A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community

Laura Havers; Kamaldeep Bhui; Ruichong Shuai; Peter Fonagy; Mina Fazel; Craig Morgan; Daisy Fancourt; Paul McCrone; Melanie Smuk; Georgina M Hosang; Sania Shakoor

doi:10.1002/jad.12347

A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community

J Adolesc. 2024 May 20. doi: 10.1002/jad.12347. Online ahead of print.

Authors

Laura Havers¹, Kamaldeep Bhui^{2

3

4}, Ruichong Shuai¹, Peter Fonagy^{5

6}, Mina Fazel⁷, Craig Morgan^{8

9}, Daisy Fancourt¹⁰, Paul McCrone¹¹, Melanie Smuk¹², Georgina M Hosang¹, Sania Shakoor¹

Affiliations

¹ Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK.
² Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, and Wadham College, University of Oxford, Oxford, UK.
³ Oxford Health and East London NHS Foundation Trusts, Oxford, London, UK.
⁴ World Psychiatric Association Collaborating Centre, Oxford, UK.
⁵ Anna Freud National Centre for Children and Families, London, UK.
⁶ Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁷ Department of Psychiatry, University of Oxford, Oxford, UK.
⁸ Health Service and Population Research, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK.
⁹ ESRC Centre for Society and Mental Health, King's College London, London, UK.
¹⁰ Department of Behavioural Science and Health, University College London, London, UK.
¹¹ Institute for Lifecourse Development, University of Greenwich, London, UK.
¹² Centre for Genomics and Child Health, Blizard Institute, Queen Mary, University of London, London, UK.

PMID: 38769710
DOI: 10.1002/jad.12347

Abstract

Background: Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association.

Methods: Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13-14-year-olds in Cornwall, United Kingdom in 2017-2019. In a cross-sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated.

Results: Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [-0.02,0.44]).

Conclusions: Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13-14-year-olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry.

Keywords: ACEs; adversity; anxiety; depression; intersectionality; moderation.

Abstract

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