Abstract
Chapter I: Lay Summary
Overall, the thesis aimed to develop a greater understanding of the ways in which poorer family relationships link to adolescent anxiety and depression (together known as internalising difficulties).
Systematic review
The systematic review aimed to explore the role family plays in the development of supportive friendships in adolescents. Adolescents spend an increasing amount of time with their friends (N. Butler et al., 2022), and these relationships are important in protecting against the development of mental health difficulties (Hall-Lande et al., 2007; Roach, 2018), however little is known about the factors which influence their development. The family environment influences many aspects of young people’s development, including their ability to establish friendships (Brown & Bakken, 2011). The review examined the relationship between whole system family functioning, defined as how well all family members interact with one another, and friendships.
The review had two aims, firstly to examine relationship between better whole system family functioning and more supportive peer relationships, and secondly to compare and contrast associations across the different areas of family functioning. These areas mostly corresponded to Olson’s Circumplex model (2000), which proposes three important aspects: communication, cohesion (the degree of closeness and affection displayed between family members), and flexibility (adaptation to new stressors and challenges). The domain of conflict was also added given its importance in other models of family functioning (Bowen, 1976) and reported frequency within families of adolescents (Kiani et al., 2016).
A systematic review was conducted using predefined criteria and search terms to explore and summarize the psychological research literature. Search terms were developed to find relevant articles. Several inclusion and exclusion criteria were also applied to make sure the final articles were focussed on the topic. Participants with and without major mental health difficulties were included.
Two databases were searched, and 11 relevant articles were summarised. The majority of studies showed a link between better family functioning and more supportive friendships. When comparing the impact of different aspects of family functioning, good communication in the family was most consistently related to better peer relationships. Evidence was mixed for the importance of flexibility and cohesion. No evidence was found for the impact of family conflict
on peer relationships. In samples of adolescents with mental health difficulties, no relationship was found between family functioning and friendships. Similarly, parents report of family functioning had little similarity with adolescents’, and only adolescent reported family functioning correlated with friendship supportiveness.
The research was found to be of a generally high quality. However, the certainty of the findings was affected by measurement issues with the most frequently used measure of family functioning, The Family Adaptability and Cohesion Scale (D. H. Olson et al., 1986). Strengths and limitations of the literature and review process were discussed. The research is useful in developing more streamlined interventions for adolescents who are struggling with friendships, enabling clinicians to target the contributing family difficulties, such as communication.
Research project
Poorer family functioning is known to increase the risk of developing internalising difficulties in adolescents (Scully et al., 2020a), however little research has examined the ways in which the variables are linked. Separate streams of literature suggest that more supportive peer relationships and the use of specific emotion regulation strategies are closely related to both family functioning and internalising difficulties (Delgado et al., 2022; Scully et al., 2020a).
Emotion regulation can be conceptualised in terms of the employment of different strategies (Gross & Muñoz, 1995) that are categorised as helpful or unhelpful in relation to the long term outcomes associated with their use (Schäfer et al., 2017). The study focused on two unhelpful strategies shown to have the strongest relationship with internalising difficulties (Schäfer et al., 2017); rumination (having repetitive unhelpful thoughts which keep us stuck in negative emotions) and emotional acceptance (allowing one’s emotional response to pass without resistance). The hypothesis stated that poorer family functioning is related to increased rumination, decreased emotional acceptance and less supportive peer relationships, which are in turn related to increased internalising difficulties. The study also aimed to understand how different aspects of family functioning were related to internalising difficulties. Mediation analysis was completed, which is the consideration of how a third variable affects the relation between two other variables.
A mostly female sample of 181 16–18-year-olds were recruited from five schools. The participants completed five measures during a single lesson using an online platform. The results showed the unique role of the family’s strength in supporting each other and adapting to challenges and internalising difficulties. The relationship between this aspect of family functioning and internalising difficulties was partially explained through using the emotion regulation strategy rumination, but not by supportive peer relationships or the use of the emotion regulation strategy of emotional acceptance.
The results highlight the importance of assessing the role of family difficulties and the use of rumination in adolescent internalising difficulties. The current gold-standard treatments for adolescents with anxiety or depression treat the individual (NICE, 2023), but family members could helpfully be involved more in sessions, with a focus on the ways in which they support each other and adapt to stressors.
Integration, impact and dissemination plan.
The systemic review and empirical project overlapped in helpful ways. The relationship between family functioning and supportive peer relationships was explored in the systematic review, and the significant correlation between the two formed the conceptual basis exploring for the mediating role of supportive peer relationships in the empirical project. The systematic review highlighted several limitations in the research literature, such as poor ethnic and gender diversity of young people within samples and a reliance on research at a single point in time with only adolescents completing questionnaires. The empirical project was able to address some of these concerns, for example by including a more ethnically diverse sample, however further limitations around the sample and design were not possible to address due to practical and time constraints.
The impact of the results in the context of current government policies and clinical guidelines were explored. The importance of family dynamics in relation to adolescent internalising difficulties contradict current guidelines which promote individual approaches to treating internalising difficulties. The impact on myself as a researcher and participants was also explored.
The research will be disseminated back to the participants through a vlog and to other clinical psychologists and researchers through social media, conferences (such as the Association for Family Therapy and Systemic Practice) and publications (in journals such as The Journal of Family Therapy).
Overall, the thesis aimed to develop a greater understanding of the ways in which poorer family relationships link to adolescent anxiety and depression (together known as internalising difficulties).
Systematic review
The systematic review aimed to explore the role family plays in the development of supportive friendships in adolescents. Adolescents spend an increasing amount of time with their friends (N. Butler et al., 2022), and these relationships are important in protecting against the development of mental health difficulties (Hall-Lande et al., 2007; Roach, 2018), however little is known about the factors which influence their development. The family environment influences many aspects of young people’s development, including their ability to establish friendships (Brown & Bakken, 2011). The review examined the relationship between whole system family functioning, defined as how well all family members interact with one another, and friendships.
The review had two aims, firstly to examine relationship between better whole system family functioning and more supportive peer relationships, and secondly to compare and contrast associations across the different areas of family functioning. These areas mostly corresponded to Olson’s Circumplex model (2000), which proposes three important aspects: communication, cohesion (the degree of closeness and affection displayed between family members), and flexibility (adaptation to new stressors and challenges). The domain of conflict was also added given its importance in other models of family functioning (Bowen, 1976) and reported frequency within families of adolescents (Kiani et al., 2016).
A systematic review was conducted using predefined criteria and search terms to explore and summarize the psychological research literature. Search terms were developed to find relevant articles. Several inclusion and exclusion criteria were also applied to make sure the final articles were focussed on the topic. Participants with and without major mental health difficulties were included.
Two databases were searched, and 11 relevant articles were summarised. The majority of studies showed a link between better family functioning and more supportive friendships. When comparing the impact of different aspects of family functioning, good communication in the family was most consistently related to better peer relationships. Evidence was mixed for the importance of flexibility and cohesion. No evidence was found for the impact of family conflict
on peer relationships. In samples of adolescents with mental health difficulties, no relationship was found between family functioning and friendships. Similarly, parents report of family functioning had little similarity with adolescents’, and only adolescent reported family functioning correlated with friendship supportiveness.
The research was found to be of a generally high quality. However, the certainty of the findings was affected by measurement issues with the most frequently used measure of family functioning, The Family Adaptability and Cohesion Scale (D. H. Olson et al., 1986). Strengths and limitations of the literature and review process were discussed. The research is useful in developing more streamlined interventions for adolescents who are struggling with friendships, enabling clinicians to target the contributing family difficulties, such as communication.
Research project
Poorer family functioning is known to increase the risk of developing internalising difficulties in adolescents (Scully et al., 2020a), however little research has examined the ways in which the variables are linked. Separate streams of literature suggest that more supportive peer relationships and the use of specific emotion regulation strategies are closely related to both family functioning and internalising difficulties (Delgado et al., 2022; Scully et al., 2020a).
Emotion regulation can be conceptualised in terms of the employment of different strategies (Gross & Muñoz, 1995) that are categorised as helpful or unhelpful in relation to the long term outcomes associated with their use (Schäfer et al., 2017). The study focused on two unhelpful strategies shown to have the strongest relationship with internalising difficulties (Schäfer et al., 2017); rumination (having repetitive unhelpful thoughts which keep us stuck in negative emotions) and emotional acceptance (allowing one’s emotional response to pass without resistance). The hypothesis stated that poorer family functioning is related to increased rumination, decreased emotional acceptance and less supportive peer relationships, which are in turn related to increased internalising difficulties. The study also aimed to understand how different aspects of family functioning were related to internalising difficulties. Mediation analysis was completed, which is the consideration of how a third variable affects the relation between two other variables.
A mostly female sample of 181 16–18-year-olds were recruited from five schools. The participants completed five measures during a single lesson using an online platform. The results showed the unique role of the family’s strength in supporting each other and adapting to challenges and internalising difficulties. The relationship between this aspect of family functioning and internalising difficulties was partially explained through using the emotion regulation strategy rumination, but not by supportive peer relationships or the use of the emotion regulation strategy of emotional acceptance.
The results highlight the importance of assessing the role of family difficulties and the use of rumination in adolescent internalising difficulties. The current gold-standard treatments for adolescents with anxiety or depression treat the individual (NICE, 2023), but family members could helpfully be involved more in sessions, with a focus on the ways in which they support each other and adapt to stressors.
Integration, impact and dissemination plan.
The systemic review and empirical project overlapped in helpful ways. The relationship between family functioning and supportive peer relationships was explored in the systematic review, and the significant correlation between the two formed the conceptual basis exploring for the mediating role of supportive peer relationships in the empirical project. The systematic review highlighted several limitations in the research literature, such as poor ethnic and gender diversity of young people within samples and a reliance on research at a single point in time with only adolescents completing questionnaires. The empirical project was able to address some of these concerns, for example by including a more ethnically diverse sample, however further limitations around the sample and design were not possible to address due to practical and time constraints.
The impact of the results in the context of current government policies and clinical guidelines were explored. The importance of family dynamics in relation to adolescent internalising difficulties contradict current guidelines which promote individual approaches to treating internalising difficulties. The impact on myself as a researcher and participants was also explored.
The research will be disseminated back to the participants through a vlog and to other clinical psychologists and researchers through social media, conferences (such as the Association for Family Therapy and Systemic Practice) and publications (in journals such as The Journal of Family Therapy).
| Original language | English |
|---|---|
| Publication status | Unpublished - 2024 |
