The second home visit, within 2 weeks of the first visit, consisted of the family

completing a structured task to assess interactions within the families. Coders were trained using

the Iowa Families Interactions Rating Scales (IFIRS) developed by Janet Melby and colleagues

at the Institute for Social and Behavioral Research at Iowa State University (Melby et al., 1999).

Coders were required to have a minimum of a bachelor’s degree in science, humanities, literature,

or education (Melby & Conger, 2001) and work no more than 20 hours a week, due to the high

intensity of the job. Coders were trained for 10-12 weeks at 20 hours per week to achieve a high

level of agreement (Melby & Conger, 2001).

27

Data from the current study only utilized the first home visit in which survey information

was collected. This current study did not utilize information collected during the second home

visit in which observational data were collected on a structured task.

Measures

Anxiety In 1991, 1992, and 1994, target adolescents reported their feelings on how much anxiety

they felt during a week. Anxiety in the current study was assessed from 10 sub-items from the

Symptoms Checklist (SCL-90-R; see Derogatis & Melisaratos, 1983). First, the target

adolescents were asked to report on anxiety on a scale from 1 (not at all) to 5 (extremely),

regarding “During the past week, how much were you distressed or bothered by ‘nervousness or

shakiness inside’, ‘trembling’, ‘suddenly scared for no reason’, ‘feeling fearful’, ‘heart pounding

or racing’, ‘feeling tense or keyed up’, ‘spells of terror or panic’, ‘feeling so restless you couldn’t

sit still’, ‘the feeling that something bad is going to happen to you’, and ’thoughts and images of

a frightening nature’.” Scores on these items were then summed in which higher levels of the

summed score reflect higher levels of anxiety. The internal consistency (Cronbach’s alpha) for

the scale equaled .83, .85, and .90 for 1991, 1992, and 1994, respectively, for the target

adolescents.

Depressive symptoms In 1991, 1992, and 1994, target adolescents reported their feelings of

distress using the 12-item depressive symptomology subscale of the Symptoms Checklist (SCL-

90-R; see Derogatis and Melisaratos, 1983). Respondents used a 5-point Likert-type scale

anchored with ‘not at all’ (1) and ‘extremely’ (5), regarding “how often during the past week

they were bothered by ‘feeling low in energy or slowed down’, ‘thoughts of ending your life’,

‘crying easily’, ‘feelings of being trapped or caught’, ‘blaming yourself for things’, ‘feeling

lonely’, ‘feeling blue’, ‘worrying too much about things’, ‘feeling no interest in things’, ‘feeling

28

hopeless about the future’, ‘feeling everything is an effort’, and ‘feelings of worthlessness’,”

Scores on these items were then summed in which higher levels of the summed score reflect

higher levels of depression. Internal consistency (Cronbach’s alpha) equaled .89, .91, and .92 for

1991, 1992, and 1994, respectively.

Physical complaints In 1991, 1992, and 1994, target adolescents reported their feelings of

physical condition using 12 common physical complaints. These complaints included headaches,

coughs, sore throats, muscular aches, stomach aches, congested nose, constipation, vomiting,

skin rashes, diarrhea, allergies, and bad acne or pimples experienced during the past three

months (Mechanic & Hansell, 1987). Respondents used a 4-point scale anchored with ‘never’ (1)

and ‘always’ (4) to indicate how often during the past three months they were bothered by

symptoms of physical complaints. Scores on the items were then summed in which higher levels

of the summed score reflect higher levels of physical complaints. Internal consistency

(Cronbach’s alpha) equaled .76, .74 and .77, for 1991, 1992, and 1994, respectively.

Marital conflict In 1991, marital conflict was measured by asking both father and mother to

report, on a five-point scale from “never” (0) to “all of the time” (4), how often you and your

spouse disagree or get upset about “Money,” “Discipline/ raising children,” “Time along

together,” “Tobacco,” “Alcohol,” “Drugs,” “Outside activities,” “Work schedules,” “Church,”

“Vacation time,” “Intimate times,” “Household chores,” “Relative/In-laws,” “Family time

together,” “Transportation,” and “Attitudes.” The rating for each item was summed to create a

score of marital conflict for each parent. Internal consistency (Cronbach’s alpha) equaled .87 for

father and .84 for mother.

Supportive Parenting In 1991, supportive parenting was measured by asking both father and

mother to report on a five-point Likert-type scale from “always” (1) to “never” (5), “I really trust

29

target child,” “I experience strong feelings of love for target child,” “How often do you talk with

the target child about what is going on in his or her life?,” “When you and the target child have a

problem, how often can the two of you figure out how to deal with it?,” “How often odes the

target child talk to you about things that bother him or her?,” “How often do you ask the target

child what he or she thinks before deciding on family matters that involve him or her?,” “How

often do you give reasons to the target child for your decisions?,” “ How often do you ask the

target child what he or she thinks before making decisions that affect him or her?,” “When the

target child has done something you like or approve of, how often do you let him or her know

you are pleased about it?”. The lists of supportive parenting were adapted from the supportive

parenting scale (Simons, Lorenz, Conger, & Wu, 1992). The rating for each item was reverse

coded so that a high score indicated high support. The supportive parenting scale was

constructed by summing the score for both parents. Internal consistency (Cronbach’s alpha)

equaled .87 for father’s supportiveness, and .84 for mother’s supportiveness.

Chronic Family economic hardships The lists of economic problems were adapted from Conger

(1988). The measure of family economic hardships was created by a 5-point Likert-type scale

anchored with ‘always’ (1), and ‘never’ (5). The targets responded to four items in1989, 1990,

and 1991, that indicated economic problems experienced by the family. The list of economic

problems included items, such as “How often do you have enough money for things like clothes,

school activities, or other things you need?,” “How often do you have enough money for doing

things you and friends like to do, such as going to movies, eating pizza, etc.?,” “How often do

you argue with your parents about not having enough money?,” and “How often do your parents

argue with each other about not having enough money?”. Two items were reverse-coded. Scores

on these items were then summed in which higher levels of the summed score reflect higher

30

levels of family economic hardships. The internal consistency (Cronbach’s alpha) of the scale

equaled .67, .70, and .67 for 1989, 1990, and 1991, respectively.

Parental depressive symptoms (control variable) Participants reported their feelings of distress

using the 13-item depressive symptomology subscale of the Symptoms Checklist (SCL-90-R;

see Derogatis and Melisaratos, 1983). Respondents used a 5-point Likert-type scale anchored

with ‘not at all’ (1) and ‘extremely’ (5) regarding how often during the past week they were

bothered by ‘loss of sexual interest or pleasure’, ‘feeling low in energy or slowed down’,

‘thoughts of ending our life’, ‘ crying easily’, ‘feelings of being trapped or caught’, ‘blaming

yourself for things’, ‘feeling lonely’, ‘feeling blue’, ‘worrying too much about things’, ‘feeling

no interest in things’, ‘feeling hopeless about the future’, ‘feeling everything is an effort’, and

‘feelings of worthlessness’. Scores on these items were then summed in which higher levels of

the summed score reflect higher levels of depressive symptoms. Internal consistency

(Cronbach’s alpha) equaled .92 for both father and mother.

Parental education (control variable) Parental education was measured by the number of years

of formal education and constructed by summing scores for both parents reported in 1991. The

mean score for father and mother is 13.54 and 13.35 years, respectively.

Gender (moderate variable) This current study also assessed the gender of the adolescent

through self-reported items. Gender was coded as 0 for females and 1 for males.

Analytical Plan

Prior to testing the hypotheses, descriptive statistics will be calculated for all this study’s

measures. Descriptive statistics include means, ranges, standard deviations, skewness, and

Cronbach’s alpha. Table 1 displays descriptive statistics, and Table 2 displays the mean

difference between males and females on study’s variables. Table 3 displays the correlations of

31

this study’s variables. The current study uses Structural Equation Modeling (SEM) to assess the

hypothesized longitudinal path model. SEM in the current study was employed to reduce the

impact of measurement error and analyze three repeated measures of health outcomes on the

succinct causal model. The latent construct of family economic hardships is captured by three

multiple indicators measured in 1989, 1990, and 1991, respectively. Moreover, the latent

construct of marital conflict is also calculated using two multiple indicators, which include

father’s and mother’s reports in 1991. The latent construct of supportive parenting is also

calculated using two multiple indicators, which include father’s and mother’s report in 1991. The

constructs of anxiety, depression, and physical complaints are measured directly by self-reported

measures. These observed measures were constructed by summing scores of individual items and

dividing the total of the items by the number of items to achieve a mean score.

Computer software program, AMOS 18.0, will be utilized to estimate standardized and

unstandardized coefficients for all paths in the SEM model. The default missing data program in

AMOS version 18.0 will use FIML (full-information maximum likelihood) to impute missing

data for all missing values. Also, model fit information will be calculated using absolute fit index

such as Chi-Squared and goodness of fit indices such as Root Mean Squared Error

Approximation (RMSEA), Comparative Fit Indices (CFI), and Tucker Lewis Index (TLI). For

good model fit, Hu and Bentler (1999) suggested that RMSEA values be close to .06 or below,

and CFI and TLI values be close to .95 or greater for model fit. However, for acceptable model

fit, Browne and Cudeck (1993) proposed that RMSEA values less than .07 and CFI and/or TLI

values in the range of .90 - .95 suggest an acceptable model fit.

The SEM framework will allow for the current study to test Hypotheses 1. This is the

direct pathways in the SEM framework.

32

Meditational Hypotheses

Three mediation effects are assessed using the two approaches in the Structural Equation

Modeling. The first approach for testing the mediating effect is the nested modeling approach in

the SEM framework (Baron & Kenny, 1986). According to this approach, mediation is said to

occur when the causal effect of an independent variable (X) on a dependent variable (Y) is

transmitted by a mediator (M). “Indirect effects” estimate the magnitude of mediation. In other

words, X affects Y because X affects M, and M, in turn, affects Y.

For example, to examine the mediating effect of marital conflicts and supportive

parenting on the association between chronic family economic hardships and adolescents’ health

problems, the first step in this analysis is to employ an SEM model in which the latent constructs

of chronic family economic hardships directly influence each of the outcome variables (i.e.,

anxiety, depression, and physical complaints) (M 1). The second step in the mediation analysis is

to create a model in the SEM framework in which the latent constructs of chronic family

economic hardships directly influence each outcome variable, as well as chronic family

economic hardships indirectly influencing each of the outcome variables through marital

conflicts (M 2), supportive parenting (M 3), and both marital conflicts and supportive parenting

(M4), respectively. The final step is to compare the direct path model (M 1) with the mediation

models (M 2, M 3, and M4). These models will be compared and discussed in the results section

to address hypotheses 2, 3, and 4. If direct paths become non-significant and meditational paths

are significant in meditational model (M 2, M 3, and M4), according to Baron and Kenny (1986),

supportive parenting and marital conflicts mediated the influence of chronic family economic

hardships on health problems.

33

For the second approach, the mediating effects of the current study are assessed using a

mediation test proposed by Sobel (1982). According to this test, the amount of mediation which

can be tested by the z-test is defined as the reduction of the effect of the initial variation on the

outcome or c – c’. This difference in coefficients is equal to the product of the effect of X on M

times the effect of M on Y or ab and so:

ab = c – c’ .

If this indirect effect on the second step of the nested modeling approach is statistically

significant, it follows there necessarily is a reduction in the effect of X on Y. One method to test

the null hypothesis (i.e., indirect effect) that ab = 0 is to test if both a and b are zero. Baron and

Kenny (1986) provide a direct test of ab, which is a modification of a test originally proposed by

Sobel (1982). This requires the standard error of a or Sa (which equals a/ta where ta is the t-test of

coefficient a) and the standard error of b or Sb (See Figure 3).

The standard error of ab equals

SEab = .

Therefore, under the null hypothesis that ab equals zero, the following,

,

is approximately distributed as z. In most cases, however, the term is insignificantly small

and can be safely omitted, yielding:

SEab = .

Hence, following the recommendation from MacKinnon, Warsi, and Dwyer (1995), the

significance of the indirect paths can be assessed using the modified Sobel test of indirect

effects:

34

z – value = .

To test the significance of the indirect effect, it was calculated by hand because this test is

not available in AMOS. A significant Sobel test suggests the level of mediation is meaningful.

The significance of the indirect paths can be assessed using the modified Sobel test of indirect

effects. According to the z-test, the mediating effect of hypotheses 2 – 4 will be assessed.

Cross-lagged hypothesis

The current study will examine a cross-lagged model to strengthen the hypothesized

associations of the theoretical path model using AMOS 18.0. Using a cross-lagged design, the

reciprocal relationship between mental problems and physical complaints will be explored in

greater detail. The benefit of this design is that it offers insight into the relative strengths of two

or more time-varying covariates on each other (Lorenz, Wickrama, & Conger, 2004). To

examine the health progression of adolescents, the “cross-lagged model” will be tested for

Hypothesis 5.

Moderational hypotheses

Moderation effects will be assessed through a stacked model approach using two groups

for the low and high levels of supportive parenting (Wickrama et al., 1995). In this approach, the

path coefficients are allowed to be different in one model for the low and the high groups, based

on one standard deviation from a mean of the grouping variable (i.e., unconstrained model). A

second model will be analyzed in which the path coefficients are held constant for the low and

high groups (i.e., constrained model). According to Bentler and Bonett (1980), a 2 difference

can be calculated for the constrained model subtracted from the unconstrained model. The 2

difference will have degrees of freedom equal to the degrees of freedom of the constrained

35

model minus the unconstrained model, and will be normally distributed. This 2 difference test

will allow for the test of significance for any significant interactions or moderations between

high and low groups for hypotheses 6 and 7.

Gender moderational hypotheses

Finally, to investigate the hypothesized gender difference, the model shown will estimate

the cross-lagged model and path model separately for males and females; these results will be

presented . The model allows comparison of male’s paths with corresponding female’s paths

using the equality constraint test (Wickrama et al., 1995). In these tests, the two theoretically-

relevant paths are constrained as equal in the model to determine whether this procedure would

significantly reduce the model fit. The change in chi-squared for one degree of freedom for each

paired comparison will be used to test whether two paths are significantly different for

hypotheses 8 and 9. Also, for Hypothesis 8, the group’s mean between male and female will be

estimated to report on whether group means among anxiety, depressive symptoms, and physical

complaints change for 1991, 1992, and 1994.

Supplement Growth Curve Analysis

Moreover, as a supplementary analysis, latent growth curve (LGC) analysis will be

performed using AMOS 18.0. The LGC model estimates individual change parameters, as well

as their differences across individuals, and systematically relates these differences to the

differences in time-invariant and/or time-varying predictors and in Sequence across individuals

(Karney & Bradbury, 1995; Wickrama, Beiser, & Kaspar, 2002). For example, this study will

relate growth parameters for depression, anxiety, and physical complaints to marital conflicts,

supportive parenting, and economic hardships, and then take the associations among growth

parameters into account.

36

CHAPTER 4

RESULTS

Descriptive Statistics of Study Variables

Table 1 presents of the descriptive statistics of the study variables for the current research.

The mean scores for anxiety showed no significant change over time; 1.40, 1.37, and 1.39, for

1991, 1992, and 1994, respectively (F(2, 752)=1.18, p>.05). However, the mean scores for

depression showed a significant increase; 1.51, 1.57, and 1.62, for 1991, 1992, and 1994,

respectively (F(2, 752)=4.99, p<.01). Also, the mean scores for physical complaints showed a

significant increase; 1.92, 2.03, and 2.01, for 1991, 1992, and 1994 (F(2, 696)=12.43, p<.001).

The mean scores for family economic hardships indicated a significant difference over time; 2.11,

2.08, and 2.20 for 1989, 1990, and 1991, respectively (F(2, 804)=9.40, p<.001). The mean scores

for marital conflicts showed no significant difference; 1.13, and 1.10, for father and mother

respectively (F(1, 396)=1.60, p>.05). Supportiveness for fathers and mothers indicated

significant differences, 3.79 and 4.02 in 1991, respectively (F(1, 405)= 92.92, p<.001). The

mean scores for parental depression indicated a significant difference in 1991, 1.32 for father and

1.50 for mother, respectively (F(1, 405)= 30.18, p<.001). Finally, mean scores for fathers and

mothers’ education were 13.54 and 13.35 years in 1991, respectively.

For the most part, skewness is not an issue for the distribution of the current study’s

variables. Father’s depression in 1991 was the most skewed variable among predictors. However,

this skewness is to be expected, based on the nature of the study variables and the self-report

measurement technique, which is subject to a potential bias in the answers.

37

Mean difference in health problems between males and females are provided in table 2.

Females report higher mean levels of depression, anxiety, and physical complaints in several

time points.

Correlations among Study Variables

Table 3 presents bivariate correlations among study variables. All outcome variables

were correlated in the expected direction. Significant correlations were observed among repeated

measures of anxiety symptoms in 1991, 1992, and 1994 (p<.01). Significant positive correlations

were also observed among repeated measures for depressive symptoms in the same period

(p<.01). Furthermore, significant positive correlations were observed among repeated measures

for physical complaints in the same period (p<.01). Also, significant contemporaneous and

longitudinal positive correlations were observed among different health domain variables;

anxiety and depressive symptoms (p<.01), between depression and physical complaints (p<.01),

and between anxiety and physical complaints (p<.01) (See Table 2).

For predicted variables, as expected, a significant correlation was observed among family

economic hardships in 1998, 1990, and 1991. The correlations ranged from .41 to .51 (p<.01). In

addition, these variables showed significant correlations with adolescents’ health problems (i.e.,

anxiety, depression, and physical complaints). The correlation coefficient ranged from .10 to .29

(p<.05) Moreover, a moderate correlation was observed between father’s marital conflicts and

mother’s marital conflicts measures. The correlation was .38 (p<.01). These variables were also

significantly correlated with most health problems during the same time period. The correlations

ranged from .11 to .15 (p<.05). However, marital conflicts for both father and mother were not

correlated with depression in 1992 and 1994. Additionally, marital conflicts measures for both

parents were significantly correlated with family economic hardships in 1989, 1990, and 1991.

38

The correlations ranged from .10 to .27 (p<.05). Furthermore, a significant correlation was

observed between fathers’ supportive and mothers’ supportive parenting. The correlation was .31

(p<.05). In addition, these variables were negatively correlated with anxiety and depression in

1991, 1992, and 1994. The correlation coefficients ranged from -.21 to -.12 (p<.05). However,

parental support for both parents was not significantly correlated with physical complaints in the

same time period. Nevertheless, parental support for both father and mother was significantly

correlated with marital conflicts and family economic hardships. The correlation between marital

conflicts and supportive parenting for both parents ranged from -.22 to -.11 (p<.05).

Testing Specific Hypotheses

Direct Path Model (Hypothesis 1)

The first hypothesis of the current study was that chronic family economic hardships

directly influence adolescents’ anxiety, depression, and physical complaints, controlling for

parental depression and education. The results can be seen in Figure 4. For anxiety, the chronic

family economic hardships directly influences anxiety in 1991 (β= .21, t=3.53). For depression,

the family economic hardships directly influence depression in 1991 (β= .29, t=4.84). Moreover,

for physical complaints, the family economic hardships directly influence adolescents’ physical

complaints in 1991 (β= .29, t=4.73). Thus, the first hypothesis of the current study was supported

by data.

Mediations of the Current Study (Hypothesis 2, 3, and 4)

Testing mediational hypothesis for marital conflicts on the association between chronic family

economic hardships and adolescents’ health problems (Hypothesis 2)

Figure 4 presents a simple SEM model in which the chronic family economic hardships

directly influence adolescent health problems. Figure 5 presents an SEM model in which the

39

chronic family economic hardship indirectly influences adolescents’ health problems through

marital conflicts (MC).

The model in Figure 4 can be compared to Figure 5 to assess the meditational effects of

marital conflicts on the association between the family economic hardships and adolescents’

health problems. The model in Figure 5 adds marital conflicts to the model in Figure 4. The

model in Figure 5 found a direct pathway between family economic hardships and adolescents’

health problems. In Figure 5, the pathway between family economic hardships and adolescents’

health problems was still significant (β=.20, t=2.96 for anxiety; β=.25, t=3.70 for depression, and

β=.28, t=4.05 for physical complaints). Moreover, the pathway between family economic

hardships and marital conflicts was significant in the model for Figure 5 (β=.38, t=4.32). The

pathways for family economic hardships and adolescents’ health problems shown in Figure 4 are

still significant in the model, as shown in Figure 5. The pathway between family economic

hardships and marital conflicts was significant. However, the pathways among marital conflicts

and all of health problems of adolescents were not significant, as shown in Figure 5. Thus, the

Sobel test cannot be used because indirect effect between chronic family economic hardships and

adolescents’ health problems is not statistically significant. Accordingly, the current study

suggests the association between chronic family economic hardships and adolescents’ health

problems is not mediated by marital conflicts, based on the mediating tests proposed by Baron

and Kenny (1986) and modified Sobel test (1995). Thus, the second hypothesis of the current

study was not supported by data.

Testing mediational hypothesis for supportive parenting on the association between chronic

family economic hardships and adolescents’ health problems (Hypothesis 3)

40

Another mediation to examine is whether supportive parenting mediates the association

between chronic family economic hardships and adolescents’ health problems. To examine this,

the current study compares the model shown in Figure 4 with the model shown in Figure 6. In

the hypothesized model of the current study shown in Figure 6, a significant association was

observed between chronic family economic hardships and supportive parenting (β= -.37, t=-3.99).

A significant association was also observed between supportive parenting and anxiety (β= -.28,

t= -2.95). However, a significant association was not observed between chronic family economic

hardships and anxiety as found for the model in Figure 6 (β=.11, t=1.67). This demonstrates the

association between chronic family economic hardships and anxiety is mediated by supportive

parenting. For depressive symptoms of adolescents, Figure 6, a significant association was

observed between supportive parenting and depression (β= -.26, t= -2.83). Also, a significant

association was still observed between chronic economic hardships and depression (β= .19, t=

2.81). However, when this model is compared with the model in Figure 4, the standardized

regression coefficient in the association was diminished from .28 (4.84) to .19 (2.81). According

to analysis of mediation hypotheses presented by Baron and Kenny (1986), to establish

supportive parenting completely mediates the association between chronic economic hardships

and depression, the effect of chronic economic hardships on depression of adolescents

controlling for supportive parenting should not be significant. However, although the direct

effect is reduced in the association between chronic family economic hardships and depression in

the current hypothesized model, the direct influence of chronic family economic hardships on

depression is still significant when controlling for supportive parenting. Therefore, partial

mediation on the association between chronic economic hardships and depressive symptoms of

adolescents is indicated. For physical complaints, a significant association was not observed

41

between supportive parenting and physical complaints (β= .07, t= .91) shown in Figure 6.

However, a direct pathway was significantly observed between chronic family economic

hardships and physical complaints (β=.31, t=4.46). Therefore, the relationship between chronic

family economic hardships and adolescents’ physical complaints is not mediated by supportive

parenting.

Moreover, to test the significance of the indirect effect, the recommendations by

MacKinnon, Warsi, and Dwyer (1995) are followed. For anxiety, the indirect effect using the

modified Sobel test is statistically significant (z = 2.35, p<.01); for depression, the indirect effect

is also significant (z = 2.23, p<.05). However, for physical complaints, the z-value for the Sobel

test was not calculated, because the indirect effect of the nested modeling approach is not met

(e.g., step 2 of the nested modeling approach).

In summary, supportive parenting mediates the association between chronic family

economic hardships and anxiety of adolescents, and partially mediates the association between

chronic family economic hardships and depression of adolescents. However, supportive

parenting did not mediate the association between chronic family economic hardships and

physical complaints. Thus, the third hypothesis of the current study was partially supported by

data.

Indirect effect of marital conflicts on adolescents’ health problems through supportive parenting

(Hypothesis 4)

The other mediation to examine is whether supportive parenting mediates the association

between marital conflicts and adolescents’ health problems. In the hypothesized model of the

current study shown in Figure 7 for anxiety and depression, a significant association was

observed between marital conflicts and supportive parenting (β= -.41, t= -3.26). A significant

42

association was also observed between supportive parenting and anxiety (β= -.31, t= -2.75), and

between supportive parenting and depression (β= -.26, t= -2.49), respectively. However, a

significant direct effect was not observed between marital conflicts and anxiety (β= -.07, t= -.72)

and between marital conflicts and depression anxiety (β=.01, t=.04) shown in Figure 7. Thus,

this suggests the association between marital conflicts and anxiety is mediated by supportive

parenting. The association between marital conflicts and depression is also mediated by

supportive parenting. For physical complaints, a significant association was not observed

between supportive parenting and physical complaints (β= .10, t= 1.00), as well as between

marital conflicts and physical complaints anxiety (β= .07, t=.79) shown in Figure 7. Therefore,

the results show the association between marital conflicts and physical complaints of adolescents

is not mediated by marital complaints (MC).

In addition, the z-values for the modified Sobel test were calculated to assess the

significance of the indirect effect. For anxiety, the indirect effect using the modified Sobel test is

statistically significant (z = 2.25, p<.05); for depression, the indirect effect is also significant (z =

2.18, p<.05). However, for physical complaints, the z-value for the Sobel test was not calculated,

because the indirect effect of the nested modeling approach is not met (e.g., step 2 of the nested

modeling approach).

In summary, supportive parenting mediates the association between marital conflicts

and anxiety and depression of adolescents. However, supportive parenting does not mediate the

association between marital conflicts and physical complaints. Thus, the fourth hypothesis of the

current study was partially supported by data.

The Operationalized SEM Model

43

Figure 8 presents the results for the comprehensive model. The factor loadings for the

study variables for the full operationalized model are presented in Figure 8. Three repeated

measures of family economic hardships significantly loaded on the latent construct of family

economic hardships (β= .66, .73, and .65, p< .001). Father’s marital conflicts (β= .65) and

mother’s marital conflicts (β= .59) also significantly loaded on the latent construct of marital

conflicts (p< .001). In addition, Father’s supportive parenting (β= .59) and mother’s supportive

parenting (β= .52) significantly loaded on the latent construct of marital conflicts (p< .001). The

operationalized model had a χ2 of 262.28 with 123 degrees of freedom. The ratio of χ2 divided by

the degrees of freedom equaled 2.13. According to Carmines and McIver (1981), a χ2 divided by

a degrees of freedom ratio of less than 3.00 suggests an acceptable fit, thus confirming this

model fits the data very well. Also, other model fit indices, such as CFI and TLI, indicate the

model fits the data very well.

For the control variables, contrary to expectations, parental education and depressive

symptoms fail to significantly predict anxiety, depressive symptoms, and physical complaints in

1991, 1992, and 1994.

Cross-Lagged Hypotheses (Hypothesis 5)

The fifth hypothesis of the current study is that adolescents’ anxiety, depression, and

physical complaints mutually influence one another over time, controlling for parental education

and depression. This hypothesis was partially confirmed in the current study as the several

significant associations among anxiety, depression, and physical complaints were observed. As

seen in Figure 8, for the association between anxiety and depression, depression in 1991

significantly predicts anxiety in 1992 (β=.14, t=2.18), and anxiety in 1992 significantly predicts

depression in 1994 (β=.15, t=2.01). Moreover, for the association between depression and

44

physical complaints, physical complaints in 1991 significantly predict depression in 1992 (β=.14,

t=3.28) and physical complaints in 1992 moderately predict depression in 1994 (β=.09, t=1.85).

Also, for the association between anxiety and physical complaints, the results indicate physical

complaints in 1991 significantly predict anxiety in 1992 (β=.10, t=2.17) and physical complaints

in 1992 significantly predict anxiety in 1994 (β=.12, t=2.34). However, the results show

depression in 1991 and 1992 does not predict physical complaints in 1992 and 1994. Anxiety in

1991 and 1992 also failed to influence physical complaints in 1992 and 1994. Consequently, the

fifth hypothesis of the current study was partially supported by data.

Moderation of the Current Study (Hypotheses 6 and 7)

Supportive parenting moderating hypotheses

Descriptive statistics show the measures for marital conflicts, supportive parenting, and

adolescents’ outcomes were all normally distributed. Therefore, the present study proceeded to

test the moderating effects (McClelland & Judd, 1993). Hypotheses 6 and 7 test the moderation

effects of supportive parenting on the association between chronic family economic hardships

and adolescents’ health problems, and between marital conflicts and adolescents’ health

problems using a stacked model approach (Wickrama, Conger, Lorenz, & Matthews, 1995).

According to this approach, the same structural model is estimated, using these two groups

simultaneously. Multiple group analysis is useful to test for differences using the “parameter

invariance” method of structural equation modeling.

In accordance with the guidelines set forth by Brookmeyer, Henrich, and Schwab-Stone

(2005), as a first step in the analysis, two groups (i.e., high vs. low supportive parenting group)

were selected from the sample in the following order (without replacement). First selected was

the low supportive parenting group—the low group whose score on supportive parenting in 1991

45

was equal to or less than one standard deviation (.34) away from the mean score (3.91) of

supportive parenting. Second, from the remaining parents, the high supportive parenting group

was selected—the high group whose score was equal to or more than one standard deviation

from the mean score of supportive parenting.

The current study followed the procedure for a stacked models approach used by

Wickrama et al. (1995) to test for moderations of study variables. According to this approach, for

the moderation effect on supportive parenting on the association between chronic family

economic hardships and adolescents’ health problems, a first model was analyzed in which the

all paths were freed across the two models. The second model was analyzed in which the path of

interest was constrained to be equal.

The fit between the model with equally constrained paths and the model with freed paths

can then be compared using a χ2 difference test (Bentler & Bonett, 1980; Wickrama et al.,

1995). For all model comparisons, a χ2 difference of 3.83 with a 1 degree of freedom is deemed

a significant moderation effect. The stacked models address hypotheses 6 and 7. Table 4

provides a summary of standardized coefficients (β), associated standard errors, intercepts, and

the differences in χ2 between low and high groups.

The first series of moderations to examine involve Hypothesis 6. This hypothesis states

the relationship between chronic family economic hardships and adolescents’ health problems is

moderated by the level of supportive parenting. For anxiety, A non-significant moderation effect

of supportive parenting on the association between chronic family economic hardships and

anxiety ( χ2= .01, df=1) was observed. For depressive symptoms, a non-significant moderation

effect of the level of a supportive parenting on the association between chronic family economic

hardships and depression ( χ2= .03, df=1) was observed. Moreover, for physical complaints, a

46

non-significant moderation effect of the level of a supportive parenting on the association

between chronic family economic hardships and physical complaints ( χ2= .18, df=1) was

observed.

In summary, there was no significant moderation in the level of supportive parenting on

the association between chronic family economic hardships and adolescents’ health problems.

Therefore, Hypothesis 6 was not supported by data.

The second series of moderations to examine involve Hypothesis 7. This hypothesis

states the association between marital conflicts and adolescents’ health problems is moderated by

the level of supportive parenting. For anxiety, a non-significant moderation effect of supportive

parenting on the association between marital conflicts and anxiety ( χ2= .26, df=1) was observed.

However, for depressive symptoms, a significant moderation effect of supportive parenting on

the association between marital conflicts and depression ( χ2= 4.13, df=1) was observed. Figure

9 illustrates the moderating effect of supportive parenting on the association between marital

conflicts and adolescents’ depressive symptoms. The graph clearly shows the interpretation for

the results of moderation. As shown in Figure 9, low level of supportive parenting had lower

average levels of depressive symptoms (M=1.71, SD=.66) than the higher level of supportive

parenting (M=1.35, SD=.40). Also, this mean difference was statistically significant (t=3.94, p

<.001). More importantly, the influence of marital conflicts on depressive symptoms was

stronger for low-level supportive parenting group than for high-level supportive parenting group.

However, for physical complaints, a non-significant moderation effect of supportive parenting on

the association between marital conflicts and physical complaints ( χ2= 1.58, df=1) was

observed.

47

Consequently, Hypothesis 7 was partially confirmed in the current study. There was only

a significant moderation of supportive parenting on the association between marital conflicts

and depressive symptoms.

Gender Difference of the Current Study (Hypotheses 8 and 9)

As in the case of supportive parenting effect, the two theoretically relevant paths are

constrained to be equal across male and female models to determine whether this procedure

would significantly reduce the model fit compared to the unconstrained model. The change in

chi-squared for one degree of freedom for each paired comparison is used to test whether two

paths are significantly different across male and female groups. Through 2 difference testing, a

model constraining path coefficient was analyzed for males and females.

Figure 10 presents the comprehensive model for gender difference on adolescents’ health

probles from 1991 to 1994. Among the 27 interaction effects, only one significant moderating

mechanism was seen in Table 5. For intra-domain continuity (i.e., homotypic continuity), the

stability coefficient of depressive symptoms in 1992 on depressive symptoms in 1994 was only

significantly different for males and females ( χ2= 5.00, df=1). Thus, Hypothesis 8 was partially

supported by data.

The other series of gender differences to examine involve Hypotheses 9. This hypothesis

states that gender moderates the associations among the family economic hardships, supportive

parenting, marital conflicts, and adolescents’ health problems. The moderating effects of gender

for the hypothesized path model can be seen in Figure 11. Through χ2 difference testing, a model

constraining all paths coefficients was analyzed for male and female. The result was a 2

difference of 40.06 with 19 degrees of freedom. This is statistically significant. In other words,

there is significantly different between males and females on the association among anxiety,

48

depression, and physical complaints over time. In detail, Table 6 presents the summary of

standardized coefficients, associated standard errors, and the difference in 2 between the

constrained model and the unconstrained model for each path for both the male and female

groups.

Among the 12 paths, two significant moderating mechanisms were seen in Table 6. For

depressive symptoms, gender of the adolescent moderates the association between chronic

family economic hardships and depressive symptoms ( 2 = 5.10, df=1). Also, gender of the

adolescent moderates the association between chronic family economic hardships and marital

conflicts ( χ2= 8.46, df=1). That is, females are more vulnerable to chronic family economic

hardships for both depressive symptoms, (β= .29, t=1.93) and marital conflicts (β= .35, t= 7.00).

Moreover, to examine the moderating effect of gender on the association between chronic

family economic hardships and depressive symptoms in 1991, the graph depicts the moderation.

As shown in Figure 12, males had lower average levels of depressive symptoms (M=1.36,

SD=.39) than females (M=1.63, SD=.53). Also, this mean difference was statistically significant

(t=4.95, p <.001). However, the influence of depressive symptoms on chronic family economic

hardships was greater among females than among males.

Also, in case of marital conflicts, the result of this moderation is quite similar to gender

moderation on association between chronic family economic hardships and depressive symptoms.

The males had lower average levels of marital conflicts (M=1.08, SD=.36) than females (M=1.14,

SD=.37). Although, this mean difference was not statistically significant (t=1.51, p >.05), the

influence of marital conflicts on chronic family economic hardships was greater among females

than among males.

49

In summary, gender of adolescents moderates the association between chronic family

economic hardships and depressive symptoms, and between chronic family economic hardships

and marital conflicts. Although gender marginally influences the association between chronic

family economic hardships and physical complaints, other associations among anxiety, marital

conflicts, and supportive parenting were not impacted by gender. Therefore, Hypothesis 9 was

partially supported by data.

Latent Growth Curve Analysis (Supplementary analysis)

As a supplementary analysis, latent growth curve (LGC) analysis using AMOS 18.0 was

estimated. The LGC model estimates individual change parameters as well as their differences

across individuals, and systematically relates these differences to the differences in time-

invariant and/or time-varying predictors, and in sequence across individuals (Karney & Bradbury,

1995; Wickrama, Beiser, & Kaspar, 2002). Consequently, through this analysis, growth

parameters of depression, anxiety, and physical complaints were related to marital conflicts,

supportive parenting, and chronic family economic hardships, and then the associations among

growth parameters were taken into account. The interlocking LGC model estimates are shown in

Figure 13.

For the current data, the results from fitting linear growth curves to three waves of

anxiety, depressive symptoms, and physical complaints (1991, 1992, and 1994) are summarized

in Table 7. As shown in Table 7, each univariate growth curve model for anxiety, depressive

symptoms, and physical complaints of adolescents showed a respectable fit with the data—a chi-

squared of 2.59, 1df; a chi-squared of .26, 1df; and a chi-squared of 18.88, 1df, respectively. Fit

indies (CFI) for the models also exceeded .90. In Table 7, significant slope shows linear trends in

50

depressive symptoms and physical complaints. More importantly, significant slope variances

show inter-individual variations in the rate of change in health problems.

The three univariate growth curves and exogenous variables were modeled together in an

interlocking trajectory model so that chronic family economic hardships, marital conflicts, and

parenting behaviors predict the adolescents’ health growth model. The interlocking trajectories

model is shown in Figure 13. The model fit indices indicate a good model fit. As expected,

exogenous variables predict the initial level of each health problem (i.e., anxiety, depressive

symptoms, and physical complaints). However, they did not predict the level of change at all. In

addition, Contrary to this researcher’s expectations, several path coefficients showed a negative

impact level of change. According to Conger, Lorenz, and Wickrama (2004), the growth curve

model, in contrast with the autoregressive model, may provide different results based on

correlation coefficients among repeated measures.

http://engdic.daum.net/dicen/search.do?m=all&q=expectations

51

CHAPTER 5

DISCUSSION

Summary and Understanding the Research Findings

Although a considerable body of empirical research has established the importance of

family context, few studies have examined the unique influences of family factors and their

multiplicative influences on a range of adolescents’ health problems (Wickrama, Conger &

Abraham, 2008). The goals of the current research were to address the unique influences of

chronic family economic hardships as they influence marital conflicts, supportive parenting, and

adolescents’ health problems (i.e., anxiety, depressive symptoms, and physical complaints). To

find unique pathways, the current study also added to the direct and indirect influence by using

an SEM framework. The current research analyzed data from a longitudinal sample of mothers,

fathers, and target adolescents (N= 404-451) to assess theoretical pathways.

The Direct Influences of Chronic Family Economic Hardships

The family stress model posits that cumulative health disadvantages over the life course

by positing that stress proliferation takes a long-term toll on health through a process that places

people already facing serious adversity at risk for continued exposure to further adverse

circumstances (Pearlin, Schieman, Fazio, & Meersman, 2005). According to stress-process

theory, this study demonstrated family mechanisms, which influence risks for developing

adolescents’ health problems over time. The current study also provides support to previous

research (Conger et al., 1992; O’Rand & Hamil-Luker, 2005; Wickrama, Conger, & Abraham,

52

2005). As expected, the current study determined chronic family economic hardships directly

influence anxiety, depressive symptoms, and physical complaints of adolescents.

The Mediating Effect of Marital Conflicts

According to Wadsworth and Compas (2002), parental conflicts partially mediated the

relationship between economic strain and adolescent adjustment. However, the current study

failed to determine the significant mediating effect of marital conflicts on the association

between chronic family economic hardships and adolescents’ health problems (i.e., anxiety,

depressive symptoms, and physical complaints). Moreover, the findings indicated that chronic

family economic hardships still have a direct influence on each of the adolescents’ health

problems after controlling for marital conflicts.

This non-significant direct influence of marital conflicts on adolescents’ health problems

is similar with recent studies. For example, Crockbenberg and Langrock (2001) reported that

marital behavior continued to only predict females' external problems, but not internal problems

such as anger, fear, and depressive symptoms. Moreover, the amount of variance accounted for

by effects was too small (i.e., 5% or less). Furthermore, in Frosch and Mangelsdorf’s study

(2001), they observed marital behaviors were not associated with child functioning.

This pathway between marital behavior and adolescents’ health problems can be inferred

from evidence that correlated parenting behaviors partially explains associations between marital

conflicts and adolescents’ health problems. Consistent with the family process model (Conger et

al., 1992), it appears that marital conflicts primarily influence inefficient parenting, which, in

turn, negatively influences their children (Conger et al., 1992).

Moreover, this association between marital conflicts and adolescents’ outcomes may be

explained by the cognitive contextual framework (Grych & Fincham, 1990), the emotional

53

security hypothesis (Cummings & Davies, 1994), and the specific emotions model (Crockenberg

& Forgays, 1996; Crockenberg & Langrock, 2001). In the cognitive-contextual framework,

emotions are conceptualized as primary responses to parental conflicts, which then influence

secondary, cognitive, processing of the event. Through its relation to cognitions, affect is thus

viewed as a mediator of the relationship between parental conflicts and adolescents’ adjustment.

The emotional security hypothesis conceptualizes affect as an additional index of emotional

security, which is ultimately related to child adjustment (Cummings & Davies, 1994). Last, the

specific emotions model posits that adolescents’ evaluations of marital conflicts lead to affective

reactions, based on adolescents’ expectations of specific goal attainment. These affective

reactions are then theorized to relate to adolescents’ internalizing and externalizing behavior

problems (Crockenberg & Langrock, 2001).

The Mediating Effect of Supportive Parenting

The current study found the association between chronic family economic hardships and

anxiety and depressive symptoms is mediated by supportive parenting. Additionally, supportive

parenting mediated the association between marital conflicts and anxiety and depressive

symptoms of adolescents. These findings are consistent with previous studies. For example,

Wicrama, Lorenz, and Conger (1997) found that through adolescent perception of parental

support, parental supportive behavior is connected with changes in adolescent health problems.

Lempers et al. (1989) also reported that the indirect effects of parental nurturance on the

association economic strain and adolescent depressive symptoms.

Moreover, in case of mediating effects on the association between marital conflicts and

adolescents’ health problems, the current study determined the association between marital

conflicts and adolescents’ mental health problems, such as anxiety and depressive symptoms, is

54

mediated by supportive parenting. This conclusion is similar with research on mediating effect of

parenting on the association between marital conflicts and child adjustment (Kaczynski, Lindahl,

Malik, & Laurenceau, 2006).

However, the current study failed to support the hypothesis that the associations between

martial conflicts and physical complaints and between chronic family economic hardships and

physical complaints are mediated by supportive parenting. These findings are similar with the

findings from previous studies. According to Wickrama et al. (1997), observed parental behavior

do not directly affect physical health status. This means that parental behavior does not have an

independent contemporaneous direct effect on adolescents-reported physical complaints in the

same fashion as perceived parental support does. Because the scale of supportive parenting in the

current study is parent-self reported, the non-significant pathway of supportive parenting on

physical complaints implies that parental supports, which adolescents think is different from the

parental supports which parents think.

In the context of the family process model, chronic family economic hardships impact

their children’s distress through other family factors, such as inefficient parenting (Conger et al.,

1997), parental depressive symptoms (Liber et al., 2008), and marital conflicts (Nicolotti et al.,

2003). In the case of physical complaints, of special interest is the finding that chronic family

economic hardships still significantly influence physical complaints after controlling for marital

conflicts and supportive parenting. This may be due to the fact that chronic family economic

hardships influence adolescent health problems through structural constraints and limitations,

such as lack of food, clothing, proper housing, leisure, and other health resources. Additionally,

recent clinical studies support the evidence that chronic stressful conditions are linked with other

negative physical complaints (Stoney, Niaura, Bausserman, & Matacin, 1999).

55

The Association among Anxiety, Depressive symptoms, and Physical Complaints over time

The results of the cross-lagged model provided evidence that anxiety and depressive

symptoms have mutual influence on one another over the adolescent years. This finding is the

same result as the Dunedin study (Moffitt et al., 2007). According to this study, anxiety and

depressive symptoms have a reciprocal relationship, based on a longitudinal study. Moreover,

the current study tested homotypic continuity of anxiety and depressive symptoms. The results

indicated all stability coefficients of anxiety and depressive symptoms are statistically significant.

This means early anxiety predicts late anxiety, and early depressive symptoms also predict late

depressive symptoms.

However, in the case of physical complaints, although the current study indicated

homotypic continuity of physical complaints, for heterotypic continuity, the study indicates early

physical complaints only predict late depressive symptoms and anxiety, but not vice versa.

In the case for comorbidity, all comorbidities occur over time. Especially, the study

showed that comorbidities between anxiety and depressive symptoms have higher rates than

comorbidity between depressive symptoms and physical complaints, and between anxiety and

physical complaints. This result is consistent with previous studies (Silberg, Rutter, & Eaves,

2001). However, the current research showed that comorbidity among anxiety, depressive

symptoms and physical complaints decreased over adolescence. This result implies that

adolescents consider anxiety, depressive symptoms, and physical complaints respectively over

time.

The Moderating Effect of Supportive Parenting

For the moderating effect, the current study indicated that supportive parenting as a

resilience factor moderated the association between marital conflicts and depressive symptoms

56

of adolescents. This result is consistent with the findings of previous studies (Gordis et al., 1997;

Frosch & Mangelsdorf, 2001). It seems that high-level supportive parenting breaks down

cognitive and emotional mechanisms that link parents’ marital conflicts with generation of

adolescents’ depressive symptoms.

However, supportive parenting did not moderate the association between chronic family

economic hardships and adolescents’ health problems. Moreover, supportive parenting did not

moderate the associations between marital conflicts and anxiety and physical complaints.

Gender Differences

For homotypic continuity, males have a higher stability coefficient for depressive symptoms

than females during 1992-1994. This means that depressive symptoms for males have stronger

homotypic continuity than females over time. Also, in the case of mean differences, females’

health problems (i.e., anxiety, depressive symptoms, and physical complaints) are higher than

males over time. It seems that severity of health problems is greater for females than for males.

This finding is consistent with previous research (Kessler et al., 2005). Furthermore, over the

three years, only males showed decreasing anxiety and increasing depression during the same

period. However, for females, only physical complaints significantly increased.

Furthermore, as can be seen in figure 11, chronic family economic hardship is stronger

associated with depressive symptoms in females. This finding is also consistent with previous

study (Lempers et al., 1989). Additionally, in the present study, females perceived more inter-

parental conflicts in relation to chronic family economic hardships than males. Earlier study may

support this finding. For example, Gottman (1990) suggested that female is largely responsible

for the emotional work in family relationships. Based on this study, adolescents female may be

more sensitive about family adversities such as financial problems and inter-parental conflicts.

57

Implications for the Current Study

The purpose of this study was to explore the mechanisms through which family

economic stressors may positively impact inter-parental conflicts and undermine effective

parenting skills, which, in turn, influence adolescents’ mental and physical health problems.

According to the family stress paradigm, negative stressors, such as economic stress and

negative life events, lead to poor mental health in parents—negatively impacting the marital

relationship and undermining effective parenting. In turn, poor parental mental health, marital

distress, and ineffective parenting are expected to have a cumulative negative impact on

adolescents’ well-being.

Specifically, this study explored whether effective parenting significantly buffered the

negative effects of economic stress and marital conflicts. The implications of such findings

would be that the benefits of positive parental supports may be limited to married couples

because this result may be difficult to apply to divorced parents or single parents. However,

according to previous research on co-parenting (Lengua, Wolchick, & Braver, 1995), research

suggests that maintaining a stable relationship with both parents, even if they are separated or

divorced, is very important for their children to keep a healthy adjustment. Hence, the long-term

outlooks on well-being and parenting effectiveness of divorced single parents does not

necessarily have to be as bleak as many make it out to be.

Managing both mental and physical health problems leads to the need to negotiate

multiple health care systems, particularly among youths in the often complex community health

care system. It is important that youths with co-occurring problems understand the separate

systems and linkages between them. However, systems can also enact policies, structures, and

processes to support service access. For example, a study by Hurlburt et al. (2004) suggests that

http://en.wikipedia.org/wiki/Parent

http://en.wikipedia.org/wiki/Legal_separation

http://en.wikipedia.org/wiki/Divorce

58

linkages between child welfare and mental health agencies lead to stronger associations between

mental health needs and mental health service use. A similar theoretical approach could be

applied to the investigation of the impact of linkages between medical and mental health systems

on adolescents with comorbid physical and mental health problems seen in community mental

health settings.

Limitations and Future Works for the Current Study

The continuity of change

The traditional regression method for analyzing change in psychiatric research typically

includes regressing the final measurement of symptoms on predictors after controlling for the

initial level of symptoms. This is known as ‘residualized scores’ or autoregression (or cross-

lagged models in the SEM framework) because covariates are used to predict residualized scores

of the final measurement after removing the effect of the initial measurement. This method

entails several limitations. First, the non-dynamic nature of these models views psychopathology

as a status rather than a process that unfolds over time (Coyn & Downy, 1991). Second, when

individual change follows a non-linear trajectory, regression methods are unlikely to reveal

intricacies of such change (Willet & Sayer, 1994). Moreover, “Ignoring the continuous nature of

change process, traditional methods prevent empirical researchers from engaging a richer,

broader spectrum of research questions, questions that deal with the nature of individual

development” (Willet, 1988, p. 347). In the context of changing continuity, the current study

showed univariate growth curve modeling for each health problem to show how each changed

over time to preserve the continuity of change for adolescents’ health problems, such as anxiety,

depressive symptoms, and physical complaints. The latent growth curve modeling approach is

needed to show individual change over time. However, the current study failed to demonstrate

59

how each of these changes is mutually related. Additionally, to identify homogeneous

subpopulations within the larger heterogeneous population and for the identification of

meaningful groups or classes of individuals, the use of latent class growth analysis (LCGA) and

general mixture modeling (GMM) approaches have recently grown in popularity in family

research, but were not covered in the current study. Thus, future research should investigate

‘interlocking’ trajectories within the context of the ‘latent growth class modeling approach’ for

adolescents’ health problems.

The gender moderating of parents

In the current study, the hypothesized mediating effects of marital conflicts on

adolescents’ health problems were not observed. However, there may be gender differences for

parents in terms of the amount of distress caused by financial events. This explanation is

consistent with a previous study demonstrating that husbands and wives respond differently to

undesirable life events (Conger et al., 1993). The results of the present study also showed an

insight of gender difference on the associations among financial strains, marital conflicts, and

adolescents’ health problems. For example, chronic family economic hardships were stronger

associated with marital conflicts for females. Moreover, females are more vulnerable to

depressive symptoms in response to financial stress. Based on the findings of the present study,

marital conflicts of fathers and mothers may differently influence the association between

chronic family economic hardship stress and adolescents’ health problems. However, marital

conflicts indicators were combined to form a latent factor in this study. Thus, it is not possible to

tease apart the differential outcomes using the current models. However, future studies could

certainly explore these differential outcomes in greater detail.

The sample size of current study

60

Another limitation is the sample size in the current study. The current study used Wave 1,

Wave 2, Wave 3, and Wave 4 of the IYFP study. The sample size for the four waves ranged from

404 to 451. Missing data were not a problem for the current study and the sample size was

adequate for the hypothesized associations. However, the sample was derived from a rural area

consisting of 100% Caucasian parents and adolescents. Information on adolescents living in an

urban setting was not assessed. Future research should incorporate a more diverse sample

population from various ethnic backgrounds to improve the generalizations made in the current

study. Future research should also assess adolescents living in a rural setting and an urban setting

to improve the findings and generalizations made in the current study.

61

Table 1. Descriptive Statistics of Study Samples (N=404 - 451)

Variables M SD Range(Max-Min) Skewness Alpha

Anxiety(91) 1.40 .46 1.00 – 3.90 1.93 .83

Anxiety(92) 1.37 .51 1.00 – 5.00 2.64 .85

Anxiety(94) 1.39 .52 1.00 – 4.43 1.98 .90

Depression(91) 1.51 .55 1.00 – 4.27 1.82 .89

Depression(92) 1.57 .60 1.00 – 5.00 1.83 .91

Depression(94) 1,62 .63 1.00 – 4.55 1.43 .92

Physical Complaints(91) 1.92 .39 1.00 – 3.17 .27 .76



Perceived FEH(89) 2.11 .63 1.00 – 4.67 .34 .67

Perceived FEH(90) 2.08 .59 1.00 – 3.75 .12 .70

Perceived FEH(91) 2.20 .66 1.00 – 4.50 .35 .67

Father’s Marital Conflicts(91) 1.13 .44 0.00 – 2.56 .03 .87

Mother’s Marital Conflicts(91) 1.10 .44 0.00 – 2.94 .43 .84

Father’s Supportiveness(91) 3.79 .43 2.00 – 5.00 -.24 .79

Mother’s Supportiveness(91) 4.02 .42 2.67 – 5.00 -.21 .80

Father’s Depression(91) 1.32 .45 1.00 – 4.77 3.14 .92

Mother’s Depression(91) 1.50 .57 1.00 – 4.38 2.30 .92

Father’s education(years) 13.54 2.14 8.00 – 20.00 .83

Mother’s education(years) 13.35 1.66 9.00 – 18.00 .74

Note. FEH= Family Economic Hardship; Max= Maximum; Min = Minimum.

62

Table 2. Mean Differences between Male and Female of the Health Problems

Variables (year) Male Mean

Female Mean t-value Male’s mean

change over time Female’s mean

change over time

Anxiety (1991) 1.33(.40) 1.45(.50) 2.60**

2.50+ .08 Anxiety (1992) 1.27(.41) 1.45(.57) 3.64***

Anxiety (1994) 1.29(.44) 1.45(.54) 3.17**

Total mean of Anxiety 1.30(.34) 1.45(.43) 4.06***

Depression (1991) 1.36(.39) 1.63(.53) 4.95***

4.53* 2.04 Depression (1992) 1.39(.46) 1.72(.67) 5.84***

Depression (1994) 1.46(.55) 1.73(.64) 4.45***

Total mean of Depression 1.40(.38) 1.69(.51) 6.56***

Physical complaints (1991) 1.90(.38) 1.95(.40) 1.30

.76 16.48*** Physical complaints (1992) 1.96(.41) 2.09(.43) 3.05**

Physical complaints (1994) 1.94(.41) 2.07(.41) 3.18***

Total mean of Physical Complaints 1.93(.33) 2.03(.35) 3.25***

Note. n = 189 (Males), and 218 (Females). Standard Deviations are in the parentheses +p<.10; **p<.01; ***p<.001

63

Table 3. Correlations among Study Variables

Note. *p < .05, **p < .01

Measures (Year) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 Anxiety(91) ____

2 Anxiety(92) .60** ____

3 Anxiety(94) .40** .48** ____

4 Depression(91) .75** .48** .38** ____

5 Depression(92) .49** .77** .40** .60** ____

6 Depression(94) .31** .39** .72** .38** .43** ____

7 Physical complaints(91) .37** .30** .26** .36** .33** .18** ____

8 Physical complaints(92) .30** .42** .31** .29** .44** .27** .59** ____

9 Physical complaints(94) .23** .32** .39** .21** .30** .36** .45** .55** ____

10 Father’s marital conflicts(91) .11* .14** .09 .12* .10 .01 .11* .09 .05 ____

11 Mother’s marital conflicts(91) .09 .11* .10 .14** .09 .06 .07 .14** .15** .38** ____

12 Father’s supportiveness(91) -.19** -.09 -.13* -.18** -.03 -.02 .02 -.02 -.02 -.22** -.14** ____

13 Mother’s supportiveness(91) -.19** -.14** -.07 -.21** -.12* -.08 -.09 -.08 -.13* -.11* -.21** .31** ____

14 Family Economic Hardship(89) .17** .11** .16** .18** .13** .10* .12* .11* .17** .20** .27** -.14** -.12* ____

15 Family Economic Hardship(90) .13** .21** .19** .16** .17** .13* .20** .23** .23** .14** .19** -.16** -.12* .51** ____

16 Family Economic Hardship(91) .18** .14** .22** .29** .13* .14** .27** .22** .23** .10* .17** -.14* -.17** .41** .47** ____

64

Table 4. Moderating Effects of Supportive Parenting

Note. L= the low group (n = 62); H= the high group (n = 69). Unstandardized coefficient in parentheses. *p<.05; **p<.01

Grouping Predictors Outcomes Standardized Coefficient

Standard Error Intercept χ2

difference

Supportive Parenting –L

Family Economic Hardship

Anxiety .20 (.37) .29 1.63

.01

Supportive Parenting – H


Anxiety .42** (.35) .12 1.28



Depression .26* (.47) .28 1.73

.03



Depression .45** (.52) .17 1.36



Physical Complaints .08 (.09) .17 1.96

.18





Marital Conflicts Anxiety .07 (.10) .19 1.63

.26 Supportive

Parenting – H Marital

Conflicts Anxiety -.01 (-.01) .09 1.28


Marital Conflicts Depression .25* (.42) .22 1.19

4.13* Supportive


Conflicts Depression -.10 (-.12) .15 1.47


Marital Conflicts


1.58 Supportive


Conflicts Physical

Complaints -.08 (-.07) .10 1.83

65

Table 5.Gender Difference of Health Problems

Note. Group: Male (n= 189), Female (n = 218). Unstandardized coefficient in parentheses *p<.05; ***p<.001

Domain Predictors (year)

Outcomes (year) Grouping Standardized

Coefficient Intercept χ2 difference

Intra-domain

Continuity (Homotypic Continuity)

Depression (1992)

Depression (1994)

Male .47*** (.57) .55

5.00*

Female .22* (.21) .82

66

Table 6. Gender Difference of the Hypothesized Path Model

Predictors (year) Outcomes (year) Grouping Standardized coefficients

Standard errors

χ2 difference

Chronic Family Economic Hardship

(1989-1991)

Anxiety(1991) Male .09 .10

.42 Female .15 .11

Depression(1991) Male .06 .10

5.10* Female .29 .15

Physical Complaints(1991)

Male .17 .09 2.11

Female .35 .10

Marital conflicts(1991)

Male .08 .03 8.46**

Female .32 .05

Supportive Parenting(1991)

Male -.40 .07 .45

Female -.17 .10

Marital Conflicts (1991)

Anxiety (1991) Male -.02 .26

.03 Female .01 .20

Depression(1991) Male -.02 .18

.01 Female -.03 .24

Physical complaints(1991)

Male .03 .24 .05

Female .08 .15

Supportive parenting(1991)

Male -.25 .21 .01

Female -.26 .17

Supportive parenting (1991)

Anxiety(1991) Male -.32 .30

.38 Female -.25 .19

Depression(1991) Male -.36 .30

.51 Female -.20 .21

Physical complaints(1991)

Male -.07 .25 .75

Female .16 .13 Note. *p<.05;**p<.01

67

Table 7. Univariate Growth Curves Model

Note. t-ratios in parentheses. **p<.01; ***p<.001

Variables Intercept Slope Chi-Square (df) CFI

Mean Variance Mean Variance

Anxiety (1991-1994) 1.39*** (62.96) .15*** (8.64) -.01(-.12) .02*** (3.36) 2.59(1) .99

Depression (1991-1994) 1.52*** (57.14) .23***(9.17) .03*** (3.30) .02***(3.17) .26(1) 1.00

Physical Complaints (1991-1994)

1.95*** (104.27) .10*** (8.81) .03*** (3.44) .01**(3.20) 18.18(1) .94

68

Early Depression (t1)

Early Anxiety (t1)

Moderating variable - Gender, Supportive Parenting Control variable - Parental Depression - Parental Education

Figure 1. Theoretical Model Note. Double arrows depict hypothesized moderating effects

Early Physical Complaints (t1)

Physical Complaints (t2)

Depression (t2)

Anxiety (t2)

Marital Conflict

Chronic Family

Economic Hardship

Supportive Parenting

69

Figure 2. Operationalized Model Note. DEP=Depression; ANX=Anxiety; Double arrows depict moderating effects of supportive parenting

Father Mother Father 1990 1991 Mother

: Intra-domain continuity (Homotypic continuity) : Cross-domain continuity (Heterotypic continuity) : Comorbidity

Cross-lagged Model Moderating variable - Supportive parenting, Gender Control variable - Parental Education - Parental Depression

Supportive Parenting

Marital

Conflicts

Chronic Family

Economic Hardship

ANX (1991)

DEP (1991)

Physical Complaints

(1991)

ANX (1992)

DEP (1992)

Physical Complaints

(1992)

ANX (1994)

DEP (1994)

Physical Complaints

(1994)

1989

The Study Time Line

3 WAVES (1991 – 1994) 1991 1989 - 1991

70

Direct effect: c’ Indirect effect: ab Total effect(c): ab + c’ a (Sa) b (Sb)

c (c’) X

M

Figure 3. Basic Mediational Structure for Sobel Test Note. a, b, and c= unstandardized regression coefficient; c’= unstandardized regression efficient after controlling for M; Sa, and Sb = standard error of a and b

Y

71

.29***(4.73)

.28***(4.84)

.21***(3.53)

.72***

.28***

.33***

Figure 4. Direct Influence of Chronic Family Economic Hardship on Adolescents’ Health Problems Note. Standardized regression coefficients, t-values in the parentheses; CFEH = Chronic Family Economic Hardship; *p<.05; **p<.01; ***p<.001

Anxiety (1991)

Depression

(1991)

Physical

Complaints (1991)

CFEH (89-91)

Control variable - Parental Depression - Parental Education

CFI= .95 RMSEA= .05 TLI= .90

72

.73***

.28***

.33***

.25***(3.70)

.20**(2.96)

.28***(4.05)

.10(1.30)

.04(.53)

.03(.37)

.38***(4.32)

Figure 5. Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Health Problems through Marital Conflict Note. Standardized regression coefficient; t-values in the parentheses; CFEH = Chronic Family Economic Hardship; MC = Marital Conflict;**p<.01; ***p<.001

Anxiety (1991)

Depression

(1991)

Physical

Complaints (1991)

CFEH (89-91)

MC (1991)

CFI= .90 RMSEA= .06 TLI= .90


73

.07(.91)

-.37***(-3.99) -.26**(-2.83)

.11(1.67)

.31***(4.46)

-.28**(-2.95)

.19**(2.81) .73***

.28***

.33***

Figure 6. Indirect Influence of Chronic Family Economic Hardship on Adolescents’ Health Problems through Supportive Parenting. Note. Standardized regression coefficient; t-values in the parentheses; CFEH = Chronic Family Economic Hardship; SP = Supportive Parenting; **p<.01; ***p<.001

Anxiety (1991)

Depression

(1991)

Physical

Complaints (1991)

CFEH (89-91)

SP (1991)

CFI= .93 RMSEA= .05 TLI= .94


74

-.31**(-2.75)

-.22*(-2.20)

-.26*(-2.49)

.10 (1.00)

.73***

.33***

.28***

.29***(4.13)

.13(1.85)

-.07(-.72)

-.41***(-3.26)

.07(.79)

.38***(4.33)

.20**(2.75)

Figure 7. Indirect Influence of Marital Conflict on Adolescents’ Health Problems through Supportive Parenting Note. Standardized regression coefficient; t-values in the parentheses; CFEH=Chronic Family Economic Hardships; MC = Marital Conflict; SP = Supportive Parenting; *p<.05; **p<.01; ***p<.001

Anxiety (1991)

Depression

(1991)

Physical

Complaints (1991)

CFEH MC (1991)

CFI= .90 RMSEA= .06 TLI= .89


SP (1991)

.01(.04)

75

.38*** -.41***

-.31**

-.28**

.10

-.07

.07

+.13

.20**

.29***

.42*** .39***

.28*** .51***

.54*** .50***

.25***

.69*** .70*** .71***

.32*** .31***

.25*** .36*** .06 .14*

.15* .05

.09

.12*

.14***

.02

.10 .09+

-.02 .10*

.67 .73 .65 .62 .59 .60 .52

χ2(123)=262.28 CFI= .94 RMSEA= .05 TLI= .90

Father Mother 1989 1990 1991

Figure 8. The Operationalized Associations of the Current Study Note. Standardized regression coefficient; DEP=Depression; ANX=Anxiety; +p<.10; *p<.05; **p<.01; ***p<.001

ANX (1991)

DEP

(1991)

Physical

Complaints (1991)

ANX

(1992)

DEP

(1992)

Physical

Complaints (1992)

ANX (1994)

DEP

(1994)

Physical

Complaints (1994)

Father Mother

Chronic Family

Economic Hardship

Marital

Conflicts (1991)

Parental Support (1991)

-.22*

.28***

.01


76

High-level Supportive

parenting group

-.12

.42

Marital Conflicts

Depressive sym

ptoms

1.71

1.35

.97 1.23

Low-level Supportive

parenting group

Figure 9. Supportive Parenting Moderation of Marital Conflict on Adolescents’ Depression Note. Unstandardized coefficient

77

Figure 10. Moderating Effect of Gender Difference on Adolescents’ Health Problems Note. Standardized regression coefficients, Female in the parentheses. All comorbidities are significant at the .001 level

+p<.10; *p<.05; **p<.01; ***p<.001

: Intra-domain continuity (Homotypic Continuity) : Cross-domain influence (Heterotypic Continuity) : Comorbidity

.35*** (.50***) .47*** (.22*)

.54*** (.57***) .41*** (.58***)

.49***(.43***) .50*** (.46***)

Female (n=218) ² (9) = 27.20

CFI = .98 TLI = .90

Male (n=189) ² (9) = 17.13

CFI = .99 TLI = .95

.16*(.09) .11(.17**) .09(.14*)

.11(-.10)

-.01(.12) .18+(-.05)

.05(.02) .07(.10)

.06(.09)

.16+(.04) -.02(.17+)

.01(.08)

.68(.61) .71(.68)

.32(.36) .27(.29) .17(.27)

.30(.27) .75(.75)

.35(.38) .24(.29)

Anxiety (1991)

Anxiety (1992)

Anxiety (1994)

Depression (1991)

Physical complaints

(1991)

Depression (1992)

Physical complaints

(1992)

Depression (1994)

Physical complaints

(1994)

78

.06(.29**)

.09(.15)

.17(.35***)

-.02(.01)

.04(.08)

-.02(-.03)

-.36*(-.20)

-.32*(-.25*)

-.07(.16)

-.25*(-.26**) .08(.35***)

Figure 11. Gender Difference on the Associations among Chronic Family Economic Hardship, Marital Conflicts, Supportive Parenting, and Adolescents’ Health Problems. Note. Standardized regression coefficients; Female in the parentheses; CFEH =

chronic family economic hardships; MC = Marital Conflicts; SP = Supportive Parenting, *p<.05; **p<.01; ***p<.001

Anxiety (1991)

Depression

(1991)

Physical

Complaints (1991)

CFEH (89-91)

MC (1991)

Males (n=189) ² (24) = 50.45

CFI= .93 RMSEA= .06 TLI= .90

SP (1991)

Females (n=218) ² (24) = 38.16

CFI= .97 RMSEA= .05 TLI= .93

-.40**(-.17)

.31***(.32***)

.72***(.72***)

.28***(.40***)

79

Males .18

.37

Chronic family economic hardships

Depressive sym

ptoms 1.63

1.36

2.10 2.16

Females

Figure 12. Gender Difference of Chronic Family Economic Hardship on Depression Note. Unstandardized coefficient.

80

χ2(77)= 155.03 CFI= .97 RMSEA=.04 TLI =.94

-.17+

-.09

.54* .53***

-.21

-.05 .03

.77*** .66**

.53*** .53**

-.12

.38*** -.41***

-.22*

.01

.06

.13

.07

-.07

-.03

.17*

.24

.36***

.20

-.01

Initial Level 1991

Rate of change 1991-1994


Initial Level 1991

Initial Level 1991


Anxiety

Depression

Physical Complaints

Chronic Family

Economic Hardship

89-91

Marital Conflicts

1991

Parental supports

1991

Figure 13. Hypothesized Interlocking Model. Note. Standardized coefficients; +p<.10; *p<.05; **p<.01; ***p<.001

-.01

-.33*

-.24*

-.11

.31

.28

-.12

.24**

-.52+

.08

-.16

81

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