Longitudinal Study of Mental Health Symptom Profiles of Maltreated and Comparison Adolescents

Background: The first generation of research on child maltreatment (CM) primarily focused on the impact of CM on discrete types of mental health problems such as depression and posttraumatic stress disorder (PTSD). There has been criticism of the use of discrete categorization of mental disorders because mental health symptoms rarely fit neatly into a single category. Recently, there has been a focus on person-centered approaches to understanding how symptoms naturally aggregate. However, this new effort to identify mental health symptom clusters has not been fully integrated into CM research. Further, while there is emerging evidence showing mental health symptom clusters found in adolescence may be different from those in adulthood, there is lack of longitudinal research examining the mental health symptoms clusters across early to late adolescence. The current study sought to identify meaningful clusters of mental health symptoms across early to late adolescence in a sample of maltreated and comparison youth.

Method: The participants were from a prospective longitudinal study on the impact of CM on development. The initial sample consisted of 9 to 13 years-old maltreated adolescents with active cases in child protective services (n=303) and demographically similar comparison adolescents (n=151). The study utilized the data at baseline and 7-year follow-up (73% retention). Measures included Child Depression Inventory (emotional and functional subscales), Multidimensional Anxiety Scale of Children (physical, anxious, social anxiety subscales), Youth Self-Report (aggression and rule-breaking behaviors subscales) and Youth Symptom Checklist (reexperiencing, avoidance, hyperarousal symptoms subscales). Latent Profile Analyses with 2 to 4 classes solutions were performed using MPlus 8.0. Diverse model fit indices as well as theoretical considerations of the meaningfulness of classification were applied in determining the optimal number of classes.

Results: The three-classes solution was chosen as the optimal number of classes for both early and late adolescence and the identified three classes were similar for both ages. The first class exhibited higher levels of depressive, PTSD and externalizing symptoms. Second group had slightly elevated anxiety symptoms but no other mental health symptoms. The third group reported overall lower levels of all mental health symptoms. A series of chi-square analyses showed that there was no statistically significant difference in class membership between maltreated and comparison groups.

Conclusion: The results did not support strong co-occurrence between depressive and anxiety symptoms in adolescence, which is commonly found in adulthood. The co-occurrence of depressive and externalizing symptoms challenges a traditional model of internalizing and externalizing symptom profiles in adolescence. An empirically based mental health classification system is important not only for clinicians but also for social scientist who integrate mental-health problems into their research. Future research should further explore change and stability of mental health symptom clustered across longer developmental spans.