A mixed methods investigation of multiple risk exposure and ...

Amixedmethodsinvestigationofmultipleriskexposureandearly

adolescentgirls’emotionalsymptoms:Mechanisms,adaptive

processes,andlivedexperience

AthesissubmittedtotheUniversityofManchesterforthedegreeofDoctorof

PhilosophyintheFacultyofHumanities

2019

OlaA.Demkowicz

SchoolofEnvironment,EducationandDevelopment

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MULTIPLERISKEXPOSUREANDEMOTIONALSYMPTOMSAMONGGIRLS

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Contents

ListofTables...............................................................................................................9

ListofFigures............................................................................................................11

ListofAbbreviations.................................................................................................12

Abstract....................................................................................................................15

Declaration...............................................................................................................16

CopyrightStatement.................................................................................................16

Acknowledgements..................................................................................................17

Chapter1:IntroductionandAims.......................................................................19

1.1ContextoftheStudy...........................................................................................19

1.2TheCurrentStudy...............................................................................................20

1.2.1AimsoftheStudy.........................................................................................21

1.2.2ResearchQuestions.....................................................................................22

1.3GuidingTheoreticalPerspectives........................................................................22

1.4OverviewoftheThesis........................................................................................23

Chapter2:EmotionalSymptomsandEarlyAdolescentGirls...............................25

2.1ChapterOverview...............................................................................................25

2.2DefiningEmotionalSymptoms...........................................................................25

2.3EmotionalSymptoms:TrajectoriesandOutcomes.............................................27

2.4GenderedMentalHealthTrendsandExperiences.............................................28

2.4.1EmotionalSymptomatologyandDisorderamongGirlsandWomen..........28

2.4.2TimeTrendsinEmotionalSymptomsamongAdolescentGirls...................31

2.5LivedExperienceofEmotionalSymptoms..........................................................33

2.6ChapterSummary...............................................................................................34

Chapter3:RiskandResilience............................................................................37


3.2RiskFactors.........................................................................................................37


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3.2.1YoungRelativeAge......................................................................................38

3.2.2LowAcademicAttainment..........................................................................39

3.2.3HighAcademicAttainment..........................................................................40

3.2.4SpecialEducationalNeeds(SEN).................................................................40

3.2.5LowFamilyIncome......................................................................................42

3.2.6YoungCarerStatus......................................................................................43

3.2.7AdverseChildhoodExperiences(ACEs).......................................................44

3.2.8NeighbourhoodSocioeconomicDeprivation...............................................45

3.3ExposuretoMultipleRiskFactors......................................................................46

3.3.1CumulativeRiskTheoryandResearch.........................................................47

3.3.2MeasurementModelsforMultipleRiskExposure......................................50

3.3.3MechanismsofMultipleRiskEffects...........................................................55

3.4ResilienceandAdaptation..................................................................................58

3.4.1FactorsSupportingPositiveOutcomes........................................................61

3.4.2SocialConnection........................................................................................63

3.4.3ActiveEngagementinHomeandSchoolLife..............................................68

3.4.4EngagementinExtracurricularActivities.....................................................69

3.5MethodologicalApproachesinRiskandResilience...........................................70

3.6ChapterSummary...............................................................................................72

Chapter4:Method.............................................................................................73


4.2StudyContext.....................................................................................................73

4.2.1HeadStart.....................................................................................................73

4.2.2NationalEvaluationofHeadStart................................................................74

4.2.3IndependenceoftheCurrentStudy............................................................75

4.3EpistemologicalApproach..................................................................................75

4.3.1Pragmatism..................................................................................................76

4.3.2WiderTheoreticalPerspectives...................................................................78

4.4ResearchDesign.................................................................................................82

4.4.1MixedMethodsDesign................................................................................82


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4.4.2QuantitativeStrand......................................................................................85

4.4.3QualitativeStrand........................................................................................87

4.4.4IntegrationofQuantitativeandQualitativeStrands...................................88

4.5Participants.........................................................................................................89

4.5.1QuantitativeSample....................................................................................89

4.5.2QualitativeSample.......................................................................................93

4.6Materials.............................................................................................................99

4.6.1QuantitativeMaterials.................................................................................99

4.6.2QualitativeMaterials.................................................................................109

4.7Procedure.........................................................................................................112

4.7.1QuantitativeProcedure.............................................................................112

4.7.2QualitativeProcedure................................................................................113

4.8QuantitativeAnalysis........................................................................................115

4.8.1StructuralEquationModelling(SEM)........................................................115

4.8.2Pre-Analysis................................................................................................118

4.8.3MainStatisticalAnalysis.............................................................................119

4.9QualitativeAnalysis...........................................................................................125

4.9.1InterpretativePhenomenologicalAnalysis(IPA)........................................125

4.9.2StagesofIPA..............................................................................................126

4.10MixedMethodsStrategy................................................................................131

4.11QualityandRigour..........................................................................................132

4.11.1QuantitativeStrand.................................................................................132

4.11.2QualitativeStrand....................................................................................133

4.11.3MixedMethods........................................................................................135

4.12EthicalConsiderations....................................................................................135

4.12.1ResponsibilitiestoParticipants................................................................135

4.12.2ResponsibilitiestoSponsorsoftheResearch..........................................138

4.12.3ResponsibilitiestotheCommunityofEducationalResearchers..............138

4.12.4ResponsibilitiestoEducationalProfessionals,Policymakers,andthe

GeneralPublic.....................................................................................................138

4.13ChapterSummary...........................................................................................138


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Chapter5:QuantitativeResults........................................................................139

5.1.ChapterOverview............................................................................................139

5.2PreliminaryAnalyses........................................................................................139

5.3ResearchQuestion1:RiskFactorsandProcesses............................................142

5.3.1RiskFactors................................................................................................142

5.3.2CumulativeRiskEffects.............................................................................146

5.3.3RiskMeasurementModels........................................................................151

5.3.4IndirectEffectsofStress............................................................................158

5.4ResearchQuestion2:FactorsandProcessesforPositiveOutcomes...............162

5.4.1PromotiveFactors.....................................................................................162

5.4.2ProtectiveFactors......................................................................................164

5.5ChapterSummary.............................................................................................175

Chapter6:QualitativeFindings.........................................................................177

6.1ChapterOverview.............................................................................................177

6.2IndividualParticipantThemes..........................................................................177

6.2.1ThemesforAmelia.....................................................................................177

6.2.2 ThemesforJennifer.................................................................................178

6.2.3ThemesforGrace......................................................................................180

6.3MasterThemes.................................................................................................181

6.3.1TheExperienceofSymptoms....................................................................184

6.3.2InternalGrappling......................................................................................190

6.3.3DemandsandControl................................................................................199

6.3.4DrawingonOthers....................................................................................205

6.4ReflexiveAppraisalDiscussion..........................................................................212

6.4.1IdentificationwithParticipants’Experiences............................................212

6.4.2BalancingUniqueandSharedExperiences................................................214

6.4.3WiderKnowledgeofParticipants..............................................................216

6.4.4ContextoftheBroaderStudy....................................................................217

6.5ChapterSummary.............................................................................................219


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Chapter7:Discussion.......................................................................................221

7.1ChapterOverview.............................................................................................221

7.2SummaryofFindings........................................................................................221

7.2.1ResearchQuestion1:RiskFactorsandProcesses.....................................221

7.2.2ResearchQuestion2:FactorsandProcessesforPositiveOutcomes........222

7.2.3ResearchQuestion3:LivedExperience.....................................................224

7.3ResearchQuestion1:RiskFactorsandProcesses............................................225

7.3.1RiskFactors................................................................................................225

7.3.2CumulativeRiskEffects..............................................................................230

7.3.3RiskMeasurementModels........................................................................234

7.3.4IndirectEffectsofStress............................................................................238

7.4ResearchQuestion2:FactorsandProcessesforPositiveOutcomes...............244

7.4.1PromotiveFactors......................................................................................244

7.4.2ProtectiveFactors......................................................................................248

7.5ResearchQuestion3:LivedExperience............................................................255

7.5.1TheExperienceofFeelings........................................................................257

7.5.2InternalGrappling......................................................................................259

7.5.3DemandsandControl................................................................................266

7.5.4DrawingonOthers.....................................................................................274

7.6Meta-InferencesandImplicationsandDirectionsforFutureResearch...........280

7.6.1Meta-InferenceOne:EmotionalSymptomsareEmbeddedinDailyLife..282

7.6.2Meta-InferenceTwo:DemandsandStresscanbePsychologically

Overwhelming.....................................................................................................283

7.6.3Meta-InferenceThree:CloseRelationshipsareCritical.............................287

7.7StrengthsandLimitations.................................................................................290

7.7.1QuantitativeStrand....................................................................................290

7.7.2QualitativeStrand......................................................................................296

7.7.3MixedMethodsDesign..............................................................................299

7.8SummaryandConclusions................................................................................301

References..............................................................................................................303


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Appendices..............................................................................................................387

WORDCOUNT:87,507


9

ListofTables

Table Page

4.1 Variablesinthequantitativestrand 88

4.2 Numberofeducationsettingsandparticipantswithineachlocal

authoritypartnershiparea

92

4.3 Proportionsofsamplestatisticscomparativetonationalnorms 93

4.4 Partnershipareas’conceptualisationsofriskusedtoselect

participants

95

4.5 StudentResilienceSurveyadjustedsubscalenamesandrationale 109

5.1 Summaryofdataassumptionreviewacrossthedataset 142

5.2 Descriptivestatisticsforcontinuousvariables 143

5.3 Intraclustercorrelationcoefficientsandbivariatecorrelation

coefficientsforvariablesinRQ1a

145

5.4 Unstandardisedandstandardisedregressionbetacoefficientsand

standarderrorsforhypothesisedriskvariablesaspredictorsof

symptoms

146

5.5 Distributionofthesampleacrossthecumulativeriskindex 149


coefficientsforvariablesinRQ1b

150


standarderrorsforthecumulativeriskindexasapredictorof

symptoms

152


coefficientsforvariablesinRQ1c

155

5.9 Unstandardisedandstandardisedfactorloadingsandintracluster

correlationcoefficientsforthelatentriskconstruct

156

5.10 Unstandardisedandstandardisedfactorloadingsforthelatentrisk

constructwithcorrelatedresiduals

156


modelfitindicesforthemultipleriskexposuremodels

158

5.12 Intraclustercorrelationcoefficientsandbivariateandlatent 161


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correlationcoefficientsforvariablesinRQ1d

5.13 Unstandardisedandstandardisedbetacoefficientsfordirect,

indirect,andtotaleffectsofmultipleriskexposure,perceived

distress,andperceivedcopingonemotionalsymptoms

162

5.14 Intraclustercorrelationcoefficientsandbivariateandlatent

correlationcoefficientsforvariablesinRQ2a

164


standarderrorsforhypothesisedpromotivevariablesaspredictors

ofsymptoms

165

5.16 Sixpossiblemoderatorvariableswithsummaryoftheoryandprior

evidenceandregressioncoefficients

168


coefficientsforvariablesinRQ2b

171

5.18 Unstandardisedandstandardisedbetacoefficientsforspecific

conditionaleffectsforindirecteffectpathways

175

6.1 ThemesforAmelia 180

6.2 ThemesforJennifer 181

6.3 ThemesforGrace 182

6.4 Masterthemesandrepresentationofparticipants 184


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ListofFigures

Figure Page

3.1 Multipleriskexposuremeasurementmodels 52

3.2 Promotiveandprotectiveconceptualmodels 61

4.1 Hierarchyofelementswithinparadigms 78

4.2 Conceptualandstatisticalmoderationmodels 124

4.3 Conceptualandstatisticalconditionalindirecteffectsmodels 125

5.1 Riskfactorsmodel 147

5.2 Linechartforemotionalsymptomsandthecumulativeriskindex 149

5.3 Statisticalmodelforcumulativeriskwithstandardisedregression

betacoefficient

151

5.4 Conceptualmodelforcumulativeriskeffectswithcovariate

model

151

5.5 Multipleriskexposuremeasurementmodels 154

5.6 Statisticalmultipleriskexposuremeasurementmodelswith

standardisedbetacoefficients

159

5.7 Directeffectsandindirecteffectsmodels 163

5.8 Promotivefactorsmodel 166

5.9 Simplifiedstatisticalconditionalindirecteffectsmodel 172

5.10 Indirecteffectsmodel 174

5.11 Specificconditionalindirecteffects 177

7.1 Conceptualrepresentationofthemesfordiscussion 253

7.2 Meta-inferencesacrossthequantitativeandqualitativestrands 278


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ListofAbbreviations

Abbr. Description

ACEs Adversechildhoodexperiences

AFNCCF AnnaFreudNationalCentreforChildrenandFamilies

APA AmericanPsychiatricAssociation

ASD AutisticSpectrumDisorder

CAMHS ChildandAdolescentMentalHealthServices

CBT Cognitivebehaviouraltherapy

CFA Confirmatoryfactoranalysis

CFI ComparativeFitIndex

CIN ChildinNeed

CR Cumulativerisk

DfE DepartmentforEducation

EHC Education,HealthandCare[plan]

FIML Fullinformationmaximumlikelihood

FSM Freeschoolmeals

ICC Intraclustercorrelationcoefficient

IDACI IncomeDeprivationAffectingChildrenIndex

IPA Interpretativephenomenologicalanalysis

MAR Missingatrandom

MCAR Missingcompletelyatrandom

MI Modificationindices

ML Maximumlikelihood

MLR Robustmaximumlikelihood

MNAR Missingnotatrandom

NCLF NationalCommunityLotteryFund

NHS NationalHealthService

NPD NationalPupilDatabase

OCD ObsessiveCompulsiveDisorder

ONS OfficeforNationalStatistics

PSS-4 Four-itemPerceivedStressScale


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RMSEA RootMeanSquareErrorofApproximation

RQ Researchquestion

SATs StatutoryAssessmentTests

SDQ StrengthsandDifficultiesQuestionnaire

SEM Structuralequationmodelling

SEN Specialeducationalneeds

SEPC Standardisedestimatedparameterchange

SES Socioeconomicstatus

SRS StudentResilienceSurvey

TLI Tucker-LewisIndex

UCL UniversityCollegeLondon

UK UnitedKingdom

WHO WorldHealthOrganization

WLSMV Weightedleastsquaremeanandvarianceadjusted

WMF WellbeingMeasurementFramework

14

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Abstract

Rationale:Evidencesuggeststhatfromearlyadolescence,girlsandwomenexperiencegreaterratesofemotionalsymptomsanddisorders,whilerecent

evidenceindicatesincreasedemotionaldistressamongadolescentgirls.The

currentstudysetouttoexaminethefactorsandprocessescontributingtoand

mitigatingemotionalsymptomsamongearlyadolescentgirls,withanemphasison

multipleriskexposure,andtoexplorehowthesephenomenaareexperienced.

Methods:Apragmaticparallelmixedmethodsdesignwasused.Aquantitative

strandincluded8,327girlsaged11–12years,comprisingbothself-reportand

demographicdata,andwasanalysedusingstructuralequationmodelling.A

qualitativestrandexploredthelivedexperienceofthreegirlsaged12years,

analysingaccountsgatheredthroughsemi-structuredinterviewsusing

interpretativephenomenologicalanalysis.QuantitativeResults:Resultsindicated

fourriskfactors:Lowacademicattainment,specialeducationalneeds,lowfamily

income,andcaregivingresponsibilities.Exposuretoagreaternumberofriskfactors

wasassociatedwithincreasedsymptoms,thoughalatentriskconstructincorporatingboththenatureandextentofmultipleriskexposureshowedthe

greatestpredictiveutility.Multipleriskeffectswerefoundtobeassociatedwith

emotionalsymptomsentirelythroughindirecteffectsviacomponentsofstress

appraisalprocesses.Familyadultconnection,schoolpeerconnection,andactiveengagementinhomeandschoollifewereassociatedwithlowerlevelsofemotional

symptoms.Familyadultconnectionandschoolpeerconnectionwerefoundtobe

protectiveinrelationtotheeffectsofmultipleriskexposureuponperceivedstresscomponents.QualitativeFindings:Foursuperordinatethemesweredeveloped:

Theexperienceofsymptoms,whichcapturesthewaysparticipantsconceptualised

andexperiencedthethoughtsandfeelingsassociatedwithsymptoms;internalgrappling,whichexploresparticipants’conflictinunderstandingthesesymptomsin

relationtothemselvesaswellastheouterworld;demandsandcontrol,which

exploresparticipants’experiencesofpersistentdemandsperceivedtobebeyondtheircontrol;anddrawingonothers,exploringthewaysparticipantsmappedout

anddrewonanemotionalsupportnetwork.Meta-Inferences:Quantitativeand

qualitativefindingswereintegratedtodevelopthreemeta-inferences:(1)

Emotionalsymptomsareembeddedindailylife,(2)demandsandstresscanbe

psychologicallyoverwhelming,and(3)closerelationshipsarecritical.Thetheoretical,methodological,andpracticalimplicationsoffindingsareexploredand

directionsforfutureresearcharediscussed.


16

Declaration

Noportionoftheworkreferredtointhethesishasbeensubmittedinsupportofan

applicationforanotherdegreeorqualificationofthisoranyotheruniversityor

otherinstituteoflearning.

CopyrightStatement

• Theauthorofthisthesis(includinganyappendicesand/orschedulestothis

thesis)ownscertaincopyrightorrelatedrightsinit(the“Copyright”)ands/he

hasgivenTheUniversityofManchestercertainrightstousesuchCopyright,

includingforadministrativepurposes.

• Copiesofthisthesis,eitherinfullorinextractsandwhetherinhardor

electroniccopy,maybemadeonlyinaccordancewiththeCopyright,Designs

andPatentsAct1988(asamended)andregulationsissuedunderitor,where

appropriate,inaccordancewithlicensingagreementswhichtheUniversityhas

fromtimetotime.Thispagemustformpartofanysuchcopiesmade.

• TheownershipofcertainCopyright,patents,designs,trademarksandother

intellectualproperty(the“IntellectualProperty”)andanyreproductionsof

copyrightworksinthethesis,forexamplegraphsandtables(“Reproductions”),

whichmaybedescribedinthisthesis,maynotbeownedbytheauthorandmay

beownedbythirdparties.SuchIntellectualPropertyandReproductionscannot

andmustnotbemadeavailableforusewithoutthepriorwrittenpermissionof

theowner(s)oftherelevantIntellectualPropertyand/orReproductions.

• Furtherinformationontheconditionsunderwhichdisclosure,publicationand

commercialisationofthisthesis,theCopyrightandanyIntellectualProperty

and/orReproductionsdescribedinitmaytakeplaceisavailableinthe

UniversityIPPolicy(see

http://documents.manchester.ac.uk/DocuInfo.aspx?DocID=24420),inany

relevantThesisrestrictiondeclarationsdepositedintheUniversityLibrary,The

UniversityLibrary’sregulations(see

http://www.library.manchester.ac.uk/about/regulations/)andinThe

University’spolicyonPresentationofTheses


17

Acknowledgements

Thereareanumberofpeoplewithoutwhomthisthesiswouldnothave

beenpossible.Firstandforemost,Iwishtothankmyprimarysupervisor,Professor

NeilHumphrey,forhissupportandguidancethroughoutthisproject.Neil,youhave

beenatremendoussourceofsupportandawonderfulmentorbothinrelationto

myPhDworkandmywiderdevelopment.Yourfaithinme,andyournever-ending

optimismthateverythingwouldworkoutperfectly,havegivenmethespaceto

figureoutmyowninterestsandvaluesasaresearcherandtodevelopabeliefin

myownjudgement.IamincrediblygratefultohavehadyouasasupervisorandI

owemoretoyouthanIwilleverbeabletoexpress.Enormousthanksarealsodue

tomysecondsupervisor,Dr.MargaritaPanayiotou,forhersupport,kindness,and

friendship.Margarita,Ifeelprivilegedtohavebeenyourfirstdoctoralstudentand

amdeeplygratefulforallofthewisdomyouhavepassedon.Thankyouforyour

infinitepatienceandforpretendingmySEMquestionswereneverdaft,evenwhen

theydefinitelywere.

ThanksareduetoDr.AnnLendrumforsharingherqualitativeexpertiseand

forprovidingmevaluablespaceandtimetoreflectasthisprojecttookshape.Iam

alsogratefultoDr.EmilyStapleyattheAnnaFreudNationalCentreforChildren

andFamiliesforthethoughtfulsupportandguidanceshehasofferedmeasI

developedasaqualitativeresearcher,aswellasfortakingthetimetoreviewdrafts

ofthequalitativesectionsofthisthesis.AdditionalthankstoProfessorJessica

Deightonforherguidanceinthelastthreeyears;Ifeelprivilegedtohaveworked

alongsideher.ThereareanumberofwidercolleaguesintheManchesterInstitute

ofEducationtowhomIoweagreatdeal,forsharingtheirtimeandexpertisewith

meandalsofortheirfriendship.Inparticular,Iwouldliketoextendheartfelt

thankstoDr.EmmaAshworth,forherfriendship,support,andherroleasmyPhD

“bigsister”,andtoDr-to-beTeeMcCaldin,forbeinganall-roundgoodeggandan

eternallypatientsoundingboardandvoiceofreason.

Ofcourse,thisthesiswasonlypossiblethankstothegirlswhosharedtheir

experiences.Ihopethatmyworkhasdonethemjustice.Thankyoualsotoallofthe

educationalsettingsandstaffandlocalauthoritiesinvolvedintheHeadStart

18

programme,whoseworkmadethisresearchpossible.Furthermore,itshouldbe

recognisedthattheNationalLotteryCommunityFundhasfundedtheHeadStart

projectaswellasmyPhD;thisisimportantworkandIamgratefultohavehadthe

opportunitytobeinvolved.IwouldalsoliketoexpressmygratitudetoDr-to-be

MiaEisenstadtandDr.JoshuaHolmesfortakingthetimeandcaretoreviewmy

participantselectionprocesseswithinthequalitativestrandofthisstudy.

Onamorepersonalnote,Iwouldliketoexpressmygratitudetomyfamily

andfriendsfortheirsupportandbeliefinme.Tomymum,Nella,thankyoufor

alwaysteachingmetoexpressmyself,andtomydad,John,thankyoufortelling

metodosousingthebiggestwordsIknow.Inparticular,Dad,thiswouldnothave

beenpossiblewithoutyoufornumerousreasons,andIhopethatyouknowthat.I

wouldalsoliketothankmypartner,Hanson,forhisconsiderablesupportduringmy

PhDandhisunfailingbeliefinme;thankyou,Hanson,foralwaysmakingmelaugh

onthedifficultdaysandcheeringtheloudestonthegoodones.Finally,thanksare

duetoMausforbeingaconsistentsourceofbothcomfortanddistractionduring

thefinalportionofmyPhD.

CHAPTERONE:INTRODUCTIONANDAIMS

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Chapter1:IntroductionandAims

1.1ContextoftheStudy

Inearlyadolescence,thedevelopmentalperiodbetweentheagesoften

and14(UnitedNationsChildren’sFund,2011),theevidencesuggeststhatgirls

begintoexperiencegreaterlevelsofemotionaldistressthandoboys(Cyranowski

etal.,2000;Kuehner,2017;Nolen-Hoeksema&Girgus,1994;Zahn-Waxleretal.,

2006).Thisgenderdifferencehasbeenshowntopersistthroughoutthelifespan.

Girlsandwomenaretwiceaslikelytoreportdepressivesymptomsanddisorders

comparedtomenfrommid-adolescenceonwards(Cyranowskietal.,2000;Kessler,

2003;Kuehner,2003,2017;Lewinsohnetal.,1998)andareoverallmorelikelyto

experienceanxioussymptomsanddisorders,thoughthisfluctuatesbasedontype

ofanxiety(McLeanetal.,2011;VanOortetal.,2009).Severalstudieshave

reportedasignificantincreaseinemotionaldistressamongadolescentgirlsin

recentyears(Collishawetal.,2010;Finketal.,2015;Lessofetal.,2016).

Accordingly,thereisaneedforresearchthatexploresthefactorscontributingto

theemergenceofsuchdifficultiesforgirlsinearlyadolescence(Finketal.,2015).

Thecurrentstudysetouttoexplorethisphenomenonwithanemphasisonriskand

resilienceprocesses;thatis,thefactorsandprocessescontributingtoemotional

symptomsaswellasthosethatsupportpositiveoutcomes.Itshouldbenotedthat

thecurrentstudyfocuseson“girls”ratherthan“females”inlinewithcurrent

understandingsthatbothbiologicalandwiderpsychosocialandculturalfactors

influencetheemergenceofemotionalsymptomsamongthisgroup,asdiscussedin

ChapterTwo.ConsiderationsaroundthisapproacharepresentedinSection7.7.

Riskfactors,orvariablesassociatedwithincreasedvulnerabilitytonegative

outcomes(Kraemer,Stice,Kazdin,Offord,&Kupfer,2001;TheWorldHealth

Organization[WHO],2005),oftenco-occur,withsomechildrenandyoungpeople

likelytoexperiencemultiplerisks(Flouri&Kallis,2007).Researchhassoughtto

investigatethewayinwhichexposuretomultipleriskfactorsaffectschildand

adolescentoutcomes,includingtheseminalIsleofWightstudy(Rutter,1979),the


20

RochesterLongitudinalStudy(Sameroffetal.,1993),researchbytheNational

InstituteofChildHealthandHumanDevelopment(Fearon&Belsky,2004),and,

morerecently,theHeadStartprogramme(Deighton,Lereya,etal.,2018),from

whichthecurrentstudydrawsitsdata.Overall,studieshaveshownthatgreater

levelsofriskexposuregenerallycorrespondtoworsenedoutcomes,including

emotionalsymptomsandwiderinternalisingdifficulties(e.g.,Appleyard,Egeland,

Dulmen,&Sroufe,2005;Gerard&Buehler,2004;Horan&Widom,2015;

Panayiotou&Humphrey,2018).Oneofthecentralhypothesesastohowsuch

effectsoccuristhatstressresponsesystemsbecomeoverwhelmedinthefaceof

highlevelsofadversity,negativelyaffectinghealthanddevelopment(Evansetal.,

2013).However,itisimportanttonotethatnotallindividualsexposedtoadversity

willexperiencenegativeoutcomes,necessitatingexaminationofthefactorsthat

supportresilience,orpositiveadaptationincircumstancesofadversityorrisk

exposure(Lutharetal.,2000;Masten,2014b;Ungar,2012).

1.2TheCurrentStudy

Thecurrentstudyoffersamixedmethodsinvestigationofmultiplerisk

exposureandearlyadolescentgirls’emotionalsymptoms.Thestudysetoutto

incorporateandbuildonexistingunderstandingsofmultipleriskexposureandits

relationshipwithearlyadolescentgirls’emotionalsymptoms,including

examinationoftheroleplayedbystressappraisal,ortheextenttowhichone

considerslifestressful(Lazarus,1966;Lazarus&Folkman,1986).Thefactorsand

processescontributingtopositiveoutcomesareexplored,withafocusonfactors

thatmaymitigatethenegativeeffectsofmultipleriskexposure.Thestudyalsoset

outtoexplorelivedexperienceofthesephenomenaamongearlyadolescentgirlsin

ordertounderstandthewaysinwhichgirlsexperienceandmakesenseofthese

areasoftheirlives.Theknowledgegeneratedthroughtheseendeavourscan

contributetoboththeoryandpracticebyfurtheringourunderstandingofthese

phenomenaandmayhaveimplicationsforthesupportandprovisionofferedtoat-

riskadolescentgirls.


21

1.2.1AimsoftheStudy

Giventheabove,theaimsofthestudyareto:

1. Increaseknowledgeandunderstandingoftheriskfactorsandprocesses

associatedwithemotionalsymptomsamongearlyadolescentgirls,witha

particularfocusonmultipleriskexposure.

Thisaimseekstocontributetotheknowledgebaseregardingtheeffectsofrisk

exposure,andparticularlyexposuretomultipleriskfactors,inrelationtoemotional

symptomsinearlyadolescentgirls.Inexploringdifferentconceptualisationsand

measurementmodelsofmultipleriskexposure,aswellasinvestigatingthestress

hypothesis,thestudywillmakebothconceptualandmethodologicalcontributions

tothisareaofresearch.

2. Assessthefactorsandprocessessupportingpositiveoutcomesinrelationto

emotionalsymptomsamongearlyadolescentgirls.

Inaddressingthisaim,thecurrentstudywilladdtoknowledgeandunderstanding

ofthefactorsthatareassociatedwithloweredemotionaldistressamongearly

adolescentgirls.Byexaminingbothpromotiveandprotectivefactors,thestudywill

furtherunderstandingaroundthefactorsassociatedwithloweredsymptomsfor

earlyadolescentgirlsasawhole,aswellashowaccesstoparticularfactorscan

disruptthenegativeeffectsofmultipleriskexposure.

3. Explorethelivedexperienceofearlyadolescentgirlswhoareexperiencing

emotionalsymptomsinthecontextofriskexposure.

Thefulfilmentofthisaimwillsupportknowledgeandunderstandingofthewayin

whichearlyadolescentgirlsexperienceandmakesenseofemotionalsymptoms

andriskexposureintheirlives.Thiswillcontributetothedevelopmentofamore

in-depthunderstandingofthesesymptomsandexperiencesincontext,which

cannotbeascertainedthroughthequantitativemethodologiesmoretypically

adoptedwithinriskandresilienceresearch.


22

1.2.2ResearchQuestions

1. Whataretheriskfactorsandprocessesassociatedwithemotionalsymptoms

amongearlyadolescentgirls?

a. Oftherisksidentified,whatisthemagnitudeoftheirassociationwith

earlyadolescentgirls’emotionalsymptoms?

b. Isthereevidenceforacumulativeriskeffectinrelationtoearly

adolescentgirls’emotionalsymptoms?

c. Whichriskmeasurementmodelbestexplainstheeffectsofexposureto

multipleriskfactorsinrelationtoearlyadolescentgirls’emotional

symptoms?

d. Arethereindirecteffectsofperceivedstressintherelationshipbetween

multipleriskexposureandemotionalsymptoms?

2. Whatarethefactorsandprocessesthatsupportpositiveoutcomesin

emotionalsymptomsamongearlyadolescentgirls?

a. Ofthepromotivefactorsidentified,whatisthemagnitudeoftheir

associationwithearlyadolescentgirls’emotionalsymptoms?

b. Towhatextentarethedirectand/orindirectrelationshipsbetween

multipleriskexposure,perceivedstress,andemotionalsymptoms

conditionaluponaccesstoprotectivefactors?

3. Whatisitliketobeanearlyadolescentgirlwhoisexperiencingemotional

symptomsinthecontextofriskexposure?

1.3GuidingTheoreticalPerspectives

Thecurrentstudydrawsonmultipletheoriesinordertoexplorevarying

perspectivesofriskandresilienceinrelationtoearlyadolescentgirls’emotional

symptoms.Firstly,theresearchisguidedbyBronfenbrenner's(1979,1999)

ecologicalsystemstheory,whichpositsthathumandevelopmentoccurswithinthe

contextofmultipleenvironmentsandprocesses.Theresearchisalsoinformedby

cumulativerisktheory,whichpositsthatgreaterriskexposurecorrespondsto


23

worsenedoutcomesandproposesthatthenumberofriskfactorsismore

importantthanthenatureofthosefactors(Evansetal.,2013;Flouri&Kallis,2007;

Rutter,1979).Explorationofthisprincipleinthestudyisalsounderpinnedby

allostaticloadtheory,ortheconceptthatheighteneddemandoverwhelmsstress

responsesystems(Evans,2003;McEwen,1998;Sterling&Eyer,1988),andbythe

transactionalmodelofstressandcopingoutlinedbyLazarusandcolleagues,

wherebystressoccursthroughaprocessofappraisal(Lazarus,1966;Lazarus&

Folkman,1984).Thestudyisalsoinformedbycurrentunderstandingsofresilience,

whichrecognisesthatadaptationtoadversitydependsuponaccesstoprotective

factorsacrosstheecologythatcancounteractthenegativeeffectsofriskexposure

(Masten,2001,2014b,2014a).Thestudy’sfocusonriskandresilienceisfurther

underpinnedbytheopposingprinciplesofequifinality(therearemultiplepathways

tosingularoutcomes)andmultifinality(similarexperiencescanresultindifferent

outcomes;Cicchetti&Rogosch,1996;Lutharetal.,2000).CicchettiandRogosch

(1996)haveoutlinedthatthesetwoconceptsprovideavaluablelensthrough

whichtoframeriskandresilienceresearchandexploretheparticularfactorsthat

leadtoconvergentordivergentpathwaysacrossindividuals.Finally,thequalitative

strandofthestudyutilisesinterpretativephenomenologicalanalysis(IPA),an

approachconcernedwiththedetailedexplorationoflivedexperience.Assuch,the

numeroustheoreticalperspectivesthatunderpinIPAguidedthecurrentstudy.

Specifically,IPAisgroundedinHusserl's(1927/1971)phenomenology,Heidegger's

(1927/1962)hermeneutic,andanidiographiccommitmenttothein-depth

explorationoftheparticular,asopposedtocreatinggeneralisations(Smith,

Flowers,&Larkin,2009;seeSection4.3.2).

1.4OverviewoftheThesis

ChapterTwooutlinesexistingtheoryandevidencearoundemotional

symptomsandearlyadolescentgirls.Theconceptofemotionalsymptomsis

explored,withconsiderationoftrajectoriesandoutcomes,andanoverviewof

currentevidencerelatingtogenderedmentalhealthtrendsandexperiencesis

presented.ChapterThreeprovidesanoverviewofriskandresilienceresearchand


24

theapplicationoftheseconceptswithinthecurrentstudy.Thischapteroutlinesthe

particularfactorsinvestigatedinthestudyandexploreshowtheresearch

contributestoknowledgeandunderstandingaroundmultipleriskexposure,the

roleofpsychologicalstress,andadaptiveprocesses.

ChapterFourpresentsthemethodologyandmethodsusedinthestudy.It

outlinesitsepistemologicalstanceanduseofamixedmethodsdesignbefore

comprehensivelydetailingeachstageoftheresearchprocess.ChaptersFiveandSix

presentthequantitativeandqualitativefindingsofthestudy,respectively.Finally,

ChapterSevenpresentsadiscussionofthestudy’sfindings,exploringquantitative

andqualitativefindingsintheirownrightbeforebringingthesetogetherintometa-

inferencesandofferingconclusions.

CHAPTERTWO:EMOTIONALSYMPTOMSANDEARLYADOLESCENTGIRLS

25

Chapter2:EmotionalSymptomsandEarlyAdolescentGirls

2.1ChapterOverview

Thischapterexploresexistingtheoryandevidencerelatingtoemotional

symptomsandearlyadolescentgirls.Itintroducestheconceptofemotional

symptomsandrelatedtrajectories,beforeoutlininggenderedmentalhealthtrends

andrecentindicationsofincreasedemotionaldistressamongadolescentgirls.

Finally,thechapterexploresthevalueofexamininglivedexperienceofthe

thoughtsandfeelingsassociatedwithemotionalsymptomsandtheuseofthis

approachinthestudy.

2.2DefiningEmotionalSymptoms

MentalhealthisdefinedbytheWHOas“astateofwellbeinginwhichthe

individualrealizeshisorherownabilities,cancopewiththenormalstressesoflife,

canworkproductivelyandfruitfully,andisabletomakeacontributiontohisorher

community”(WHO,2001,p.1).Themostcommonlyreportedformsofmental

healthsymptomsanddisordersamongchildrenandadolescentsinthegeneral

populationcanbebroadlyclassifiedaseitherinternalising(e.g.,anxietyand

depressivesymptomsanddisorders,somaticcomplaints,andsuicidalideationand

behaviours)orexternalising(e.g.,attention-deficithyperactivitydisorder,disruptive

behavioursanddisorders,oppositionaldefiantdisorder,andconductproblemsand

disorders;Kovess-Masfetyetal.,2016;Polanczyk,Salum,Sugaya,Caye,&Rohde,

2015).Thecurrentstudyfocusesonemotionalsymptoms,whichcapturesboth

depressiveandanxioussymptoms(e.g.,sadmoodandworry;alsosometimes

referredtoasemotionalproblems,emotionaldifficulties,oremotionaldistress).

Thedistinctionbetweensymptomanddisordershouldbenotedhere;termssuchas

“symptom”arecommonlyusedtorefertoanobservablestateorbehaviourthat

maybepresenttosomeextentamongthegeneralpopulation,while“disorders”

aretypicallydefinedbynarrowcriteriaspecifyingaparticularcombinationandlevel

ofspecificsymptoms(Friedetal.,2016).Thatis,individualsmayexperiencesome


26

levelofagivensymptomatology(e.g.,depressivesymptoms),withoutnecessarily

fulfillingthecriteriaforadiagnosticdisorder(e.g.,MajorDepressiveDisorder;

AmericanPsychiatricAssociation[APA],2013).Thecurrentstudyfocuseson

emotionalsymptoms,ratherthanclassifiedpsychiatricdisorders,foranumberof

reasons.Firstly,asnoted,studieshaveindicatedarisespecificallyinemotional

symptomsamongadolescentgirlsinthegeneralpopulation.Secondly,thestudy

focusesonacommunitysampleratherthanaclinicalsampleandsoisinterestedin

varyinglevelsofsymptomatologyratherthanonlythosefulfillingcriteriafor

disorder.Finally,anumberofstudieshavechallengedthedistinctionbetween

“symptom”and“disorder”,utilisingnetworkanalysistodemonstratethat

symptomsofdepressionandanxietygobeyondthosespecifiedwithinconstricted

diagnosticcriteria,indicatingthatpsychopathologyisnotnarrowlyexpressed

throughdistinctdisorders(Friedetal.,2016;McElroy&Patalay,2019).Thus,the

studysoughttolookbeyonddiagnosticcriteriaandexaminemoregenerallevelsof

symptomatology.Inoutliningfindingsacrossthewiderliterature,however,

evidencerelatingtobothsymptomatologyanddisorderisdrawnupon;insuch

instances,thesetermsareutilisedasappropriatefortransparency.

Researchhasshownthatdepressiveandanxioussymptomsaredistinctbut

stronglyinter-related(Cummingsetal.,2014;Nolen-Hoeksema,2000),with

symptomsoftenidentifiedasintertwined(Friedetal.,2016;McElroy&Patalay,

2019)andhighcomorbidityratesfrequentlyreportedamongadolescents(e.g.,

Angold&Costello,1993;Balázsetal.,2013;Brady&Kendall,1992;Edbrooke-

Childs,Wolpert,Zamperoni,Napoleone,&Bear,2018;WHO,2017).Cummingset

al.(2014)identifiedseveralpossiblehypothesesforthiscomorbidity,including

sharedriskfactors,asequentialassociationinwhichtheexperienceofonesetof

symptomsleadstotheother,andattributiontoasharedunderlyingfactor,suchas

negativeaffectivity.Itshouldadditionallybenotedthatbothdepressiveand

anxioussymptomscanalsobecapturedwithinaglobaldomainof“internalising

difficulties”,whichasnotedalsoencompasseswiderdifficultiessuchassocial

withdrawalandsomaticsymptoms(Achenbach,1966;Fornsetal.,2011).Current

perspectivesholdthatitcanbeusefultoexaminethesevaryinginter-related


27

constructsbothindependentlyandinunison,dependingonthestudyaim

(Cummingsetal.,2014;Fornsetal.,2011;Zahn-Waxleretal.,2000).

2.3EmotionalSymptoms:TrajectoriesandOutcomes

Depressionandanxietyareamongthemostcommonmentalhealth

difficultiesacrossthelifespanandposeaglobalpublichealthchallenge(WHO,

2017).Psychopathologyresearchhasconsistentlydemonstratedthatmentalhealth

disorders,includingdepressionandanxiety,oftenhavetheironsetduring

childhoodandadolescence,with75%ofallmentalhealthdisordersoccurringby

theageof24years(Kessleretal.,2005)and50%emergingspecificallyduring

adolescence(Belfer,2008).Thetransitionfromchildhoodintoadolescenceisoften

highlightedasapivotalmomentintrajectoriesofdepressionandanxiety,withthe

typicalage-of-onsetfrequentlyidentifiedasearlyadolescence(e.g.,Costello,

Copeland,&Angold,2011;deLijsteretal.,2016;Jones,2013).Whilelowerratesof

depressionandanxietydisordersareusuallyobservedamongchildrenandyounger

adolescentscomparedtoolderagegroups(WHO,2017),prevalencestudieshave

identifiedworryinglevelsofsymptomatologyanddisorderamongthisgroup.For

instance,onerecentlarge-scalestudy,alsoutilisingHeadStartdata,foundthat

approximatelyoneinfiveadolescentsscoredhigherthanthethresholdtoindicate

abnormallevelsofemotionalsymptoms(Deightonetal.,2019).Anotherrecent

EnglishinvestigationbytheNationalHealthService(NHS)foundthatoneintwelve

childrenandyoungpeopleagedfiveto19wereidentifiedashavinganemotional

disorder,includingdepressiveandanxiousdisorders(NHSDigital,2018).

Emotionalsymptomsinadolescencehaveanumberofshort-andlong-term

implications.Evidenceindicatesassociationswithvariousnegativehealth

behavioursanddisordersincludingeatingdisorders(e.g.,Lewinsohn,Striegel-

Moore,&Seeley,2000;Touchetteetal.,2010)anddrugandalcoholuse(Katonet

al.,2010;McKenzieetal.,2010),aswellascontributingtoloweredschool

attendanceandattainment(Deighton,Humphrey,etal.,2018;Katonetal.,2010;

Owensetal.,2012).Researchhasconsistentlyindicatedthatpersistentemotional

symptomsduringthistimeincreasetheriskofdeliberateself-harm(e.g.,Moranet


28

al.,2011;Pattonetal.,2007)andsuicidalideationandbehaviours(e.g.,Kandel,

Raveis,&Davies,1991;Lewinsohn,Rohde,&Seeley,1996;Murphy,2014).Thereis

alsoconsistentevidenceofarelationshipbetweensuchsymptomsinadolescence

andbroadermentalhealthdifficultiesanddisordersinlateryears(e.g.,Kessleret

al.,2005;Roza,Hofstra,VanDerEnde,&Verhulst,2003).Inadulthood,emotional

symptomsareassociatedwithhigherratesofunemploymentandlowered

productivity(Lerner&Henke,2008).Aglobalsystematicreviewidentified

depressivedisordersastheleadingcauseofdisability,withhigherestimatesfor

womenthanmen(Ferrarietal.,2013),whileMathersandLoncar(2006)estimate

thatby2030,depressionwillbealeadingcauseofdiseaseburdeninhighincome

countries.

Suchoutcomeshighlightbothanethicalandeconomicresponsibilityto

understandandsupportmentalhealth(includingemotionalsymptoms)during

adolescence(Kielingetal.,2011).Epidemiologicalresearchhassoughttoestablish

theparticularantecedentsandcorrelatesassociatedwithemotionalsymptoms

acrossthelifespan,whichcansupportearlyidentificationandinterventionfor

thoseatrisk.However,thereisaneedtounderstandthiswithinparticulargroups

andtoexamineunderlyingprocesses.Furthermore,whilethereisawidefieldof

literatureexploringtheantecedentsandimplicationsofemotionalsymptoms,

muchlessiscurrentlyknownregardingthelivedexperiencesofadolescents

managingthesesymptomsorthemeaningoftheseexperienceswithintheirdaily

lives.Thecurrentstudysetouttoexaminethefactorsandprocessesrelatingto

emotionalsymptomsspecificallyamongearlyadolescentgirls,through

identificationofoverarchingpatternsaswellaslivedexperience.

2.4GenderedMentalHealthTrendsandExperiences

2.4.1EmotionalSymptomatologyandDisorderamongGirlsandWomen

Epidemiologicalresearchhasconsistentlyindicatedthatfromearly

adolescenceonwards,girlsandwomenexperiencegreaterratesofdepressiveand

anxioussymptomsanddisordersrelativetomen(Cyranowskietal.,2000;Kuehner,

2017;Nolen-Hoeksema&Girgus,1994;Zahn-Waxleretal.,2006).Frommid-


29

adolescenceonwards,approximatelytwiceasmanywomenasmenworldwide

experiencedepression(Cyranowskietal.,2000;Kessler,2003;Kuehner,2003,

2017;Lewinsohnetal.,1998).Whileatageneralleveldepressionwasidentifiedin

2004asthethirdleadingcauseofdiseaseburden,itwasfoundtobetheleading

causeforwomenaged15–44years(WHO,2004).Indeed,thereisalsoevidence

thatdepressiveandanxiousdisordersareassociatedwithgreaterburdenamong

womenthanmen,suggestingthattheyarenotonlymoreprevalentamongwomen,

butcanalsobemoredisabling(McLean,Asnaani,Litz,&Hofmann,2011;WHO,

2004).Priortoadolescence,observedgenderdifferencesfordepressiveand

anxioussymptomsaretypicallysmall(Rozaetal.,2003),withashiftoccurring

betweentheagesof11and13years,whengirlsaretypicallyfoundtobegin

exhibitinggreatersymptomatology(Boretal.,2014;Nolen-Hoeksema,2001;Roza

etal.,2003;Salketal.,2016).Asnotedabove,girlsandwomenareonaverage

twiceaslikelytoexperiencedepressivesymptomsanddisorderscomparedtomen;

thisdisparityhasbeenidentifiedasemergingfromtheageof15yearsonwards

(Cyranowskietal.,2000;Kessler,2003;Kuehner,2003,2017;Lewinsohnetal.,

1998).Thesefindingsappeartobemorestablefordepressivesymptomsand

disordersthanforanxiety.Forinstance,thereisalsoevidencethatgirlsaremore

susceptibletoanxioussymptomsanddisordersevenduringchildhood(McLeanet

al.,2011;VanOortetal.,2009),whiletheage-of-onsetandmagnitudeofgender

differencescanfluctuatebasedontheparticularanxietydisorder(McLeanetal.,

2011).Overall,though,itappearsthatearlyadolescencemaybeapivotaltimein

theemergenceofemotionalsymptomsamonggirls.

Researchershaveattributedsuchgenderdifferencestoawiderangeof

factors.Thisincludespsychologicalandsocioculturalfactorssuchasgirls’and

women’sgreaterruminativecoping(Johnson&Whisman,2013;Nolen-Hoeksema

&Girgus,1994),chronicstrainindailylife(Fredrickson&Roberts,1997;Hammen,

2005;Kuehner,2017;Nolen-Hoeksema,1990,2001;Nolen-Hoeksema&Girgus,

1994),societalobjectificationandharassment(Fredrickson&Roberts,1997;Skoog

etal.,2016),gender-relatedviolencesuchaschildhoodsexualabuse,intimate

physicalandsexualviolence,andrape(Fredrickson&Roberts,1997;Hammen,


30

2005;McLean&Anderson,2009;Nolen-Hoeksema,2001),lowself-esteemand

bodydissatisfaction(Bologninietal.,1996;Kostanski&Gullone,1998;Nolen-

Hoeksema,1990;Nolen-Hoeksema&Girgus,1994),emphasisanddependenceon

socialrelationships(Cyranowskietal.,2000),andgreaterempathyskills(Keenan&

Hipwell,2005).Researchershavealsohighlightedanumberofpotentialbiological

andphysiologicalcontributors,includinggreatergeneticpredisposition(Hankinet

al.,2015;McLeanetal.,2011;Merikangasetal.,1985;Steineretal.,2003),

increasedstressreactivityovertime(Compasetal.,1993;Nolen-Hoeksema,2001),

andincreasesinspecificadrenalandovarianhormonesassociatedwithincreased

risk(Albert,2015;Nolen-Hoeksema,2001;Steineretal.,2003).

Nolen-HoeksemaandGirgus(1994)positedthattheemergenceofgender

differencesforemotionalsymptomatologyanddisorderduringearlyadolescenceis

likelynotattributabletoanyonefactor,buttoaninteractionofvarious

contributors.Assuch,theauthorsarguedthatthereisaneedfortheoretical

frameworksthatcanintegratebothbiologicalandpsychosocialfactors,suchas

thoseoutlinedabove.Subsequently,Hyde,Mezulis,andAbramson(2008)outlined

the“ABCmodel”foradolescentdepression,integratingaffective(e.g.,emotional

reactivity),biological(e.g.,pubertalhormones,geneticpredisposition),and

cognitive(e.g.,rumination,objectifiedbodyconsciousness)factors.Hydeetal.

(2008)arguedthatthesearethemajorindividual-leveldomainsthatinteractwith

widersocioculturalfactorstoinfluencedepressivesymptoms.Indeed,researchinto

thisareahasnowproducedcompellingevidencethatbiologicalcomponents,such

asthesexhormonesproducedbyfemalesduringpuberty,caninteractwithwider

individualandinterpersonalstressorsandriskfactorsfordepressiveandanxious

symptomsduringadolescence(Hankinetal.,2015;Kuehner,2017;McLeanetal.,

2011;McLean&Anderson,2009).Thecurrentstudydoesnotseektodirectly

assesstrajectoriesofchangeofgenderdifferencesandwasnotabletoexplore

biologicalfactorsgivenuseofsecondarydata.Nevertheless,thestudycanoffera

numberofcontributionstoknowledgeandunderstandinginthisareagivenits

focusonearlyadolescenceasapivotaldevelopmentalstagefortheemergenceof

emotionaldifficulties.


31

2.4.2TimeTrendsinEmotionalSymptomsamongAdolescentGirls

Inrecentyearstherehavebeenindicationsofanincreaseinthelevelsof

emotionalsymptomsexperiencedbyadolescentgirlsintheUnitedKingdom(UK).

Indeed,despitewidespreadconcernsthatchildandadolescentmentalhealthis

worsening,longitudinalresearchhasdemonstratedthatprevalenceratesforother

symptomsanddisordershaveremainedmostlystableacrossrecentdecades

(Collishawetal.,2010;Maughan,Collishaw,Meltzer&Goodman,2008).Onestudy

identifiedanincreaseinthelevelsofself-reportedemotionalsymptomsintwoUK-

basedsamplesofadolescentgirlsaged11–13in2009and2014,achangenot

evidencedinboys’responses,inadditiontoanincreasednumberofgirlsatriskof

disorder(Finketal.,2015).Similarly,Lessofetal.(2016)reportedanincreaseinthe

levelsofemotionalsymptomsreportedbyadolescentgirlsaged14/15inUK-based

samplesbetween2005and2014.Somestudiesfoundnoevidenceofsuchan

increase(Collishawetal.,2010;Greenetal.,2005;Pitchforthetal.,2018),while

recentevidencesupportsincreasedratesofemotionaldisorderamongboth

adolescentgirlsandboys(NHSDigital,2018).

Thoughtherearesomeexceptions,asystematicreviewofinternational

timetrendsinadolescentmentalhealthreportedthatmostoftheincludedstudies

identifiedanincreaseingirls’levelsofself-reportedpsychologicaldistress(Boret

al.,2014).Anumberofmethodologicalexplanationshavebeenposited,including

thoserelatedtothemethodologicalchallengesinassessingcohorttrends,though

testingsuchhypothesesischallengingandassuchtheseexplanationsremain

relativelytheoretical(Collishaw,2015).Forinstance,prevalenceestimatesand

comparisonsofpsychopathologyacrossgroupsusingquestionnairemethodscanbe

sensitivetominordifferencesinitemwording(Goodmanetal.,2007)andcandiffer

acrossinformants(Collishawetal.,2009),suggestingthatthereisapossibilityof

reportingeffectsacrossthisevidencebase(Collishaw,2015).Disparitiescouldalso

berelatedtothetimeatwhichdatawascollected.Forexample,whileCollishawet

al.(2004)foundnoevidenceofthisincreaseacrosssamplesfrom1974,1986,and

1999,alateranalysiscomparingthesamesamplefrom1986alongsideasample


32

from2006identifiedasignificantincrease(Collishawetal.,2010).However,recent

findingsfromPitchforthetal.(2018)spannedasimilarlengthoftimebetween

cohorts(1995and2018)andfoundnoevidencetosupportawideninggendergap.

Ithasalsobeenarguedthatgrowingawarenessofmentalhealthhas

contributedtothemedicalizationofeverydayemotionsandstresslevels,which

thusmaybecomeconflatedwithsymptomsanddisorders(Collishaw,2015;

Dowrick&Frances,2013).Intheirsystematicreview,Boretal.(2014)exploredthe

possibilitythatthisgrowingawarenessmayhaveledtoincreasedreadinessto

reportmentalhealthsymptomsamongadolescents.Giventhatincreaseshave

beenobservedspecificallyamonggirls,thishypothesiswarrantsfurtherexplanation

infutureresearch(thoughisbeyondthescopeofthecurrentstudy).Researchhas

demonstratedthatgirlsareoftenmorestronglyencouraged,relativetoboys,to

inspectanddiscusstheiremotionsthroughoutchildhoodandadolescence(Berkeet

al.,2018;Fivush,2007;Root&Denham,2010).Indeed,culturallydominantor

hegemonicmasculinityidealsinWesterncountriescanaffectthewaysinwhich

boysandmenunderstandandrespondtotheirownemotions,potentially

introducingabarrierforexpressingemotions,seekinghelp,andadaptivecoping

behaviours(Cleary,2012;Landstedtetal.,2009;Oransky&Marecek,2009).

However,thoughdifferencesinthewaysthatboysandgirlsaretaughttomanage

andexpressemotionshaslongbeendocumented,thereisnoevidencesuggesting

increasedreadinesstoreportamonggirlsinrecentyears,orindeedatall.Indeed,a

qualitativestudyfocusingonUKadolescentsconcludedthatgirlswerenot

necessarilymorewillingtoreportsymptomscomparedtoboysandfoundthatboth

groupsdescribedsimilarperceivedrepercussionsofdoingso,suchasnegativepeer

reactions(MacLeanetal.,2010).

Ofcourse,itispossiblethatthisevidencereflectsagenuineincreasein

emotionalsymptomsamongrecentcohortsofadolescentgirls.Thisincreaseis

morecommonlyreportedthannot(Boretal.,2014)andhasbeenobservedacross

varyingstagesofadolescence.Aspreviouslyoutlined,genderdifferencesinmental

healthgenerallyemergeduringearlyadolescence,typicallyaroundtheageof12

years(Boretal.,2014;Rozaetal.,2003).Therefore,indicationsofheightened


33

prevalenceinthelevelsofemotionalsymptomsamong11-13year-oldgirls(Finket

al.,2015)suggeststhatincreasedlevelsofemotionalsymptomsmaybeoccurring

attheagesuchdifficultiestypicallybecomemorelikelyingirls,ratherthanata

laterstageofadolescence.Suchevidencehighlightsaneedforongoingresearch

examiningfactorsandprocessescontributingtodifficultiesamongthisparticular

agegroup,asitappearstobeapivotalstageingirls’mentalhealthtrajectories.

Althoughitiswellestablishedthattherearegenderdifferencesinmental

healthtrendsacrossthelifespan,asdiscussedearlierinthischapter,thereisno

clarityregardingthecauseofthisapparentincreaseinemotionalsymptomsin

adolescentgirls(Boretal.,2014).Researchershavepositedarangeoffactorsthat

maybecontributingtosuchanincrease,suchassocialmediausage(Finketal.,

2015),increasedsexualisationofadolescentgirls(Boretal.,2014;Finketal.,2015),

increasedacademicpressure(Boretal.,2014;Collishawetal.,2010),andalackof

prioritisationofemotionalsymptomsinschools(Finketal.,2015),thoughsuch

potentialexplanationsremainlargelyspeculative.Itisimportanttonotethatthe

currentstudyisnotfocusedonfactorsthathavecontributedtoanincreaseingirls’

emotionalsymptomsovertimeandinsteadfocusesmoregenerallyonassociated

factorsamongarecentsample.Furthermore,theuseofqualitativeinquiryinthe

proposedstudymaycontributetocurrentunderstandingsofhowemotional

symptomsareperceivedbyearlyadolescentgirlsexperiencingthem.Indeed,when

seekingtounderstandthefactorsthatcontributetooutcomeswithinaparticular

population,itcanbeavaluableexercisetoexplorewhatsuchsymptomsmaymean

tothatpopulationanditsplaceintheirlives(Smithetal.,2009).

2.5LivedExperienceofEmotionalSymptoms

Oneofkeyfacetsofthestudy’squalitativestrandisitsexplorationofhow

emotionalsymptomsareperceivedandexperiencedbyearlyadolescentgirls;that

is,howthesesymptomsactuallyappearandfeeltothosewhohavethem.The

studyofdifficultemotionsandmentalhealthsymptomsanddisordersasfeltand

experiencedsubjectivelybytheindividualisimportantforanumberofreasons.The


34

centralityofemotionsandmentalhealthsymptomswithinindividuals’day-to-day

livesisinandofitselfanimportantreasontounderstandhowtheseare

subjectivelyexperiencedandunderstood(Eatough&Smith,2006b).Practically,

greaterinsightintohowindividualsthinkabouttheseexperiencescanfacilitate

moreemotionallysensitiveapproachestosupportandtherapeuticinput,whichis

particularlyimportantinthecontextofadolescencegiventhatthisappearstobea

vulnerableperiodformentalhealthsymptomatologyanddisorder.Todate,there

hasbeenlittledirectexplorationofthewayinwhichvariousmentalhealth

symptoms,includingemotionalsymptoms,arefeltandunderstoodbyadolescents,

despitepersistentinterestintoemotionalandmentalhealthprocessesduringthis

time.Thisapproachisinformedinpartbypastworkfocusedonphenomenological

inquiryintoemotionexperience,orthewayinwhichemotionsarefeltand

constructed,whichaimstoofferinsightintothenuancesofthesephenomenaand

processesandtheroletheyplayinthoughtsandbehaviour.(Eatough&Smith,

2006b;Frijda,2005).Inparticular,thisemphasisonunderstandinghowsymptoms

areexperiencedisguidedbyworkfromEatoughandSmith(2006b,2006a),who

haveusedIPAtoexploreadultwomen’sangerexperiences,highlightingthatIPAis

particularlyvaluableheregivenitsemphasisonmeaningmaking.Thus,here,the

currentstudysoughttobuildaricherunderstandingofemotionalsymptomsamong

earlyadolescentgirlsbyconsideringhowthesedifficultiesandassociatedthoughts

andfeelingsarefeltandpsychologicallyconstructed.Greaterunderstandinginthis

areamaygenerateinsightintothemeaningoftheseexperiencesamongthis

populationaswellashowgirls’understandingsmayinformtheirdecisionsand

responsesinrelationtothesesymptoms.

2.6ChapterSummary

Emotionalsymptomatologyanddisordersoftenhavetheirage-of-onsetin

childhoodandadolescence.Fromearlyadolescence,girlsandwomenexperience

greaterratesofemotionalsymptomatologyanddisorderandevidencesuggestsa

recentincreaseamongadolescentgirls.Thestudysetouttoexplorethefactorsand

processescontributingtosuchdifficultiesamongthisgroup,includingtheroleof


35

stress,whichisconsideredtoplayakeyroleintheincreasedratesofsymptoms

observedamongthisgroup.

36

Blankpage

CHAPTERTHREE:RISKANDRESILIENCE

37

Chapter3:RiskandResilience

3.1ChapterOverview

Thischapterprovidesanoverviewofriskandresilienceresearchandthe

applicationoftheseconceptsinthestudy.Itoutlinestheriskvariablesinvestigated

herebeforeexploringtheoryandresearcharoundmultipleriskexposure.Next,the

chapterdiscussestheconceptofresilienceandoutlinesthevariablesassessedhere

inrelationtopositiveoutcomes.Finally,itreflectsonmethodologicaltrendsacross

thisfieldandconsiderstheadvantagesofqualitativeinquiryaspartofamixed

methodsframework.

3.2RiskFactors

Tosomeextent,riskfactorsoftenoperatewithoutagreatdealofspecificity,

withmanyfactorsfunctioningasriskyinrelationtomultipleoutcomesandinthe

contextofvaryingpopulationsandcircumstances(Flouri&Kallis,2007).For

example,povertyandsocialinequalityareshowntohavewide-rangingnegative

effectsacrossthelifespan,includingpoorerphysicalhealth,mentalhealth,child

development,andaccesstoeducation(Brooks-Gunn&Duncan,1997;Reiss,2013).

Nevertheless,theextenttowhichagivenfactorfunctionsasriskycanvary

substantiallydependingonwiderfactors,suchaspopulationcharacteristics(e.g.,

differentialeffectsbasedongenderorethnicity;Lansford,Deater-Deckard,Dodge,

Bates,&Pettit,2004;Leventhal&Brooks-Gunn,2000;McCarty,2008;Panayiotou

&Humphrey,2018)andthenatureoftheriskexposureitself,suchasthetiming,

duration,andchronicityofexposure(Najman,Clavarino,etal.,2010;Reiss,2013;

Wodtke,2013).Thus,itisnecessarytoexaminetheorisedriskfactorsacross

differentpopulationsandcircumstancesinordertounderstandtheirinfluencein

specificcontexts.

Thecurrentstudysetouttocontributetoknowledgeandunderstandingof

theriskfactorsforemotionalsymptomsamongearlyadolescentgirls.Previous


38

researchhasidentifiedawiderangeofriskfactorsassociatedwithemotional

symptomsduringchildhoodandadolescence,spanningmultipledomainswithinthe

developmentalecology.Forinstance,researchhasconsistentlyindicatedthatlow

familyincomeisassociatedwithanincreasedriskofinternalisingdifficulties,

includingemotionalsymptoms(Eamon,2002;Glied&Pine,2002;Morrisonetal.,

2014;Najman,Hayatbakhsh,etal.,2010;Santiagoetal.,2011).Thecurrentstudy

buildsonpreviousresearchbyexaminingmultipleriskfactorsalongsideone

anotheraspartofabroadersetofexplanatoryvariables.Inpreviousstudiesthese

riskfactorshaveoftenbeeninvestigatedinisolation,whichdoesnotcapturethe

naturalco-occurrenceofriskfactorsandsofailstocontrolfortheconfounding

effectsofothercontributingfactors(Evansetal.,2013;Flouri&Kallis,2007;

Sameroffetal.,2003).Thefollowingsubsectionsexplorethehypothesisedrisk

variablesincludedforassessmentinthecurrentstudy,withattentiontofactors

acrossindividual,family,andneighbourhoodlevels,guidedbyBronfenbrenner's

(1979,1999)ecologicalsystemstheory.However,itshouldbenotedthatthe

currentstudycannotofferacomprehensivereviewofallpossibleriskvariables

givenitsuseofsecondarydata.Furthermore,whilethebelowsectionsattimes

considerevidenceofgenderdifferencesrelatingtoagivenriskvariable,thestudy

doesnotdirectlyinvestigatesuchdifferences.Instead,thestudycandevelop

knowledgeoftherelationshipsbetweensuchfactorsandemotionalsymptoms

specificallyamongearlyadolescentgirlsasavulnerablegroup.

3.2.1YoungRelativeAge

Thereismodestevidenceofarelationshipbetweenyoungrelativeageand

emotionalsymptomsduringchildhoodandadolescence,withthosewhoare

youngestrelativetotheirpeersintheiracademicyear(e.g.,thoseborninsummer

monthsinEngland)morelikelytoexperiencedistress.Sucheffectsareunderstood

tobeduetodifferencesinschoolingexperiences,ratherthaneffectsofmonthor

seasonofbirthsuchasincreasedriskofprenatalinfection,andindeedthereis

someempiricalsupportforthishypothesis(Goodman,Gledhill,&Ford,2003).

Threestudieshaveidentifiedanassociationbetweenyoungrelativeageand


39

emotionalsymptomsinchildrenandadolescentsinaUKcontext(Crawford,

Dearden,&Greaves,2013;Goodmanetal.,2003;Patalayetal.,2015).Research

hasreportedtypicallysmall,thoughpracticallymeaningful,effectsizes(Goodman

etal.,2003),includingwithinonestudyfocusedspecificallyonearlyadolescents

(aged11–13years;Patalayetal.,2015)asinthecurrentstudy.

Notably,however,therehasbeenlimitedinvestigationofthisriskfactor

and,furthermore,asmallnumberofstudieshavenotfoundevidenceofan

association(Jeronimusetal.,2015;Lienetal.,2005).However,theseinvestigations

havebeenfocusedonnon-UKsamplesand,asoutlinedabove,relativeageeffects

arethoughttooperatethroughschoolexperiences,whichdifferacrosscountries

(Goodmanetal.,2003).Assuch,effectsmaybespecifictoparticulareducation

systems,warrantingfurtherresearchwithinUKpopulations.

3.2.2LowAcademicAttainment

Researchhasconsistentlyindicatedthatlowacademicattainmentactsasa

riskfactorforinternalisingdifficulties,includingemotionalsymptoms,atvarious

stagesofchildhoodandadolescence(e.g.,Bond,Toumbourou,Thomas,Catalano,

&Patton,2005;Moilanen,Shaw,&Maxwell,2010;Panayiotou&Humphrey,2018).

Studiestypicallyreportsmalltomoderateeffects(e.g.,Bondetal.,2005;Moilanen

etal.,2010;Panayiotou&Humphrey,2018;Weeksetal.,2016).Althoughtheexact

natureofthisrelationshipisnotfullyknown,itisunderstoodthatperceivedfailure

inacademicperformancecanincreasenegativeaffectandself-perceptionsand,

thus,triggerorworseninternalisingdifficulties(Moilanenetal.,2010;Panayiotou&

Humphrey,2018).Notably,thereissomeevidencetosuggestthatthemagnitude

oftheassociationbetweenlowacademicattainmentandinternalisingdifficultiesis

significantlystrongeramonggirlsthanboys(McCarty,2008;Panayiotou&

Humphrey,2018),whichmayreflectthetheorythatgirlsareinclinedtoevaluate

themselvesmorenegativelythanareboys(Pomerantzetal.,2002).Itisimportant

tonotethatalthoughresearchindicatesalongitudinalrelationshipbetweenlow

attainmentandsymptoms(Deighton,Humphrey,etal.,2018;Moilanenetal.,2010;

Panayiotou&Humphrey,2018;Verboom,Sijtsema,Verhulst,Penninx,&Ormel,


40

2014;Weeksetal.,2016),somestudieshavefoundevidenceofbidirectionality

(Deighton,Humphrey,etal.,2018;Verboometal.,2014),necessitatingcautionin

assumingcausalitywithoutlongitudinalanalysiscontrollingforpriorlevelsofboth

variables.

3.2.3HighAcademicAttainment

Alongsideevidencethatlowacademicattainmentisassociatedwith

emotionalsymptoms,thereissomeresearchtosuggestthatthesamemaybetrue

ofhighacademicattainmentandcognitiveability,thoughatpresentevidenceis

scant(Patalay&Fitzimons,2018;Skeltonetal.,2010;J.E.Williams,1996).Ithas

beenhypothesisedthathighattainmentandcorrespondingengagementinmore

challengingacademicworkresultsinincreasedworkloadandpressure,thus

increasingstress,whichinturnleadstoemotionalsymptoms(Suldoetal.,2008).In

feministdiscourseandresearch,ithasbeentheorisedthatacrossthelifespan,high

levelsofsuccessandachievementareparticularlyproblematicforthemental

healthofgirlsandwomeninawaytheyarenotforboysandmen(e.g.,Clance&

Imes,1978).Ithasbeenarguedthatanincreasedfocusontheunderachievement

ofboyshascastgirlsasnaturallyacademicallysuccessfulandnon-problematized

(Jones&Myhill,2004;Renold&Allan,2006;Ringrose,2007;Skeltonetal.,2010).

Thisdiscoursecreatesaninaccuratelypolarisedimageofgenderdifferencesin

schoolfunctioningandmayhaveplacedheightenedpressureongirlstofulfil

genderedexpectationsaroundschooling,includingconsistentlyhighattainment,

whichcouldbeproblematicformentalhealth(Jones&Myhill,2004;Renold&

Allan,2006;Ringrose,2007;Skeltonetal.,2010).Indeed,itcouldalsobeargued

thatsuchissuesmayalsoexplainwhylowacademicattainmentappearsparticularly

problematicforgirls,asexploredintheprevioussubsection.

3.2.4SpecialEducationalNeeds(SEN)

Thereissomeevidencetosuggestthatchildrenandadolescentswhohave

specialeducationalneeds(SEN)experienceincreasedratesofemotionalsymptoms.


41

SENisacollectivetermforvariousadditionalneeds;someofthemostcommonly

recordedtypesofSENinEnglandaremoderatelearningdifficulties,speech,

languageandcommunicationsneeds,andAutisticSpectrumDisorder(ASD;

DepartmentforEducation[DfE]&OfficeforNationalStatistics[ONS],2017a).There

areseveralpossibleexplanationsfortheassociationbetweenSENandemotional

symptoms,whichcannotbeexhaustivelydetailedhere.Onecommonhypothesis,

however,isthatthisrelationshipisduetostresscausedbyproblemsnavigating

educationandpeerrelationships,alongsideotherfactorssuchasloweredself-

esteemandmorenegativeself-judgements(Alexander-Passe,2006;Nelson&

Harwood,2011).IthasalsobeensuggestedthatpupilsdiagnosedwithSENsuchas

learningdisabilitiesmayhavetheiremotionalneedsoverlookedduetoan

increasedfocusontheiracademicneeds(Nelson&Harwood,2011).

Studieshavereportedassociationsbetweeninternalisingsymptomsand

specifictypesofSEN,suchaslearningdifficulties(Emerson,2003;Heiman&

Margalit,1998)anddyslexia(Alexander-Passe,2006;Nelson&Gregg,2012).

Studiestypicallyreportmoderateeffectsizes,asreplicatedinameta-analysisofthe

relationshipbetweenlearningdisabilitiesandanxiety(Nelson&Harwood,2011).

Researchhasevidencedhighratesofdiagnosablepsychiatricconditionsamongthe

SENpopulation,includinganxiousanddepressivedisorders(e.g.,Brereton,Tonge,

&Einfeld,2006;Emerson,2003;Emerson&Hatton,2007;Simonoffetal.,2008).A

smallnumberofstudieshaveindicatedthateffectsoninternalisingdifficultiesin

thispopulationmaybegreaterforgirlsthanforboys,asobservedinsampleswith

ASD(Mandyetal.,2012;Solomonetal.,2012),dyslexia(Nelson&Gregg,2012),

andlearningdisabilities(Emerson&Hatton,2007).

Althoughtherehavebeensomelarge-scaleinvestigations(e.g.,Emerson,

2003;Emerson&Hatton,2007;Heiman&Margalit,1998),researchintothe

relationshipbetweenSENandemotionalsymptomsisoftenreliantonsmallsample

sizesduetolowprevalenceofmanySENconditions.Studiesarefrequently

descriptiveratherthaninferential,limitingtheconclusionsthatcanbedrawn.

Furthermore,considerableheterogeneity,bothwithinspecificSENconditionsand

acrossSENasabroadcategorisation,restrictstheextenttowhichresearchintoany


42

onetypeofSENcanbegeneralisedtootherswiththesameorotherconditions.

Furthermore,childrenandadolescentswithSENappearmorelikelythantheir

peerstobeexposedtoarangeofotherriskfactors,suchasfamilialpoverty(DfE&

ONS,2017b;Emerson,2003;Emerson&Hatton,2007).Indeed,Emersonand

Hatton(2007)foundthataccountingforadditionalriskfactorssubstantially

reducedthevarianceexplainedbyparticipants’learningdisabilities,suggestingthat

effectsinthispopulationmayrelatetothepresenceofmultipleriskexposure.The

currentstudyseekstocontributetocurrentknowledgeandunderstandingofSEN

asariskfactorforemotionalsymptomsbyprovidingalarge-scaleinvestigation

utilisinginferentialstatisticalmethodstooffermorerobustinferencesregarding

thispopulation.

3.2.5LowFamilyIncome

Researchhasconsistentlyindicatedarelationshipbetweenlowfamily

incomeandincreasedemotionalsymptomsduringchildhoodandadolescence(e.g.,

Glied&Pine,2002;Morrisonetal.,2014).Longitudinalresearchhasevidencedthat

theseeffectsoperateovertime,indicatingalevelofcausality(e.g.,Eamon,2002;

Najmanetal.,2010;Santiagoetal.,2011).Thereareseveralexplanatory

hypotheses,thoughthesearenotconsideredmutuallyexclusiveandindeeditis

likelythattherearemultiplepathwaysunderpinningthisassociation(Eamon,2002;

Reiss,2013).Onekeytheoryisthatindividualsandfamilieslivinginpoverty

experiencegreateramountsofstressthathinderstheirmentalhealth,including

stressdirectlycausedbyalackofmoneytomeetneedsandthatcausedby

increasedexposuretootherstressorsanduncontrollablelifeevents(Santiagoetal.,

2011).Indeed,severalstudieshavedemonstratedthatpoverty-relatedstressis

directlyrelatedtoemotionalsymptoms(e.g.,Miech,Caspi,Moffitt,Wright,&Silva,

1999;Santiagoetal.,2011;Wadsworthetal.,2008;Wadsworth&Santiago,2008).

Longitudinalresearchhassuggestedthatlivingwithpovertyaffectsearlybrain

development,whichmayinturnnegativelyaffectemotionandstressregulationin

lateryears,thusnegativelyimpactingmentalhealth(Barchetal.,2016;Lubyetal.,

2013).


43

Investigationsintotherelationshipbetweenlowfamilyincomeand

emotionalsymptomshavereportedrangingeffectsizes,dependingonspecific

populationcharacteristicslikeageandgender(Mendelsonetal.,2008;Reiss,2013).

Indeed,asystematicreviewoftherelationshipbetweenwidersocioeconomic

status(SES)andmentalhealthoutcomesnotedthattherearemixedfindings

regardingwhethergenderdifferencesarepresent(Reiss,2013).Somehave

reportedthatgirlsexperiencedisproportionateeffectsspecificallyfromlowfamily

income(Leveetal.,2005),thoughothershavenotfoundsuchevidence(e.g.,

Mendelsonetal.,2008;Santiagoetal.,2011).

3.2.6YoungCarerStatus

Ayoungcarerisachildoradolescentwhoprovidesongoingcareforafamily

member,mostoftenasiblingoraparent,typicallyduetofactorssuchasdisability,

illness,andalcoholanddrugabuse(Cheesbroughetal.,2017;Hounsell,2013;

Ireland&Pakenham,2010).Asmallnumberofstudieshavefoundincreasedriskof

emotionalsymptomsamongthisgroup(Banksetal.,2001;Shifren&Kachorek,

2003)andaqualitativemeta-synthesisfoundyoungcarersoftendescribedmental

healthsymptomsanddifficulties,includingemotionalsymptoms(Rose&Cohen,

2010).Thereareseveralhypothesesfortheseapparentadverseeffects,including

emotionalneedsbeingoverlooked(Svanbergetal.,2010;Thomasetal.,2003),

interferencewithdevelopmentprocesses(Cox&Pakenham,2014),disruptedor

inconsistentparenting(KennethIPakenhametal.,2012),andanxietyassociated

withthecircumstancenecessitatingcare(Warren,2006).Someresearchhas

indicatedthatyoungcarersaredisproportionatelygirls(ScottishGovernment,

2017;Sharmaetal.,2016),althoughHounsell(2013)concludedthatyoungcarersin

Englandareequallylikelytobegirlsorboys.

Researchwiththispopulationhasbeenhinderedbytherelativelysmall

proportionofyoungcarerswithinthegeneralpopulation,alongsidedifficultiesin

consistentlyidentifyingthisgroupgiventhatschoolsdonotroutinelydocument

youngcarerstatus.Thereisalsoconsiderablescopeforfindingstobesample-

specific,asstudiesfrequentlyfocusoncaregivingaroundspecificconditionsor


44

circumstances.Whereresearchdoesexpandtoawiderfocusongeneralyoung

caregiving,definitionsofwhatconstitutescaregivingstatusvaryacrossbothdata

sourcesandstudies(Banksetal.,2001;Cheesbroughetal.,2017),limitingthe

abilitytogeneralisefindings.Furthermore,severalauthorshaveobservedthatthe

categorisationofyoungcarerstatusasariskfactormayfailtocapturethe

complexityofthiscircumstance(Aldridge,2006;Cox&Pakenham,2014;Newman,

2002),overlookingfactorssuchasthenatureofthecircumstancenecessitatingcare

(Ireland&Pakenham,2010b),thelevelofsupportinplace(Cox&Pakenham,2014;

Olsen&Clarke,2003),andthepossiblebenefitsofcaregiving(Banksetal.,2001).

3.2.7AdverseChildhoodExperiences(ACEs)

Researchhasconsistentlyshownthatadversechildhoodexperiences(ACEs),

whichareexperiencescharacterisedbyfamilydysfunctionandchildhood

maltreatment(Hughesetal.,2017;Youssefetal.,2017),actasariskfactorfor

negativeoutcomesacrossthelifespan,includingemotionalsymptoms(Chapmanet

al.,2004;DeVenter,Demyttenaere,&Bruffaerts,2013;Dubeetal.,2001;Hughes

etal.,2017;Schilling,Aseltine,&Gore,2007;Turner,Finkelhor,&Ormrod,2006;

Youssefetal.,2017).ACEsincludeexperiencesresultingindirectharmtochildren

andadolescents,suchasabuse,andthosethatcauseindirectharm,suchas

exposuretodomesticviolenceorsubstanceabuse(Cavanaugh,Petras,&Martins,

2015;Hughesetal.,2017;Schillingetal.,2007).Itisgenerallyunderstoodthatthe

mechanismunderpinningthenegativeeffectsofACEsisthechronicstresssuch

experiencesplaceonindividuals,impactingneurobiologicalfunctioningand

developmentalprocesseswhich,inturn,leadtonegativeoutcomes(Danese&

McEwen,2012;Hughesetal.,2017).

Inarecentsystematicreviewandmeta-analysis,Hughesetal.(2017)found

thatstudiestypicallyreportlargeeffectsizesintherelationshipbetweenACEsand

adultmentalillhealth,includingemotionalsymptoms.AlthoughACEsisacollective

termcomprisingawiderangeofadverseexperiences,researchhasindicateda

limitedamountofspecificitybetweenparticularexperiencesandmentalhealth

outcomes,withwide-rangingeffectscommonlyobserved(Hughesetal.,2017;


45

Schillingetal.,2007).Indeed,itappearsthatACEsarelikelytoco-occur(Dubeet

al.,2001;Hughesetal.,2017),whilepreviousfindingshavesuggestedadose-

responserelationshipinrelationtodepressivesymptoms,withsymptomatology

increasingasthenumberofACEsonehasbeenexposedtoincreases(Chapmanet

al.,2004;Youssefetal.,2017).Furthermore,thereisgrowingevidencethatACEs

mayhavecumulativeeffectsonadultoutcomes(Hughesetal.,2017),including

specificallyinrelationtoemotionalsymptoms(Schillingetal.,2007;Youssefetal.,

2017).AlthoughpreviousresearchhasexaminedtheeffectsofACEsthroughoutthe

lifespan,studiesarepredominantlyfocusedonadultoutcomes,withonlyasmall

numberofstudiesreportingeffectsamongchildrenandadolescents(Schillingetal.,

2007;Turneretal.,2006).

3.2.8NeighbourhoodSocioeconomicDeprivation

Severalstudieshaveidentifiedanassociation,typicallysmallinsize,

betweenneighbourhoodsocioeconomicdeprivationandemotionalsymptoms

duringchildhoodandadolescence(Flourietal.,2012;Flouri&Sarmadi,2016;Mair

etal.,2008;Schneiders,2003;Sundquistetal.,2015;Xueetal.,2005).

NeighbourhoodsocioeconomicdeprivationisconceptualisedaslowSESatthe

neighbourhoodlevelandcomprisesmultipledimensions,includinglowhousehold

income,receiptofbenefits,lowlevelsofeducation,andovercrowding(e.g.,Denny

etal.,2016;Drukker&vanOs,2003).Ithasbeenhypothesisedthatthis

circumstanceencompassesstressorsthatnegativelyaffecthealth,suchaslackof

resources,inadequatehousing,andviolence,thoughthisprocessisnotfully

understood(Mairetal.,2008).Thereissomeevidencethatlocalarea

characteristicsdisproportionatelyaffectthementalhealthofgirlsandwomen

(Brazil&Clark,2017;Staffordetal.,2005),whichisthoughttobebecausegender

roleexpectationsplacegreateremphasisonsocialandcommunityactivityfor

women(Kavanaghetal.,2006;Staffordetal.,2005).

Thoselivingindeprivedneighbourhoodsaremoreoftenexposedtoa

greaternumberofriskfactorsacrossotherdomains,suchaslowfamilySES,which

canproducecompoundeffects(Boyle&Lipman,2002;Stafford&Marmot,2003;


46

Sundquistetal.,2015);however,neighbourhood-levelvariablesoftenremain

significantaftercontrollingforwiderfactors(Mairetal.,2008;Schneiders,2003;

Stafford&Marmot,2003;Xueetal.,2005).Currently,researchexploringthe

mentalhealtheffectsofneighbourhooddeprivationpredominantlyfocuseson

adults(Sundquistetal.,2015)andisoftenspecifictowiderEuropeancountriesand

AmericaratherthanEngland,limitinggeneralisabilitytoanEnglishadolescent

population.

3.3ExposuretoMultipleRiskFactors

Whilesingleriskfactorsdoappeartobeindividuallyassociatedwith

negativeoutcomes,thereisgrowingevidencethattheyfrequentlydonotoccurin

isolation.Researchhasindicatedthatriskfactorstendtoclusterandsoindividuals

areoftenexposedtoseveral(Flouri&Kallis,2007).Forexample,familialpovertyis

associatedwitharangeofotherriskfactors,suchaslivinginpoorerandmore

dangerousneighbourhoods(Evans,2004;vanHametal.,2011),attendingschools

withfewerresourcesandlessexperiencedteachingstaff(Evans,2004;Gorard,

2016b;Lupton,2005),andbeingidentifiedashavingSEN(DfE&ONS,2017b;

Emerson,2003;Emerson&Hatton,2007).Indeed,EvansandEnglish(2002)found

thatchildrenexposedtofamilialpovertywerelikelytobeexposedtomorerisk

factorsthantheirmoreaffluentpeers.Thisclusteringofriskfactorscaninpartbe

explainedbyBronfenbrenner's(1979,1999)ecologicalsystemstheory,asoutlined

inChapterOne.Thatis,distalfactorslikeclass,race,andculturecanhavewide-

ranginginfluenceovervaryingaspectsanddomainsofanindividual’slife,including

exposuretoriskfactorsacrossmultipledomains,whileinteractionbetweenrisk

factorsislikelytooccur(Evansetal.,2013).

Fromaresearchperspective,suchfindingsfirsthighlighttheneedto

investigatemultipleriskfactorsalongsideoneanother,ratherthaninisolation,so

asnottoover-estimatetheinfluenceofanyonevariable(Sameroffetal.,2003).

Thishasledtoanincreaseintheinvestigationofmultipleriskfactors,often

throughmultipleregressionapproachesthatmoreaccuratelyestimatetheeffects


47

ofeachindividualfactor(Evansetal.,2013).However,thereisagrowing

understandingthatmultipleriskfactorsmayworktogethertocollectivelyinfluence

outcomestoagreaterextentthanwhenexperiencedinisolation,thusbecoming

morethanthesumoftheirparts(Evansetal.,2013;Rutter,1979,1981;Sameroff,

2006;Sameroffetal.,2004).Indeed,thereisevidencetosuggestthatasinglerisk

factorinisolationmaynotexertmeaningfulorlastingeffects,butthatwhenthe

sameriskfactoroccursalongsideothers,theconsequencesmaybemore

substantial(Rutter,1979,1981;Sameroffetal.,2003).Howandwhythismaybe

thecase,however,islesswellunderstood(Evansetal.,2013).Thecurrentstudy

investigatesbothwhetherandhowexposuretomultipleriskfactorsmayaffect

outcomesinthecontextofearlyadolescentgirls’emotionalsymptoms.The

followingsubsectionsexplorekeytheoreticalandmeasurementperspectivesand

previousliteraturerelatingtomultipleriskexposure.

3.3.1CumulativeRiskTheoryandResearch

TheconceptofcumulativeriskstemsfromtheseminalworkofRutter

(1979)duringtheIsleofWightstudiesintochildpsychiatricdisorder,inwhichhe

collatedariskindexofsixfactors,designatingeachparticipantascorerangingfrom

zeroto4+basedontheirlevelofexposure.Rutter(1979)foundevidenceofan

associationbetweenthenumberofriskfactorsandthelikelihoodofchild

psychiatricdisorder.Thoseexposedtooneorzeroriskfactorsexhibitedan

approximatelytwopercentchanceofdisorder;thislikelihoodincreasedwitheach

riskfactorand,attheupperendofthescale,childrenexposedtofourormorerisk

factorsshowedmorethan20%probabilityofdisorder.Furthermore,therewasno

particularcombinationofriskfactorswithgreaterpredictivepower;rather,it

appearedthatthenumberofriskfactorsparticipantswereexposedtowasmore

importantthantheirnature(Rutter,1979).

Cumulativerisktheorybuildsonthisworkandencapsulatestwocore

assumptions.Firstly,the“accumulationprinciple”positsthatthemoreriskfactors

oneisexposedto,thegreaterthenegativeeffectsonagivenoutcome(Evansetal.,


48

2013;Sameroff,2000).Thisisfurtherunderpinnedbythegrowingevidence,as

discussedearlierinthissection,thatriskfactorsmayworktogethertoinfluence

outcomesandthusleadtomoresevereconsequencesthantheindividual

contributionsofanygivenriskfactor,or“massaccumulation”.Secondly,the

“number-over-natureprinciple”holdsthatitisthenumberofriskfactorstowhich

anindividualisexposed,ratherthantheirspecificnature,whichbestpredicts

outcomes(Evansetal.,2013;Sameroff,2000).Thissecondassumptionisgrounded

intheprincipleofequifinality,whereintherearemultiplepathwaystosingular

outcomes(Cicchetti&Curtis,2006;Cicchetti&Rogosch,2002;Lutharetal.,2000).

Assuch,incumulativeriskresearch,riskvariablesaredichotomised(1=risk

present,0=riskabsent)andsummedtocreateanunweightedcompositescoreof

thenumberofriskstowhichanindividualisexposed(Evansetal.,2013;Flouri&

Kallis,2007).Typically,theindexdoesnotcapturethemaximumrangeofrisk

factorsbutinsteadisimposedwithanupperlimitof“xormore”toindicatea

saturationofriskfactors(e.g.,Oldfield,Humphrey,&Hebron,2015;Panayiotou&

Humphrey,2018;Rutter,1979).Thisindexingapproachisconsistentwiththe

understandingthatmanychildrenandadolescentsareexposedtonumerousrisks

andthatthesefrequentlyco-occuracrossmultipledomainsoftheindividual’s

ecology(Evansetal.,2013;Flouri&Kallis,2007).

Todate,researchhaspredominantlyfocusedonidentifyingwhether

cumulativeriskeffectsarepresent;findingsaregenerallyconsistent,withmost

publishedinvestigationsreportingevidenceofeffects(Evansetal.,2013).Several

studieshavefoundanassociationbetweencumulativeriskexposureinchildhood

andadolescenceandemotionalsymptomsandbroaderinternalisingdifficulties,

bothconcurrently(Flouri&Kallis,2007;Jones,Forehand,Brody,&Armistead,

2002;Panayiotou&Humphrey,2018)andlongitudinally(Appleyardetal.,2005;

Gerard&Buehler,2004;Horan&Widom,2015;Panayiotou&Humphrey,2018).

However,intheirsystematicreviewofthecumulativeriskliterature,Evansetal.

(2013)foundthatcumulativeriskeffectsarenotuniform,withanumberof

demographiccharacteristics,includinggender,moderatingsucheffects.Giventhat

riskfactorsthemselvesarealsohighlycontext-specific,suchfindingsdemonstrate


49

theneedtoextendthislineofresearchtospecificoutcomesandgroupsofinterest

inordertounderstandthenatureofmultipleriskeffectsinparticularcontexts.

Thus,thecurrentstudyaimstocontributetoexistingevidencebyexaminingthe

associationbetweencumulativeriskexposureandemotionalsymptomsamong

earlyadolescentgirls,giventhatthisappearstobeapivotalmomentinmental

healthtrajectoriesamonggirlsandwomen.

LimitationsofCumulativeRiskTheoryandResearch

Oneofthecentralfeaturesofcumulativerisktheory,oftenconsideredits

keystrength,couldsimultaneouslybeconsideredaweakness;namely,itsadditive

premiseandindexingapproach.Thistenetreflectsanattempttomirrortheway

riskfactorsnaturallyco-occur,whilethesimplicityofthisapproachmakesthe

conceptparticularlyeasytounderstandfornon-researchers,suchaspolicymakers

(Evansetal.,2013).However,ithasbeenarguedthatthisisanoverlyreductionist

methodforcapturingthewaythatmultiplestressorsoccurandoverlooksthe

complexityofthephenomenonofmultipleriskexposureincontext,aswellasthe

interactionsoccurringacrossecologicaldomains(Belskyetal.,2012;Burchinalet

al.,2000;Halletal.,2010).Ithasbeensuggestedthatwhilethemodelof

cumulativeriskoffersanumberofadvantages,thisreductionismdoesnotlend

itselftounpickingthemorecomplexetiologicalmechanismsunderpinningthe

effectsofmultipleriskexposure(Belskyetal.,2012;Kraemeretal.,2001).The

approachdoesnotallowexplorationordirectmodellingoftheinteractionsthat

occurbetweenriskfactors,whichisoneofthecentralpremisesinhowmultiplerisk

exposureoccursinthefirstinstance(Evansetal.,2013).Inaddition,thenumber-

over-natureprinciple,aswellastheequalweightaffordedtoeachriskfactorin

constructingacumulativeriskindex,isinconsistentwithevidencethattheeffects

ofindividualriskfactorscanvarysubstantially(Halletal.,2010).Methodologically,

ithasbeenarguedthatcollapsingindividualriskfactorinformationintoasingle

compositevariablemaybestatisticallyproblematic,asthelossofinformationmay

reducesensitivityandpredictivepowerinrelationtotheoutcomeofinterest

(Belskyetal.,2012;Evansetal.,2013;Halletal.,2010;Kraemeretal.,2001).


50

Thenumber-over-natureprincipleisalsoatoddswithresearchindicating

thatfactorssuchastiminganddurationofexposureareofimportance(Evansetal.,

2013).Theprocessofdichotomisingindividualriskvariablesinordertocreatea

cumulativeriskindexcancausethelossofmorenuancedriskinformationand,

furthermore,createsasample-specificvariablethatcannotbeassumedtobe

generalisabletothebroaderpopulation(Evansetal.,2013).Indeed,themost

frequentapproachtodichotomisingcontinuousvariablesisdesignatingthoseinthe

sample’supperquartileofexposureas“at-risk”,furthercontributingtosample-

specificity(Evansetal.,2013).Inaddition,thisapproachclassifiesriskbasedon

rarityandisnotsensitivetothethresholdatwhichavariableactuallyconstitutesa

risk(Evansetal.,2013;Kraemeretal.,2005).

3.3.2MeasurementModelsforMultipleRiskExposure

Theconceptualandmethodologicallimitationsofthecumulativeriskmodel

indicateaneedforinvestigationofalternativemeasurementapproaches.

Identificationofthemostappropriaterepresentationofriskexposureisparticularly

necessaryifresearchistomovebeyondestablishingwhethercumulativerisk

effectsoccur,giventhattheyfrequentlyareshowntodoso,andbegintoexplore

theunderlyingmechanismsinordertounderstandwhytheseeffectsoccur(Belsky

etal.,2012).Thecurrentstudysoughttoexploredifferentmeasurementmodelsof

multipleriskexposurewithvaryinglevelsofrepresentationofboththemagnitude

andnatureofriskexposure,giventhatthesefeaturesarecentraltocumulativerisk

theoryandindeedtoitslimitations.Specifically,threemeasurementmodelswere

exploredinrelationtoemotionalsymptomsinthecurrentstudy,asshowninFigure

3.1(overleaf).Itshouldbenotedthattheaimofthisinvestigationisnottooffera

definitiveguideonthemostappropriaterepresentationforfutureresearch;rather,

itistoexplorethesedifferentmodelsinthecontextofearlyadolescentgirls’

emotionalsymptoms,withinonespecificsample.


51

Figure3.1.Multipleriskexposuremeasurementmodels.ModelAshowsamultipleregression

approach,ModelBincludesthecumulativeriskindexasapredictor,andModelCcomprisesalatent

riskconstruct.


52

ThemultipleregressionapproachshowninModelA,whereineachriskfactoracts

asaseparatepredictor,primarilyrepresentsthenatureofeachriskfactor.Asa

modelofmultipleriskexposure,multipleregressionaccountsfortheeffectsofco-

occurringriskfactorstoavoidover-estimationoftheeffectsofanyonevariable.

Thus,thismodelacknowledgesthefrequentco-occurrenceofriskfactors,and

controlsfortheinteractionsthatoccurbetweenthem,butdoesnotdirectlymodel

theeffectsofthisco-occurrence.Assuch,thecumulativeriskmodelshownin

ModelBisoftenconsideredanimprovementuponthisapproachasitdirectly

acknowledgesthewaythatriskfactorscanworktogethercollectivelytoinfluence

outcomesandisthusmoreconsistentwithourunderstandingofriskexposure

(Evansetal.,2013;Flouri&Kallis,2007).Thecumulativeriskindex,then,

representsthenumberofriskfactorsinitsmeasurementofmultipleriskexposure

(Evans&Kim,2013;Flouri&Kallis,2007;Halletal.,2010).

Researchutilisingstructuralequationmodelling(SEM)hasindicatedan

alternativeapproachtounifyingmultipleriskfactorsinanalysiswhileovercoming

someofthelimitationsinherenttocumulativerisktheory,asshowninModelC.

Specifically,asmallnumberofstudieshaveprovidedsupportfora“latentrisk

construct”,whereriskfactorsaretreatedasmanifestindicatorsofalatentmultiple

riskfactor(Belskyetal.,2012;Burchinaletal.,2000;Halletal.,2010;Loukasetal.,

2008).Alatentconstructisonewhichishypotheticalandcannotbedirectly

observed;assuch,itisstatisticallyinferredthroughmultipleproxies(Kline,2016).

Thus,alatentriskconstructallowsriskfactorstobeconvertedintoasingle

predictorvariablewithoutlossofinformationastothenatureofeachindividual

riskfactor(Belskyetal.,2012;Burchinaletal.,2000;Halletal.,2010).Thismay

offeramorenuancedmeasurementofthewayinwhichcombinedriskfactors

operate,incontrasttothesimpleaccumulationapproachincumulativerisktheory,

andmayovercomelimitationsofacumulativeriskindex(Burchinaletal.,2000;Hall

etal.,2010).Specifically,alatentconstructallowsdirectmodellingofthe

interactionsbetweenriskfactors,whichaspreviouslynotedisacentraltheoryasto

howmultipleriskexposureoccursandexertsitsinfluence(Evansetal.,2013).

Ratherthansimplycontrollingfortheseasinthemultipleregressionapproach,a


53

latentapproachdirectlydrawsonthisinformationtoestimatetheunderlying

construct.Inalatentconstruct,factorloadingsofriskfactorsarenotconstrainedto

beequalbutarefreetovary;inotherwords,riskfactorsdonothaveequalweight

asinacumulativeriskindex(Belskyetal.,2012;Burchinaletal.,2000;Halletal.,

2010).Therefore,alatentriskconstructallowsdifferentialrepresentationofeach

riskfactorinrelationtothebroaderconstructofriskexposure,inlinewiththe

strengthsoftheserelationshipsasobservedwithinthedata(Belskyetal.,2012;

Burchinaletal.,2000;Halletal.,2010).Furthermore,retainingindividualriskfactor

informationwithinalatentvariablemayovercomethereducedsensitivityand

predictivepowerassociatedwithcreatingacompositevariableinthecumulative

riskindex(Burchinaletal.,2000;Halletal.,2010).Thismethodalsoprovidesthe

opportunitytoincludeinformationsuchastiminganddurationofriskfactors,

whereavailable(Halletal.,2010).

Overall,then,thelatentriskapproachmayofferamorenuanced

representationofthewaythatriskfactorsinteractandworktogethertoinfluence

outcomes(Burchinaletal.,2000;Halletal.,2010).Furthermore,latentvariables

representtheoreticalconstructsthatarenotdirectlymeasurableandthuscanonly

berealisedthroughmeasurementofacollectionofindicatorvariables(Brown,

2015;Brown&Moore,2012;Kline,2016).Inthisway,alatentriskconstructmore

closelyreflectsourunderstandingofmultipleriskexposureasacomplex

phenomenonoccurringacrossecologicalsystems.Inthissense,exposuretoagiven

setof“riskfactors”cannotentirelycapturethiscomplexity,andinsteadrepresent

markersthatprovideinsightintobroadersystemsofdisadvantagewithinwhich

childrenandyoungpeopleexist.Inthisway,theuseoffactoranalysisinlatent

modellingallowsempiricaltestingofwhethertheriskvariablesofinterestdoinfact

representanassumedoverarchingconstruct.Itisgenerallyconsideredacrucial

steppriortoinferentialanalysistoestablishthatone’sdatasupportsthe

assumptionthatagivensetofvariablesreflectasharedconstruct(Borsboom,

Mellenbergh,&VanHeerden,2003;Brown,2015;Gefen,Rigdon,&Straub,2011).

However,indevelopingacumulativeriskindexthereisnoopportunitytoformally

assessthisassumptionasthereiswithalatentriskconstruct,andthusanyfindings


54

relyonanuntestedassumptionthatthecompositevariabledoesinfactrepresenta

singularandcoherentconstruct.

Todate,veryfewpublishedstudieshavemadeuseofalatentriskconstruct

inthisareaofworkandonlytwostudieshavecomparedsomekindoflatent

representationwithotherapproaches.Burchinaletal.(2000)identifiedthree

distinctriskconstructsthroughexploratoryfactoranalysisandsubsequentlymade

useoffactorscoresaspredictors,whicharevaluesdenotingparticipants’relative

positiononalatentfactor.Theauthorscomparedthiswithmultipleregressionand

acumulativeriskindexaspredictorsofcognitiveandlanguagedevelopmentand

concludedthatthemostappropriaterepresentationofmultipleriskexposuremay

dependuponthestudycontextandsample(Burchinaletal.,2000).Specifically,

theysuggestedthatalatentapproachmaybeusefulinstudieswithfewerrisk

factorsavailable,interestindevelopmentaltrajectories,ormoderatetolarge

samplesizes(Burchinaletal.,2000).Halletal.(2010)extendedthisapproach,

arguingthatitismoreconsistentwithourunderstandingofmultipleriskexposure

asabroadsystemtospecifyonelatentvariablecapturingallriskfactorsofinterest,

ratherthanmultiplelatentfactorsforsubsetsofrisk.Indeed,akeyfeatureofSEM

isthatitisoftenguidedbytheoryratherthandata-drivenandassuchitisgenerally

recommendedtospecifyalatentfactorbasedonexistingtheoryandknowledge.A

moreexploratoryapproachsuchasthatusedbyBurchinaletal.(2000)maybe

moreusefulininstanceswherepoormodelfitisobservedforthehypothesised

factorstructure,whichmayreflectadivergencebetweentheoryandtheparticular

databeingused.InthecaseofHalletal.(2010),asinglelatentconstructwasfound

tohavegoodmodelfit,andtheauthorsfoundthatthisfactorhadgreater

predictivepoweroverchildcognitivedevelopmentthanacumulativeriskindex.

However,inthisstudythefactorwasspecifiedusinganon-traditionalmethod

wherebyindicatorscausethelatentvariable(formativeindicators),ratherthanthe

otherwayaround,asistypicallythecase(reflectiveindicators;Halletal.,2010).

Thisapproachessentiallyactsasafunnelbyunifyingtheindividualeffectsofeach

riskfactor,ratherthandrawingoninteractionsbetweenriskfactorstoinfera


55

broaderconstruct,asisthecasewithtraditionalreflectivefactorindicators(Hallet

al.,2010).

Thecurrentstudybuildsonthesepreviousmethodologicalinvestigationsby

exploringstatisticalrepresentationsofriskspecificallyinthecontextofemotional

symptomsamongearlyadolescentgirls.InlinewithHalletal.(2010),asinglelatent

factorwasexploredtoreflectcurrentunderstandingsofmultipleriskexposureasa

singularbutbroadsystemofdisadvantage,thoughtraditionallatentmodellingwas

utilisedtodirectlymakeuseofthetransactionsbetweenfactors.Alatentvariable

wasused,ratherthangeneratingfactorscoresasusedbyBurchinaletal.(2000),to

facilitatefullinformation.

3.3.3MechanismsofMultipleRiskEffects

Ithasbeenarguedthatriskresearchnowneedstomovebeyondsimply

identifyingwhethermultipleriskeffectsarepresentandinsteadfocuson

understandingthemechanismsofhowsucheffectsoccur(Belskyetal.,2012;Grant

etal.,2003).Giventhatexposuretomultiplerisksinfluencesvaryingaspectsof

healthanddevelopment(Evansetal.,2013;Horan&Widom,2015),itappearsto

bethateffectsoperatethroughbroadermechanismsthatunderpingeneralised

outcomes,ratherthantranslatingdirectlyintonegativeeffectsinanyonearea.

Althougharangeofpathwayshavebeenhypothesisedandinvestigatedfor

individualriskfactors,theunderlyingmechanismsofmultipleriskeffectsareless

wellunderstood,andthereisnotyetastrongexplanationunderlyingtheprinciples

ofcumulativerisktheory(Evansetal.,2013).Threehypotheseshavebeen

identified:(a)Increasedstressandacorrespondingheightenedengagementof

responsesystems;(b)mediationthroughadditionalelementsinthewider

environment,suchasmaternalresponsiveness;and(c)disruptiontointeractions

acrosstheecologicalsystemandthustodevelopmentalprocesses(Evansetal.,

2013).

Thecurrentstudyfocusesontheroleofstress.Whileitisacknowledged

herethattherearelikelymanyco-occurringpathwaysunderlyingtheseeffectsand


56

indeeditwouldbeusefultoexaminethesetogether,thisresearchfocuses

particularlyontheroleofstressforanumberofreasons.Primarily,itshouldbe

notedthatthedatasetunderpinningthisresearchcontainsdataonstress,butdoes

notincludevariablesthatwouldallowexplorationofadditionalhypothesesandas

suchthestudyislimitedtothisinvestigation.However,thereisaclearneedfor

researchthatdoesfocusdistinctlyontheroleofstressinthiscontext.Intermsof

gender,thereisevidencetosuggestthatgirlsandwomenarepronetoreport

higherlevelsofstressthandoboysandmenwithinbothadolescenceand

adulthood(Charbonneauetal.,2009;Hampel&Petermann,2006;Matud,2004),

indicatinganeedtoexaminetheconsequencesofstressspecificallyamongthis

group.Indeed,chronicstressisthoughttobeakeycontributortothehighratesof

emotionalsymptomatologyanddisorderobservedamonggirlsandwomenacross

thelifespanandtoitsemergenceamonggirlsduringearlyadolescence(e.g.,de

Lijsteretal.,2016;Girgus&Yang,2015;Meadowsetal.,2006;Nolen-Hoeksema,

2001).Furthermore,thestresshypothesisiscentraltocumulativerisktheorybut

hasalimitedevidencebaseasitoftenreliesuponmodestsamples,asisdiscussed

below.

Thereisgrowingsupportforthenotionthatstressplaysacentralfactorin

thewaythatriskinfluencesoutcomes.Notably,manyindividualriskfactorsare

theorisedtoexerttheireffectsbyintroducingstressindailylife,buildinginto

chronicstressovertimeandthusaffectingvariousoutcomes.Forinstance,as

discussedearlierinthechapter,stressisakeyhypothesisfortherelationship

betweenemotionalsymptomsandriskfactorsincludingSEN(Alexander-Passe,

2006;Nelson&Harwood,2011),lowfamilyincome(Miechetal.,1999;Santiagoet

al.,2011;Wadsworthetal.,2008;Wadsworth&Santiago,2008),andACEs(Danese

&McEwen,2012;Hughesetal.,2017).Thus,thestresshypothesisinmultiplerisk

exposurebuildsonthisconcept,positingthatasriskfactorsaccumulate,thereis

increaseddemandontheindividual,resultinginheightenedstressand

overwhelmedresponsesystemsthatinturnnegativelyimpacthealthand

development(Evansetal.,2013;Evans&Kim,2013).


57

Muchofthepreviousdiscussionandresearchonthishypothesishasbeen

focusedonallostaticload.Advancesinneurobiologicalresearchhaveindicatedthat

organismscontinuallyadjusttomeetdailyphysicalandsocialdemandsthrougha

dynamicprocesstermedallostasis,whereinvariousbiophysicalandphysiological

systemsworktogethertomaintainaninternalequilibrium,orhomeostasis(Evans,

2003;McEwen,1998;Sterling&Eyer,1988).Thatis,agivendemandmayleadto

aninternalresponse,suchasincreasedcortisollevelsorheightenedblood

pressure.Tomaintainstabilityinthiscontext,threeintegratedsystems,specifically

theneural,neuroendocrine,andimmunesystems,mustdetectboththedemand

andtheinternalresponseandworktoaccordinglyregulateandmediateinternal

responses(Evans,2003;McEwen,1998;Sterling&Eyer,1988).Allostaticload

occurswherethisdemandbecomestoogreatovertime,causingthesesystemsto

eitherbecomeoverworked,failtosufficientlyrespond,orbecomeoverlysensitive,

andleadingtonegativeimplicationsforphysical,emotional,andcognitive

processes(Evans,2003;Hughesetal.,2017;McEwen,1998;Sterling&Eyer,1988).

Theapplicationofthisphenomenontomultipleriskexposure,then,maygo

somewaytoexplainboththeaccumulationeffectsandthenumber-over-nature

principlewithincumulativerisktheory(Evans,2003;Evansetal.,2013).Thatis,

exposuretoseveraldifferentriskfactorsislikelytoresultinachildoradolescent

havingheightenedengagementofthestressandresponsesystems.Indeed,thereis

someevidenceofaconcurrentandlongitudinalassociationbetweenchildhood

cumulativeriskexposureandphysiologicalbiomarkersofallostaticload,including

increasedneuroendocrinestressactivity,restingbloodpressure,andbodyweight

(Brodyetal.,2013;Evans,2003;Evansetal.,2007;Evans&Kim,2012).However,

thesestudieshavenotdirectlyinvestigatedanyformofmediationpathway

throughstressintherelationshipbetweenmultipleriskexposureandnegative

outcomes.Furthermore,priorresearchhasbeenreliantonsomewhatmodest

samplesizesof100–500participants,asmeasuringbiomarkersofallostaticload

systemsusingthemethodsestablishedbyEvans(2003)ishighlydemandingin

termsoftimeandresources.


58

Assuch,thequantitativestrandofthecurrentstudysetouttoempirically

investigatetheroleofstressasanunderlyingmechanisminmultipleriskeffects,in

thecontextofearlyadolescentgirls’emotionalsymptoms.Thestudydoesnot

makeuseofallostaticbiomarkers,inpartbecausetheresearchisconstrainedbyits

secondaryanalysisofadatasetthatincludedself-reporteddataforglobalperceived

stress,ratherthanbiophysicalorphysiologicalvariables.However,therearea

numberofadvantagestothisapproach.Firstly,thisallowstheuseofalargesample

toinvestigatetheserelationshipsonagreaterscalethaninpreviousresearch.

Furthermore,thisapproachgivescredencetothegeneralunderstandingthatstress

isalargelysubjectivephenomenon,withsubstantialindividualdifferencesinthe

extenttowhichagiveneventisconsideredstressful(Lazarus,1966;Lazarus&

Folkman,1984).Theindividualappraisalofagivensituationasstressfulis

consideredtoplayacentralroleintriggeringstressandallostasisresponsesystems

(Burkeetal.,2005;Clarketal.,2007;Logan&Barksdale,2008;Sladeketal.,2016),

whileithasbeensuggestedthatbiophysicalstressresponsesmayincreasethe

perceptionofstress(McEwen,1998).Indeed,asmallnumberofstudieshave

identifiedanassociationbetweenglobalperceivedstress,whichisageneralised

perceptionofstressinday-to-daylife,andarangeofallostaticbiomarkersinboth

adolescentsandadults(e.g.,Oldehinkeletal.,2011;Sladeketal.,2016;Zimmaroet

al.,2016).Thus,thecurrentstudymayprovideinsightbyexaminingwhether

multipleriskexposureresultsinabroadfeelingofstressasappraisedand

experiencedbytheindividual.Thisapproachallowsinvestigationofstressthrough

asimilarlensacrossbothstrandsofthestudy;thatis,thefocusonperceivedstress

withinthequantitativestrandmirrorsthephenomenologicalnatureofthestudy’s

qualitativestrand.

3.4ResilienceandAdaptation

Despiteourunderstandingthattherearefactorsandprocessesthat

increasethelikelihoodofnegativeoutcomes,researchhasshownthatthe

outcomesamongthoseexposedtosuchriskcanvarygreatly(Masten,2001,2014b,

2016).Effortstounderstandwhysomeindividualscanthriveinadverseconditions,


59

whileothersaremorenegativelyimpacted,hasledtoawidebodyofresearch

focusedonthephenomenonofresilience,orpositiveadaptationinthefaceof

adversity(Masten,2001,2014b,2016).Previousinvestigationshaveidentifiedthat

childrenandadolescentsareabletoadapteveninextremecircumstances,suchas

livinginarmedconflictzones(Barber,2013;Nguyen-Gillhametal.,2008).Such

findingschallengedeterministicnotionsthathighlevelsofadversityautomatically

leadtonegativetrajectories,highlightingthatriskisaphenomenongroundedin

probabilityratherthancertainty(Masten,2014b).Thus,whileriskresearchis

underpinnedbyequifinality,theconstructofresilienceisgroundedinmultifinality,

whereinsimilarexperiencescanleadtodifferentoutcomes.Thatis,anindividual’s

functioninginagivencircumstancedependsuponthenatureoftheirindividual

widerecologicalenvironment(Cicchetti&Rogosch,1996;Nolen-Hoeksema&

Watkins,2011;Ungar&Liebenberg,2011).

Masten(2001,2014a,2016)hasoutlinedfour“waves”ofresilienceresearch

todate.Earlyinvestigation,orthe“firstwave”,developedinitialconceptualisations

ofresilienceanditsmeasurement.Initially,itwasbelievedthatresiliencewasa

fixedindividualtrait,withhumanseitherableorunabletoadapttoadverse

circumstances(Masten,2001,2014a,2014b;Rutter,1987;Ungar,2011).Thefield

hasmovedawayfromthisstance,withthesecondwaveofresearchdevelopingan

understandingofresilienceasadynamicandfluidprocessofadaptationthatshifts

overtime,withmanyindividualslikelytoexperiencebothgoodandpoor

functioningwithinarangeofareasacrosstheirlifetime(Barber,2013;Masten,

2001,2014b,2014a;Ungar,2011).Thisresearchdevelopedanunderstandingthat

thispositiveadaptationispromotedthroughinteractionsbetweentheindividual

andelementsoftheirecologicalenvironment,whichthenoperatetomitigatethe

negativeeffectsofrisk(Masten,2014b,2016;Ungar,2011).Theseresourcesthat

canreduceriskeffectsareconceptualisedasprotectivefactors,andasshown

overleafinFigure3.2differfrompromotivefactors,whicharevariablesassociated

withpositiveoutcomesforallindividualsregardlessofriskstatus.


60

Figure3.2.Promotiveandprotectiveconceptualmodels.

However,researchhasindicatedthatthetwooftenoverlap,withthesamefactors

frequentlyidentifiedasbothpromotiveandprotective,suchasapositivefamily

climate.Suchsimilaritieshavedemonstratedthatadaptationtoriskreliesonthe

everydaysystemsencounteredbymostindividuals,ratherthanrequiring

substantiveadditionalefforts(Masten,2001,2014b).Assuch,whileearly

investigationsofresiliencesetouttoidentifywhatmakesspecificindividualsable

toadapt,researchhasinsteadfoundthatresilienceisacommonphenomenonthat

occursacrossthelifespanandissupportedbyeverydayinteractionsandprocesses

(Masten,2001,2014a,2014b;O’DoughertyWright&Masten,2015).Thishasled

Masten(2001,2014b)toconceptualisethephenomenonas“ordinarymagic”.

Thethirdwavebuiltthislearningintoappliedpreventionbyseekingto

increaseaccesstoprotectivefactorsamongat-riskpopulations.Thefourthand

mostrecentwaveofresilienceresearchisprimarilyconcernedwithunderstanding

theunderlyingprocessesofhowsuchfactorsenablepositiveadaptation,drawing

onrecentadvancesinthestudyofneurologicalandbiologicalprocessesandin

statisticalmodelling.Inlinewiththisfourthwave,thequantitativestrandofthe

studysetouttoexploreprotectivefactorsspecificallywithinthecontextofthe

stresshypothesis,tounderstandtherolesuchvariablesplaywithintheunderlying

mechanismsofriskandsymptomatologyinamongearlyadolescentgirls.This

constitutesafocusnotonlyonthefactorsassociatedwithimprovedoutcomesbut

alsoontheadaptiveprocessesbywhichsuchfactorsinfluenceoutcomesMasten

(2001,2014a,2014b)distinguishesbetweenprotectivefactors,orthevariables

associatedwithadaptationtorisk,andadaptiveprocesses,orthespecificsystem


61

throughwhichagivenprotectivefactorinfluencesoutcomes.Ithasbecome

increasinglynotedacrossresilienceresearchthatprotectivefactorsmaywell

functiontoimproveoutcomesbydisruptingunderlyingstressprocesses(Barnes,

2016;Masten,2014b,2018),howevertherehasbeenlimiteddirectinvestigationof

thisprinciple.

3.4.1FactorsSupportingPositiveOutcomes

Thecurrentstudyassessesbothpromotiveandprotectivefactorsinorder

tounderstandwhetherthereisadistinctionbetweenthetwointhecontextof

earlyadolescentgirls’emotionalsymptoms.Itshouldbenotedthatprotective

factorscanoperatepreventatively,actingtodirectlymoderatetheeffectsofrisk

exposure,aswellasretrospectively,supportingrecoveryfromnegativeimpacts

overtime(Masten,2016).Asthecurrentstudyiscross-sectional(seeChapter

Four),itisnotpossibletoisolateherewhetherobservedeffectsserveapreventive

orrecoveryfunction,whichwouldrequiremorecomplexmodellingwithina

longitudinaldesign.Itshouldalsobenotedthattherehasbeendiscussion

regardingwhetherriskandpromotive/protectivefactorscanbeconceptualisedas

distinctfromoneanotheror,alternatively,occurringatoppositeendsofa

continuum.Forinstance,Masten(2018)highlightsthatgoodemotionregulation

skillsareoftenidentifiedasofferingabufferingeffectinthefaceofrisk,butpoor

emotionregulationskillscanexacerbatethewiderrisksassociatedwithcertain

typesofadversity,suchasfamilialpoverty.Thecurrentstudytreatsriskand

promotive/protectivefactorsasdistinctratherthanexaminingeachoneona

spectrum,inordertofacilitatepathwaymodellingexaminingthewayinwhich

theseinteracttoinfluenceoutcomes.However,futureresearchcouldexamine

theseaspartofalargerinteractivenetworkexploringdifferentfactorsasa

continuuminrelationtomentalhealthoutcomesamongadolescents,asrecently

exploredbyFritz,Fried,Goodyer,Wilkinson,andvanHarmelen(2018).

Althoughpreviousresearchhasidentifiedarangeofprotectivefactorsin

relationtoemotionalsymptomsduringadolescence,itcannotbeassumedthat

theseareconsistentacrossallpopulations(Fergus&Zimmerman,2005;Smokowski


62

etal.,2004;Ungar,2011).Thedegreetowhichprotectivefactorsmoderatethe

effectsofriskcanfluctuatebasedongroupcharacteristicssuchasgender(Benzies

&Mychasiuk,2009;Sun&Stewart,2007),age(Sun&Stewart,2007;Ungar,2011),

SES(Benzies&Mychasiuk,2009;Zolkoski&Bullock,2012),andlocalcontext

(Fergus&Zimmerman,2005).Thereisaneed,then,forresearchfocusedon

specificpopulations,outcomes,andcircumstancesinordertounderstandtheway

inwhichresiliencecanoperatefordifferentgroups(Alvord&Grados,2005;

Masten,2014a).Thecurrentstudycontributestounderstandingofthecapacityfor

resilienceinthefaceofmultipleriskexposureandspecificallyinrelationtoearly

adolescentgirls’emotionalsymptoms.However,protectivefactorscanbehighly

context-specificinawaythatcannotalwaysbecapturedstatisticallyinlarge-scale

orheterogeneoussamples.Insomecontexts,factorstypicallycategorisedasrisky

actasatypicalprotectivefactors(Bottrell,2009;Masten,2014b;Ungar,2011).For

instance,withdrawalfromschoolparticipationmaybeprotectiveforanindividual

fromanethnicminoritybackgroundiftheschoolenvironmentfacilitates

marginalisationofthatgroup(Ungar,2011).Similarly,somefactorsmayserveas

bothriskandprotectionsimultaneously,suchasapeernetworkthatprovides

supportbutalsonormalisesriskybehaviourslikedrugabuse,asidentifiedby

Bottrell(2009)inaqualitativestudyofasupportgroupforadolescentmothers.

Thus,whilequantitativeinvestigationcanprovideinsightintothestatistical

interactionsbetweenthesephenomena,itcannotexplorethecomplexitiesofthem

incontext,norprovideinsightintotheexperienceandroleoftheindividualin

theseinteractions,whichnecessitatesqualitativeexploration(Bottrell,2009;Ungar,

2003,2011).Accordingly,thecurrentstudy’smixedmethodsapproachaimedto

offeramorecomprehensiveunderstandingoftheseprocessesincontextwithin

earlyadolescentgirls’emotionalsymptoms.

Thecurrentstudyfocusesexclusivelyonfactorsacrosstheexternal

elementsoftheecologicalsystem,withaparticularfocusontheroleof

interpersonalconnection.Historically,researchhaspredominantlyfocusedon

individual-levelprotectivefactors,resultingincomparablylessevidencerelatingto

externalfactors.Correspondingly,discourseoftenplacesanonusontheindividual


63

toberesponsiblefortheirownresilience,ratherthanonwidersystemicservices

(Burman,2018;Ungar,2012).Thus,thefocushereonexternalfactorscontributes

toabroaderefforttoshifttheonusawayfromtheindividualandontothewider

environment,thuscontributingtodevelopingunderstandingsoftherolethatwider

individualsandsystemscanplay(Burman,2018;Ungar,2012).Thisdecisionwas

furtherunderpinnedbythestudy’suseofsecondarydatameasuredusingthe

StudentResilienceSurvey(SRS;seeSection4.6.1),whichincludedagreaterfocus

uponexternalfactorsandlimitedmeasurementofinternalfactorstheoretically

linkedwithemotionalsymptoms.Inaddition,theresearchplacesaparticular

emphasisontheroleofperceivedinterpersonalconnection,whichisexploredin

greaterdetailinthefollowingsubsection.

3.4.2SocialConnection

Itisgenerallyagreedthathumanshaveacoreneedforsocialconnection

andthatinterpersonalrelationshipsplayakeyroleingeneralhealthand

developmentaswellasresiliencethroughoutthelifespan(Cacioppo&Patrick,

2008;Fritz,deGraaff,etal.,2018;Masten,2014b;Sun&Stewart,2007;Ungar,

2012).Socialrelationshipsandinteractionsaremultifacetedandthequantitative

strandofthestudyfocusesspecificallyonsocialconnection,broadlydefinedas

perceivedinterpersonalclosenesswithindividualsandgroups(Lee,Draper,&Lee,

2001;R.M.Lee&Robbins,1998).Thisisdistinctfrommorespecificbehaviours

suchassocialsupport(Barrera,1986),althoughsuchconstructsaredrawnuponat

timesinthissectionandindeedareexploredmoredirectlyinqualitativeinterviews.

Perceivedconnectionwithothersduringchildhoodandadolescenceisoften

associatedwithreportsoflowerlevelsofinternalisingdifficulties,including

emotionalsymptoms,functioningasbothpromotive(e.g.,Bondetal.,2007;Bovier,

Chamot,&Perneger,2004;EwellFosteretal.,2017;Malaquias,Crespo,&

Francisco,2015)andprotective(e.g.,Bondetal.,2007;Carbonelletal.,2002;

Masten,2014b).Attheotherendofthisconceptualspectrum,feelingsofloneliness

andsocialisolationinchildhoodandadolescencehavebeenshowntopredict

greaterlevelsofemotionalsymptoms,highlightingtheimportanceofperceived


64

socialconnectionforthisoutcome(e.g.,Hall-Landeetal.,2007;Harris,Qualter,&

Robinson,2013;Qualteretal.,2010,2013).Itislikelythattherearemultiple

adaptiveprocessesunderpinningtherelationshipbetweensocialconnectionand

emotionalsymptoms,includingfeelingsofsafetyandsecurity,instillingapositive

senseofself,distractionfromdifficulties,anddirectsupportwithcopingwithand

managingchallenges(Cacioppo&Patrick,2008;Gassetal.,2007;Masten,2014b;

Ungar,2012).Thestressbufferinghypothesis,setoutbyCohenandWills(1985),

suggeststhatsocialrelationshipsfunctiontoimprovewellbeingbylesseningthe

extenttowhichnegativelifeeventsareappraisedasstressful.Severalstudieshave

identifiedanassociationbetweensocialconnectionandloweredstressthroughout

thelifespan,includingbothperceivedstress(Lee,Keough,&Sexton,2002;

Panayiotou&Karekla,2013)andbiomarkers(Evansetal.,2007;Seemanetal.,

2002;Sladek&Doane,2014).However,studieshavetypicallyfocusedupon

moderationofthedirecteffectsofexposuretoadversity,ratherthanexamining

howprotectivefactorsoperatewithinunderlyingstressmechanisms.Morerecent

researchhasbeguntoexpandtoexaminethewaysinwhichstress,adaptation,and

copingprocessesareembeddedwithinwiderecologicalsystems,including

interpersonalinteractionsandrelationships(Skinner&Zimmer-Gembeck,2016).As

such,thecurrentstudysetouttoexaminethefunctionofsocialconnectionsinthe

stressprocessesthatmayunderpinriskeffectsamongearlyadolescentgirls.

Researchexploringtherelationshipbetweeninterpersonalrelationshipsand

mentalhealthhaveoftenfocusedonrelationshipsatagenerallevelorhave

examinedspecificdomains(e.g.,family,peer,orschoollevel)inisolation.More

recentlytherehasbeenanemphasisoninvestigatingmultiplesourcesof

connectednessalongsideoneanother,inordertobetterisolatetheirdifferential

contributionstohealthanddevelopment(EwellFosteretal.,2017;Holt-Lunstadet

al.,2017;Ja&Jose,2017).Assuch,thequantitativestrandofthecurrentstudy

soughttoexaminethefunctionofparticularsourcesofsocialconnection,namely

withinthefamily,school,widercommunity,andpeergroup,inordertosupport

developingknowledgeofthecontributionsmadebytheseconnectionsandtobuild

understandingoftheirroleinstressappraisalprocesses.Researchhasalso


65

suggestedthatthesalienceofparticularsourcesofsocialsupportvariesovertime,

withparentalconnectionbeingimportantduringchildhoodandpeersbecoming

particularlysalientduringadolescence(Umbersonetal.,2010).Thus,the

quantitativestrandofthestudysoughttoinvestigatethecontributionsofdifferent

sourcesofconnectionforgirlsduringearlyadolescenceasapivotalpointinmental

healthdevelopment.Alongsidethis,thequalitativestrandsoughttogobeyondthis

compartmentalisedperspectiveandprovidecomplementaryinsightintohow

relationshipswithothersareseentorelatetotheexperienceofemotional

symptomsandriskexposureandexplorehowgirlsnavigatetheserelationshipsasa

partoftheirlives.

FamilyAdultConnection

Familymembers,particularlyparentsandcarers,areoftenseenasacritical

sourceofinterpersonalconnectionthroughchildhoodandintoadolescence

(Umbersonetal.,2010).Connectionwithfamilymembersduringthistimeis

frequentlyfoundtobeassociatedwithloweredinternalisingandemotional

symptoms(Costelloetal.,2008;Day&Padilla-Walker,2009;Lereyaetal.,2016;

McGrawetal.,2008;Rowe,Zimmer-Gembeck,&Hood,2016;Schulenbergetal.,

2007;Vineretal.,2012;Wille,Bettge,&Ravens-Sieberer,2008).Familyconnection

hasalsobeenfoundtobeinverselyassociatedwithemotionalsymptomswithinat-

riskpopulations(EwellFosteretal.,2017)andtoactasaprotectivefactor

moderatingtheeffectsofrisk(Conger&Conger,2002;Klieweretal.,2004;Li,

Nussbaum,&Richards,2007),includingmultipleriskexposure(Willeetal.,2008).

However,examinationoftheprotectivefunctionoffamilyconnectionfor

emotionalsymptomsremainslimitedoverall,includinginthecontextofmultiple

riskexposure.Thereisalsosomeevidencethatexposuretoeitherpositiveor

negativefamilyinteractionscanaffectgirlsmorestronglythanboys,thoughthis

remainslimited(Telzer&Fuligni,2013).Boththequantitativeandthequalitative

strandofthecurrentstudymayprovidefurtherinsightintotheroleoffamily

connectioningirls’experiencesandoutcomes.

Connectiontoone’sparentstypicallybecomeslesssalientovertime,with

peerconnectionbecomingmoremeaningfulforhealthanddevelopmentoutcomes


66

fromearlyadolescence(Umbersonetal.,2010).Whileparentsactasastressbuffer

inearlychildhood,withobserveddifferencesinindicatorsofstresswhenparents

arepresentoroffersupport,sucheffectsarecomparablylessmeaningfulor

altogetherabsentamongadolescents(Gunnaretal.,2015;Hostinaretal.,2014,

2015).Thefocushereonearlyadolescenceandthestresshypothesisallows

examinationofwhetherandhowfamilyconnectionfunctionsinthecontextofrisk

andperceivedstress,duringaperiodconsideredcriticalforbothgirls’mental

healthandtheroleoftheparent.

SchoolAdultConnection

Asmallnumberofstudieshaveidentifiedanassociationbetweenpositive

teacher-pupilrelationshipsandlowerlevelsofinternalisingsymptoms,including

emotionalsymptoms(Lereyaetal.,2016;Murray&Greenberg,2000;O’Connor,

Collins,&Supplee,2012;Wang,Brinkworth,&Eccles,2013),thoughLongobardi,

Prino,Marengo,andSettanni(2016)foundthataftercontrollingforwider

connectionacrossthefamilyandpeergroups,thisrelationshipofferedno

contributions.Thereremainslimitedresearchexaminingtheprotectivefunctionof

theserelationshipsforemotionalsymptoms.Itmaybethatpositiveconnection

withateacher(orotherschooladult)canfacilitatefeelingsofvalueandbelonging,

orsupportpositiveemotionalandbehaviouraldevelopment(Sointuetal.,2017).

Forindividualswithlimitedpositiverelationshipsathome,apositiverelationship

withaschooladultmightofferacompensatoryresource(Hamre&Pianta,2001).

Notably,accesstoschool-basedrelationshipsfluctuatesduringtimesofeducational

transition,aschildrenandadolescentslosepreviousconnectionswithteachersand

createnewrelationshipsinanewschool,whichcanbechallengingandcanleadto

lowergeneralschoolconnectedness(Loukasetal.,2016).Thecurrentstudy’sfocus

onearlyadolescencereflectsthepointatwhichpupilsinEnglandhaverecently

transitionedfromprimaryschool,wheretheytypicallyhaveonemainclassteacher,

tosecondaryschool,withmultipleteachersacrossthecurriculum.

Researchinthisareaisgenerallylimitedbytheuseofsmallsamplesizes(ca.

150–300)and,crucially,studieshavefrequentlyutilisedsimpleregression

modellingandthusfailedtoaccountforclusteringwithinthedata.Giventhatsuch


67

researchisoftenconductedwithinschools,theremaywellbedifferencesinoverall

levelsofadult-pupilconnectionsbetweenclassesandschoolsthatmayaffectthe

independenceofthedata,necessitatingmorecomplexapproaches.

CommunityAdultConnection

Thecurrentstudyexaminedperceivedconnectionwithanadult“awayfrom

school”,inrecognitionthatparticipantsmaydrawuponrelationshipsandsupport

beyondthefamilyandschoolcontext.Qualitativeresearchhassuggestedthat

adolescentsvaluepositiveandcaringrelationshipswithtrustedadultsregardlessof

theirdomainorrole(Munford&Sanders,2016;Ungar,2004b).Thus,thisfocus

allowsforabroaderscopeofthewayinwhichwiderrelationshipswithadultsmay

contributetoearlyadolescentgirls’emotionalsymptoms,inbothapromotiveand

protectivecapacity.Giventheemphasishereonawidercontext,thespecificityof

thisconnectionisbroadandmaycapturerelationshipswitharangeofpeoplesuch

asgrandparentsandextendedfamily,communityorreligiousleaders,orfamily

friends.

SchoolPeerConnection

Throughoutchildhoodandadolescence,schoolisacentralcontextwithin

whichyoungpeopleengagewithothersonaday-to-daybasis,providingimportant

opportunitiestodevelopsocialskillsandbuildrelationships.Thecurrentstudy

focusesonpeers,whichreferstoanindividual’ssocialgroup;thatis,arelatively

smallgroupsofindividualswithwhomoneinteractsregularly(Jaccardetal.,2005;

A.Ryan,2000;Wilkinson,2010).Thisincludesbutgoesbeyondthenarrower

“friends”,whichcapturesmoreselectiveassociationsthattypicallyofferdifferent

ormorepronouncedqualities,suchasattachment,closeness,andsupport(Jaccard

etal.,2005;Ryan,2000;Wilkinson,2010).

Researchhasconsistentlyindicatedthatpeersareamongthestrongest

socialfactorspredictinghealthbehavioursandoutcomesduringadolescence,as

individualsbecomemoreindependentfromtheirparents(Brown&Larson,2009;

Umbersonetal.,2010).Severalstudieshavefoundthatelementsofpeer

connectionandrelationshipsareassociatedwithloweredlevelsofadolescent


68

internalisingproblems,includingemotionalsymptoms(e.g.,Bosacki,Dane,&

Marini,2007;Lereyaetal.,2016;McGrawetal.,2008;Millingsetal.,2012;Van

Voorheesetal.,2008).Whilethereareindicationsthatpeerconnectioncanprovide

bufferingeffectsinparticularat-riskgroupsinrelationtowideroutcomessuchas

qualityoflife(e.g.,Flaspohleretal.,2009),thereislittledirectexaminationoftheir

protectiveeffectinrelationtoemotionalsymptoms.Therearesomeindicationsof

genderdifferencesintheeffectsofpeerconnection,withgirlsshowinggreater

sensitivitytobothpositiveandnegativepeerexperiences(Bakkeretal.,2010;

Rotenbergetal.,2014),necessitatingfurtherexaminationwithinearlyadolescent

girls.

3.4.3ActiveEngagementinHomeandSchoolLife

Thestudyalsoinvestigatedthepromotiveandprotectivefunctionofthe

extenttowhichparticipantsviewedthemselvesasactivelyengagingintheirhome

andschoollives,inlinewithitsinterestinhowindividualsinteractwiththeexternal

featuresoftheirenvironment.Activeengagementinhomeandschoolliferefers

heretoperceptionsofbeingactivedecision-makersandcontributorsacrossthese

contexts.Duringearlyadolescence,individualsgenerallyexperiencegreater

autonomyanddecision-makinginthehome,particularlysoforgirls(Gutman&

Eccles,2007;Wray-Lakeetal.,2010).Studieshaveindicatedthatchildrenand

adolescentswithgreatercapacityfordecision-makingandcontrolinthehome

generallyreportlowerlevelsofemotionalsymptoms(Beckeretal.,2010;Borelliet

al.,2015;Radziszewskaetal.,1996).Ithasbeensuggestedthatcontributingto

decision-makinginthehomeoffersopportunitiestoidentifyandrespondto

stressorsindailylife,thusdevelopingstressappraisalandcopingcapacities(Becker

etal.,2010;Borellietal.,2015).Intermsofactivecontributionthroughchoresand

otherformsofsupport,researchhasgenerallyfocusedonbroaderoutcomessuch

aspsychologicalwellbeing.Whilesuchcontributionscanpresentchallenges,

potentiallyincreasingburdenandcreatingtension,itisbelievedthatoverallthis

createsasenseofbelongingandsupportssatisfactionandwellbeing(Fuligni&

Pedersen,2002;Fuligni&Telzer,2013;Kavanaughetal.,2015).


69

Activeengagementinschoolisgenerallyexaminedasadimensionof

broaderinstitutionalschoolconnection(e.g.,Bondetal.,2007;EwellFosteretal.,

2017;Loukasetal.,2016),withlimitedresearchexaminingthisnarrowerconstruct

bothgenerallyandinrelationtomentalhealth.Ithasbeenarguedthatthe

developmentalneedsofadolescents,includingthedesireforautonomyand

decision-making,canbeincongruentwiththerulesandsystemsusuallyinplacein

schools,whichareoftenrigidandunamenabletonegotiationwithpupils(Eccleset

al.,1993;Hargreaves,2017;Smetanaetal.,2004).Whileitwouldbeusefulto

examinethedifferentialfunctionsofactiveengagementwithinhomeversusschool

contexts,thesubscaleusedtogatherdataspecifiestheseasasingularconstruct

andsothiswasnotpossible(seeSection4.6.1).Capturedtogether,however,these

insteadofferinsightintotheroleofperceivedactiveengagementindailylife,given

thathomeandschoolarethemajorcontextswithinwhichearlyadolescents

operateonaday-to-daybasis.

3.4.4EngagementinExtracurricularActivities

Finally,thestudyexaminedtheroleofperceivedengagementin

extracurricularactivitiesandhobbies,suchasart,drama,music,sport,andspecial

interestgroupsandclubs.Extracurricularactivitiesareoftendiscussedwithinthe

contextofpositiveyouthdevelopment,whereitisunderstoodthatsuch

engagementcanprovidepositiveopportunitiesforsocialconnectionand

belongingness,aswellassupportingasenseofachievementandpositive

recognitionfromothers(e.g.,Alvord&Grados,2005;Nicholson,Collins,&Holmer,

2004;Schaeferetal.,2011).Thereisalsosomeevidencethatthesebenefitsmaybe

greaterforthosefromlowersocioeconomicbackgrounds(Blomfield&Barber,

2011).Amodestnumberofstudieshaveidentifiedanassociationbetween

extracurricularactivityandlowerlevelsofemotionalsymptomsduringadolescence

(Guèvremontetal.,2014;Lereyaetal.,2016;Molinuevoetal.,2010),thoughthere

isalackofdirectexaminationofitsprotectivefunctioninrelationtoriskeffects.

Notably,extracurricularactivityoftencorrespondstohigherlevelsofconnection

withinthefamily,school,andneighbourhoodcontexts;assuch,effectsshouldbe


70

examinedalongsidethesecontextstoavoidover-estimation(FeldmanFarb&

Matjasko,2012;Kilmeretal.,2010),asisthecaseinthecurrentstudy.

3.5MethodologicalApproachesinRiskandResilience

Theriskandresilienceresearchfieldisprimarilydrivenbyquantitative

inquiry.Thismeansthatthelanguageandconstructstypicallyusedareinherently

statisticalinnature;thatis,thereisadominantfocusonprobabilityand

risk/promotive/protectivefactorsasvariablesassociatedwithincreasedlikelihood

ofparticularpositiveornegativeoutcomes.Asaresult,whilethereisagreatdeal

ofresearchidentifyingcorrelatesandpredictorsofhealthanddevelopment

outcomes,andanincreasedfocusontheeffectsofmultipleriskexposure,there

remainsalimitedunderstandingoflivedexperienceandwhatitmeanstobean

“at-risk”childoradolescent.Whilequantitativeinquiryhasprovidedextensive

evidenceonriskandresiliencebothconceptuallyandinthespecificcontextofchild

andadolescentmentalhealth,therearealsoanumberofadvantagesthat

qualitativeinquirycanoffer.

Atagenerallevel,limitedrepresentationsoflivedexperience,or“whatitis

like”,risksreducingyoungpeopletodatapointsandoverlookingthecomplexity

andmeaningfulnessoftheseexperienceswithintheirdailylivesandlifelong

trajectories(Todres&Wheeler,2001;Yilmaz,2013).Qualitativeresearch,and

particularlyphenomenologicalapproachesasusedinthecurrentstudy,canserve

tohumaniseotherwisedistant“others”inawaythatquantitativeinquirydoesnot

afford,bringingthefocusbackfrompatternsandvariablestopeople(Todres,2007;

Todres&Wheeler,2001).Similarly,suchmethodscanbeparticularlyhelpfulfor

elevatingthevoicesofmarginalisedandunheardgroups(Larkinetal.,2006;Larkin

&Thompson,2012;Pietkiewicz&Smith,2014;Reidetal.,2005),aswithchildren

andyoungpeopleandparticularlythoseexperiencingriskanddisadvantage

(Bottrell,2009).

Qualitativeinquirycanalsoproviderichinsightintothecomplexityof

phenomenaincontext(Johnson&Onwuegbuzie,2004;Mertens,2015),offering


71

thepotentialtowidenthemarginsofthewaywedefineandunderstandthe

phenomenonofinterestbeyondthenarrowedinformationprovidedby

quantitativevariables(Bottrell,2009;Ungar,2003).Indeed,qualitativeresearchled

andpromotedbyUngarandcolleagues(Ungar,2003,2004a;Ungar&Liebenberg,

2011)hasexpandedandchallengedearlierunderstandingsofresilience,

demonstratingthecomplexityandcontextualspecificityofthephenomenon.IPA

hasbeenhighlightedasparticularlyvaluablewhenexaminingcomplexphenomena

(Smith&Osborn,2015a;Wagstaffetal.,2014),whileitsidiographicfocuson

particulargroupsandcontextssupportsthecurrentstudy’saimtounderstand

thesephenomenawithinthespecificcontextofemotionalsymptomsamongearly

adolescentgirls.Finally,qualitativeresearchmaybeparticularlyhelpfulin

addressingenduringquestionsregardingtheunderlyingmechanismsofriskand

resilienceinrelationtomentalhealthoutcomes.Thatis,exploringlivedexperience

ofthesephenomenacanfacilitateagreaterunderstandingofthewaysthat

differentaspectsofanindividual’sliferelatetooneanotherandchangeovertime.

Thislevelofanalysismayelucidateunderlyingprocessessuchastransactionsacross

“riskfactors”,theroleofstress,andtheareasandresourcesthatearlyadolescent

girlsdrawoninnavigatingtheseareasoftheirlives.

Useofqualitativeinquirywithinamixedmethodsstudycanfacilitate

explorationofbothoverarchingpatternsandindividualnuanceandcomplexity,

thusovercomingsomeofthelimitationscommonacrosstheriskandresilience

researchfield.Indeed,Ungar(2019)hasrecentlyhighlightedthattheuseofmixed

methodscanfacilitatebroaderconceptualisationsanddiscoursesaroundriskand

resilienceprocesses,whilealsofacilitatingamorein-depthunderstandingofthese

phenomenathatneitherapproachcouldofferinisolation.Furthermore,itis

notablethatbothstrandsofthecurrentstudyhaveadistinctfocusontheways

thatriskandresilienceprocessesaresubjectivelyexperiencedandunderstood,but

adoptadifferentleveloffocusinthisendeavour.Thatis,thequantitativestrand

focusesonmentalhealthsymptomsthatpredominantlymanifestthemselves

internally(Fredrickson&Roberts,1997;Hammen,2005;Kuehner,2017;Nolen-

Hoeksema,1990,2001;Nolen-Hoeksema&Girgus,1994)andtherolethat


72

subjectivestressappraisalandperceptionsofaccesstoprotectivefactorscanplay,

whilethequalitativestrandseekstoexploreindividualisedsense-makingofthese

phenomena.Thespecificuseofmixedmethodsinthecurrentstudyispresentedin

thefollowingchapterwithconsiderationofhowthequantitativeandqualitative

strandsarebroughttogethertogenerateinsightintoriskandresilienceprocesses

inrelationtoearlyadolescentgirls’emotionalsymptoms.

3.6ChapterSummary

Thestudysetouttoinvestigateeighthypothesisedriskvariablesandto

examinemultipleriskeffectswithattentiontodifferentconceptualisationsand

measurementapproaches,aswellastheroleofstressappraisal.Buildingonthe

conceptofresilience,thestudysoughttoexaminesixhypothesised

promotive/protectivefactors,withanemphasisonexternalfactors.Finally,this

chapterhashighlightedthatmixedmethodsmayfacilitateamorecomprehensive

understandingofthecomplexityandmeaningfulnessoftheseprocesses.

CHAPTERFOUR:METHOD

73

Chapter4:Method

4.1ChapterOverview

Thischapterdetailsandjustifiesthemethodologyandmethodsutilisedin

thecurrentstudy.Itexploresthestudy’scontext,epistemologicalstanceand

influence,anddesign,beforeoutliningeachstageoftheresearchprocess,namely

participants,materials,procedure,andanalyticalstrategy.Finally,effortsforquality

andrigouraredetailedandanoverviewofethicalconsiderationsispresented.

4.2StudyContext

ThedatainthecurrentstudywerecollectedfortheevaluationofHeadStart,

along-termpreventionandpromotionprogrammefocusedonimprovingresilience

andemotionalwellbeingforat-riskyoungpeopleacrosssixareasofEngland.The

projectandevaluationarefundedbytheNationalCommunityLotteryFund(NCLF)

andtheevaluationisbeingcarriedoutbyanAnnaFreudNationalCentrefor

ChildrenandFamilies(AFNCCF)-ledconsortium.

4.2.1HeadStart

HeadStartisalong-termprogrammetriallingarangeofinterventionsand

initiativesaimedatimprovingresilienceandemotionalwellbeingfor10-16year-

olds.Theprogrammeaimsto:

1. Improveemotionalwellbeing;

2. Improveengagementinschoolandacademicattainment;

3. Reducetheonsetofdiagnosablementalhealthdisorders;and

4. Reduceengagementin“risky”behaviour.

HeadStartisbeingdeliveredoverafive-yearperiod(2016–2022)acrosssixlocal

authority-ledareas,specificallyBlackpool,Cornwall,Hull,Kent,Newhamand

Wolverhampton.Theseareaswereselectedforinclusioninthisphaseofthe

CHAPTERFOUR:METHOD

74

programmebasedontheirinvolvementinapreviouspilotingphaseofthe

programme,alongsideconsiderationofdemographiccharacteristicsandlocality.

4.2.2NationalEvaluationofHeadStart

TheevaluationofHeadStartiscurrentlybeingundertakenbyaconsortium

ledbyAFNCCF,involving:

• TheEvidenceBasedPracticeUnit(UniversityCollegeLondon[UCL]and

AFNCCF);

• ChildOutcomesResearchConsortium(AFNCCF);

• TheUniversityofManchesterInstituteofEducation;

• LondonSchoolofEconomics;and

• CommonRoom(aconsultancyorganisationfocusedoninvolvingchildrenand

youngpeopleindevelopingresearch,policy,andpracticerelatingtothem).

Thisevaluationhasthreekeystrands,witharangeofdatautilisedtoaddresseach

one:(a)Quantitativeexplorationofimpact,(b)qualitativeexplorationof

experienceandmechanismsand(c)evidence-basedpracticeanddissemination.

Quantitativedataisgatheredannuallyfrompupilsin114educationsettings

(baselineN=30,843).Thiscomprisesalongitudinalcohortfollowedthroughthe

projectfromYear7(2016/2017)onwards(51%atbaseline),alongsideyear-on-year

snapshotmeasurementsofYear9pupils(2016/2017;49%atbaseline;Deighton,

Lereya,etal.,2018).Thesedataaregatheredeachacademicyearbetween

2016/2017and2021/2022.ParticipantscompletetheWellbeingMeasurement

Framework(WMF),comprisingseveralmeasuresrelatedtowellbeing,mental

health,andresilience(EvidenceBasedPracticeUnit,n.d.).Partnershipareastrack

individuals’engagementwithHeadStartservicesandinterventionsforuseinthe

evaluation.DemographicdataisaccessedfromtheNationalPupilDatabase(NPD).

Qualitativedataisgatheredthroughannualsemi-structuredinterviewswith

childrenandyoungpeople(baselineN=63;Stapley&Deighton,2018),following

onelongitudinalcohortfromYears5and7(2016/2017)onwards.Thesedatawill

begatheredeachacademicyearbetween2016/2017and2021/2022.Further

CHAPTERFOUR:METHOD

75

quantitativeandqualitativedataisgatheredfortheevaluationofprogramme

deliveryandsummativeevaluationsofspecificinterventions;anoverviewofthis

processisnotdescribedhere,asthecurrentstudydoesnotdrawonthisdata.

4.2.3IndependenceoftheCurrentStudy

Thecurrentstudydrawsonquantitativeandqualitativedatagatheredinthe

2016/2017baselinestageofHeadStart.Thecurrentstudyisindependentfromthe

mainevaluationasitfocusesondiscreteaimsandresearchquestionsand

addressesthesethroughseparateanalyses.Thus,itconstitutesanoriginalstudy

thatoffersuniquecontributionstoadolescentmentalhealthresearchand

developmentalpsychopathology.TableA1,AppendixAoutlinesthedifferences

betweenthecurrentstudyandtheevaluationofHeadStart.Itshouldbenotedthat

theauthorofthecurrentstudywasfundedasaresearchassistantforthemain

evaluationandwasinvolvedinthequantitativeandqualitativeevaluationstrands.

4.3EpistemologicalApproach

Itisnecessarywithinsocialresearchtoexplorethebeliefsandassumptions

underpinningtheresearchprocess.Variousconceptualisationshavebeenproposed

tomakesenseofsuchphilosophicalfoundationsandthewayinwhichtheyoperate

toguideresearch.Kuhn(1962)firstintroducedtheideaofparadigms,ordistinct

worldviewsencompassingspecificsetsofbeliefsandassumptions.Lincolnand

Guba(1985)extendedthisbroadconceptualisation,outliningatripartitemodel

withinwhichparadigmscontainedthreespecificbeliefsystems;namely,ontology,

epistemologyandmethodology.However,Crotty(1998)contendedthatontology,

whichcapturesassumptionsregardingthenatureofreality,andepistemology,

whichrelatestothestudyofthisreality,areconceptuallyintertwinedandthus

difficulttoseparate,suggestingthat“totalkoftheconstructionofmeaningisto

talkoftheconstructionofmeaningfulreality”(p.10).Thecurrentstudyapplied

Crotty's(1998)framework,conceptualisingtheresearchprocessasconsistingof

fourkeyelements:(a)Epistemology,orthenatureofknowledgeand,thus,ofthe

CHAPTERFOUR:METHOD

76

relationshipbetweentheresearcherandtheresearch;(b)theoreticalperspective,

orthestanceadoptedbytheresearcher;(c)methodology,ortheresearchdesign;

and(d)methods,orthetoolsandproceduresusedtocollectandanalysedata.

Crotty(1998)outlinedthisasahierarchicalprocess,witheachelementinformedby

theprecedingone(seeFigure4.1).

Figure4.1.Hierarchyofelementswithinparadigms.ReprintedfromThefoundationsofsocial

research:Meaningandperspectiveintheresearchprocess,byM.J.Crotty,(1998),SAGEPublications

Ltd.Copyright1998byMichaelCrotty.

4.3.1Pragmatism

Pragmatismisaphilosophicalschoolofthoughtconcernedwithmeaning

andaction,ratherthanabstractthought,conceptualisingtruthandknowledgeas

provisionalratherthanabsolute(Johnson&Onwuegbuzie,2004;Maxcy,2003).As

aresearchparadigm,pragmatismhasrejectedtraditionallydualistapproachesand

insteademphasisespluralism,whereindifferingtheoriesorperspectivesare

valuablefordevelopingameaningfulunderstandingofaphenomenon(Johnson&

Onwuegbuzie,2004).Hence,pragmatismchallengestheincompatibilitythesis

(Howe,1988),whichcontendsthatquantitativeandqualitativemethodsare

underpinnedbyincompatibleepistemologiesandthusshouldnotbemixed

(Bryman,2008;Johnson&Onwuegbuzie,2004).Quantitativepurists(e.g.,Maxwell

Methods

Methodology

Theoretical

perspective

Epistemology

CHAPTERFOUR:METHOD

77

&Delaney,2004;Popper,1959)havetypicallysubscribedtoa(post)positivist

philosophy,withinwhichanobjectiverealityexistsandmaybemeasured,if

imperfectly,meaningthatestablishinggenerallawsisbothachievableand

desirable(Creswell,2014;Greene,2007;Johnson&Onwuegbuzie,2004).

Contrastingly,qualitativepurists(e.g.,Guba&Lincoln,1989;Schwandt,2000)

generallyadvocateinterpretivismorconstructivism,bothunderpinnedbyabeliefin

multiplesubjectiveconstructionsofreality,meaningbroadgeneralisationsare

neitherdesirablenorachievable(Greene,2007;Guba&Lincoln,1989;Johnson&

Onwuegbuzie,2004).

Bothquantitativeandqualitativepuristsarguethattheseunderlying

paradigmaticdifferencesareinsurmountable(Greene,2007;Johnson&

Onwuegbuzie,2004).Pragmatism,however,eschewssuchmetaphysicalconcerns

andinsteadadoptsa“whatworks”epistemologicalapproach,eitherignoringor

settingasidethesedifferencesinordertofocusonfindingaworkableapproachto

theresearchproblem(Creswell&PlanoClark,2011;Miles&Huberman,1984;

Morgan,2007,2014).Asaresult,pragmatismoffersadvantagesinresearch

concerningthe“realworld”andhasgainedincreasingpopularityacrossthesocial

sciences(Bryman,2008;Morgan,2014).

Inparticular,thecurrentstudyutilisedmixedmethodspragmatisminorder

toaddressitsaims,drawingtogetherbothquantitativeandqualitativeinquiry

throughouttheentireresearchprocess,includingepistemology,datacollection,

analysis,andinferences.Althoughpragmatismisnotcommittedtoanyone

method,itisnowtheprimaryparadigmutilisedwithinmixedmethodsresearch

(Greene,2007,2008;Morgan,2007,2014).Itsemphasisonworkabilityaffords

researcherstheabilitytoblendapproaches(Johnson&Onwuegbuzie,2004;

Morgan,2014).Indeed,theparadigm’sadvocacyofpluralismnotonlyallowssuch

blendingbutactivelyplacesvalueontheuseofmultipleapproachesand,thus,

methods(Morgan,2014).Ontologically,apragmaticpositionassumesthat

knowledgeissubjectivelyconstructedbutisalsogroundedinasharedreality

(Creswell,2014;Johnson&Onwuegbuzie,2004).Recognitionofbothmultipleand

singularrealitiesenablesexplorationofnumerousworldviewswithinonestudy,

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78

evenwheretheseofferdifferentorevenconflictingperspectives(Creswell&Plano

Clark,2011;Miles&Huberman,1984).Inthecurrentstudy,theadoptionof

pragmatismallowsinvestigationofthephenomenaofinterestthroughdifferent

lenses,thusdevelopingamorecomprehensiveunderstanding;these

epistemologicalperspectivesareexploredbelow.

4.3.2WiderTheoreticalPerspectives

Postpositivism

Postpositivismisaschoolofthoughtevolvedfrompositivism,andis

groundedprimarilyintheworkofPopper(1959)andKuhn(1962).Whilepositivism

assumesthatthereisanobjectiverealitythatcanbeobjectivelymeasured,

postpositivismtakesamorecriticalstance,whereinknowledgeofthisrealitycan

onlybeimperfectgiveninherentbiasesandbarrierswithintheresearchprocess

(Creswell,2014).Forexample,withinpostpositivism,aresearchhypothesisis

understoodtobeinformedbytheprevailingconsensusandpreviousresearchand

socannotbeobjective(Kuhn,1962;Popper,1959;Shadishetal.,2002).Inpart,the

rejectionofpositivismarosethroughincreasedempiricalattentiontophenomena

thatcouldnotbedirectlyobserved,includinghumanexperiencessuchasfeeling

andthinking(Mertens,2015),asisofinterestwithinthecurrentstudy.Thus,

postpositivistresearchdoesexploregenerallawsbutfocuseson“theory

falsification”,offeringprobabilisticinferencesratherthanabsolutetruths(Mertens,

2015;Ponterotto,2005;Popper,1959).However,thepursuitoffalsificationmust

itselfberecognisedasfallible(Kuhn,1962;Shadishetal.,2002);theapproach

assumesfirstlythatanycausalhypothesishasbeenperfectlyspecified,whichthe

natureoftheoryrendersimpossible,andsecondlythatthemethodsandmaterials

utilisedprovideanaccuratemeasurementoftheconstructofinterest(Kuhn,1962).

Thisindicatesaneedtoinvestigateahypothesisthroughmultipletheoretical

lenses,acrossheterogeneousconditionsandcontexts,andwithconsiderationof

potentialmediatingandmoderatingfactors(Shadishetal.,2002).

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Thecurrentstudyadoptedpostpositivismasalenstoaddressresearch

questions(RQs)1a–dand2a–bastheyseektoaddressspecifichypothesesand

focusoninternalandperceivedprocessesthatcannotbedirectlyobserved.As

such,findingsrepresentprobabilisticclaimsandarecontextuallygroundedwithin

thestudy’ssampleandmethods.Furthermore,conclusionsarenotofferedas

singularfactsbutrepresentacontributiontothebroaderliteratureonrisk

exposure,adaptiveprocesses,andemotionalsymptomswithindifferentcontexts.

InterpretivePhenomenology

Phenomenologyisconcernedwiththewaythatconsciousbeingsinteract

with,andexperience,phenomena.Thus,phenomenologicalresearchseekstolearn

aboutaphenomenonbyaccessinganindividual’slivedexperienceofit(Moran,

2000;Smithetal.,2009).PhenomenologystemsfromtheworkofHusserl

(1927/1971),thoughthereareanumberofmorerecentvariationswhichcanbe

classifiedaseitherdescriptiveorinterpretiveinnature(Mayoh&Onwuegbuzie,

2015;Moran,2000).Descriptivephenomenologicalresearchiscloselyalignedwith

Husserl's(1927/1971)originalapproach,seekingtoexploreanddescribepersonal

experiencesinordertounderstandaphenomenonasitpresentsitself,thusgaining

an“insider’sperspective”(Lopez&Willis,2004;Mayoh&Onwuegbuzie,2015;

Moran,2000).Suchresearchstrivestobepurelydescriptiveandtokeepthevalues,

experiences,andpreconceptionsoftheresearcherfrominfluencingconclusions

(Lopez&Willis,2004;Moran,2000).

Interpretivephenomenologyrealignsthefocustotheindividualthemselves

andthewayinwhichtheymakesenseoftheirexperienceofthephenomenonof

interest(K.A.Lopez&Willis,2004;Smithetal.,2009).Thisapproachstemsfrom

Heidegger(1927/1962),whoexpandedphenomenologybyincorporatingthe

conceptofhermeneutics,orthestudyofmeaningandmeaningfulinterpretation.

Interpretivephenomenologypositsthattheinsider’sperspectivecontains

embeddedmeaningsthattheparticipantmayormaynotbeawareofand,

furthermore,thatareinfluencedbytheirlifeworld;thatis,theperson’sown

individualcontext(Biggerstaff&Thompson,2008;K.A.Lopez&Willis,2004;Smith

etal.,2009).Furthermore,thisformofphenomenologyisgroundedinthenotion

CHAPTERFOUR:METHOD

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thatinaccessingandexploringanother’sexperience,theresearcherandtheir

worldviewisinherentlyimplicated,thusbringingan“outsider’sperspective”.The

influenceoftheresearcher’svalues,experiences,andpreconceptionsisconsidered

notonlyunavoidablebutalsovaluable,astheresearchermaybeabletogenerate

furtherinsightthroughtheprocessofinterpretation(Larkin&Thompson,2006;

Mayoh&Onwuegbuzie,2015;Pietkiewicz&Smith,2014;Smithetal.,2009).

Thecurrentstudyutilisedonevariationofinterpretivephenomenology,

interpretativephenomenologicalanalysis(IPA),inordertoaddressRQ3.IPAisan

approachconcernedwiththedetailedexplorationofpersonalexperienceand

understandingthewaysinwhichindividualsmakesenseofthisexperience(Smith,

1996,2004,2011a;Smithetal.,2009).Findingsrelatenottothephenomenonof

interestitselfbutrathertotheparticularindividual’sexperiencesand

understandingofthephenomenon(Larkinetal.,2006).Theapproachisshapedby

multipleinfluencesbutisprimarilyunderpinnedbythreekeyphilosophies,drawing

onbothHusserl's(1927/1971)phenomenologyandHeidegger's(1927/1962)

hermeneuticalongsideanidiographiccommitmenttothein-depthexplorationof

theparticular,ratherthanthecreationofgeneralisations(Smithetal.,2009).As

such,IPAattemptstounderstandasmallnumberofparticipants’individual

experiencesofagivenphenomenon,seekingtoidentifyboththatwhichisunique

andthatwhichissharedbetweentheiraccounts(Reidetal.,2005;Smithetal.,

2009).

ThefocusonindividuallivedexperienceinIPAreflectsanontological

assumptionthatthereisnofixedobjectiverealityand,thus,thatitisnecessaryto

accessothers’constructionsofrealityinordertodevelopunderstanding(Mayoh&

Onwuegbuzie,2015;Smithetal.,2009).Indoingso,theinteractionbetweenthe

participants’lifeworldsandtheresearcher’slifeworldisunderstoodtocreatenew

meaningsandinsight(Larkinetal.,2006;Pietkiewicz&Smith,2014).Itisimportant

tonotethattheinterpretationsdrawnfromthisprocessarenotassertedasfacts

butasinherentlycontextualfindings(Reidetal.,2005;Smithetal.,2009).Assuch,

thereisaneedforexplicitreflexivityofthewayinwhichtheresearcher’svalues,

experiencesandpreconceptionsinfluencetheresearchprocessand,thus,how

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theseareimplicatedintheresultingfindings(Biggerstaff&Thompson,2008;Smith

etal.,2009;Willig,2013).

UnitingPostpositivismandInterpretivePhenomenologywithinaPragmatic

Approach

Puristswouldarguethattheseapproachescannotbeunitedwithinasingle

studyduetofundamentaldifferencesintheirmetaphysicalassumptions.For

instance,postpositivismassumesanobjectivereality(Creswell,2014;Kuhn,1962;

Popper,1959),whileinterpretivephenomenologypositsthatrealityisindividually

constructed(Mayoh&Onwuegbuzie,2015;Smithetal.,2009).Asnoted,froma

mixedmethodspragmatismperspectiveitisnotonlyacceptablebutevenvaluable

tosetasidethesedifferencesandbringtogethervariedapproachestofacilitatea

fullerunderstandingofagivenphenomenon.However,itcouldbearguedthat

thereareareasofsimilarityacrossthesetwoparadigms,particularlyintheir

applicationinthecurrentstudy.Althoughtheseworldviewsdifferintheir

assumptionsofreality,theyeachrecognisethatdatacannotofferarepresentation

ofasingularreality,giventhatpostpositivismrecognisesthatrealitycannotbe

perfectlymeasured(Creswell,2014).Thisisconsideredparticularlytruewhere

inquiryrelatestointernalhumanprocesses(Mertens,2015),asinthecurrent

study.Indeed,bothstrandsincorporateadistinctfocusonthewayinwhich

participantsperceiveandexperienceparticularphenomena.Thequantitative

strandnotonlyrecognisesthatfindingsinherentlyreflectsubjectiveappraisalsof

realitybutsetouttodosobydesign,givenitsfocusonself-reportedstress

appraisalprocesses,mentalhealthsymptomsthatlargelymanifestthemselves

internally,andtheinfluenceofperceivedaccesstoprotectivefactors.Not

dissimilarly,thequalitativestrandexploresthewayinwhichearlyadolescentgirls

experienceandmakesenseofthesamesymptomsandappraisetheirouterworlds.

Thus,regardlessofbeliefsaboutwhetherrealityitselfisobjectiveorsubjective,

bothsetsofinformationretainanexplicitemphasisonrealityasperceivedand

experiencedattheindividuallevel.Furthermore,ashasbeenexploredhere,

neitherstanceassumestheabilitytoprovideentirelygeneralisablefactsbut

insteadoffershighlycontext-specificinferencesrecognisedtobegroundedwithin

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theparticularcircumstancesofthestudy.Inbothcasesthisspecificityextendsto

includeboththeresponsesoftheparticularparticipantsengagedinthestudyas

wellasrecognisingtheinherentinfluenceoftheresearcher’svaluesandbeliefs.

Assuch,theintegrationofbothpostpositivismandinterpretive

phenomenologywithinthecurrentstudyisnotconsideredproblematic.Thestudy

asawholehassoughttodrawtogetherthesedifferingapproachestoexplorea

particularsetofphenomenaasperceivedandexperiencedbyearlyadolescentgirls,

withone(postpositivism)providinganunderstandingofgeneralpatternsatan

overarchinglevelandtheother(interpretivephenomenology)offeringinsightinto

individualisedexperiences.Consistentwiththeuseofmixedmethodspragmatism,

theuseofeachoftheseapproachestogethercandeveloparicherandmore

meaningfulunderstandingoftheseparticularphenomena.Assuch,eachstrandhas

beencarriedoutwithsensitivitytotheparticularphilosophicalassumptionsthat

underpinthem,withattentiontothewayinwhichtheseshouldinformmethods

anddecisions.

4.4ResearchDesign

4.4.1MixedMethodsDesign

Apragmaticparallelmixedmethodsdesignwasutilisedtoaddressthe

researchaims,comprisingbothaquantitativeandaqualitativestrand.Consistent

withtheadoptionofpragmatismasanoverarchinglens,thisdesignwasguidedby

theresearchquestionsandmethodswereselectedtobestaddressthem.The

quantitativestrandaddressedRQs1a–dand2a–bgiventheirfocusonbroad

patterns,whilethequalitativestrandaddressedRQ3duetoitsinterestin

individuallivedexperience.

Greene,CaracelliandGraham(1989)outlinedfivekeypurposesformixed

methodsdesigns:(a)Triangulation,wherethestudyseeksconvergenceoffindings

acrossdifferentmethods;(b)complementarity,wherethestudyseekstoenhance

thefindingsofeachmethodwiththoseoftheother;(c)development,wherethe

findingsfromonemethodinformtheother;(d)initiation,wherethestudyaimsto

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discovernewperspectivesorinterpretations;and(e)expansion,wheremixed

methodsareusedtoincreasethebreadthofinquiry.Mixedmethodswereutilised

heretofacilitatecomplementarityacrossfindings.Inacomplementaritydesign,

differentfacetsofthesamephenomenaareinvestigatedinordertodevelopa

morecompleteunderstandingofthephenomena,withtheintegratedstrands

consideredtoadduptomorethanthesumoftheirparts(Bryman,2006;Bryman,

Becker,&Sempik,2008;Greeneetal.,1989).Thisdesignseekstocapitaliseonthe

strengthsofeachmethodinordertooffsettheother’slimitations(Greeneetal.,

1989).Forexample,whilethetypicallydeductivenatureofquantitativemethodsis

usefulwheninvestigatingspecifichypotheses,theuseofinductiveinquirycanbeof

valueinexploringlessestablishedorcomplexphenomena(Johnson&

Onwuegbuzie,2004;Mertens,2015),asinthecurrentstudy.Additionally,different

methodsoffercontrastinglevelsoffocus,aswassoughtinthecurrentstudy;

CreswellandPlanoClark(2011)haveobservedthatquantitativeinquiryfocuseson

themanyandoverlookstheindividual,whilequalitativeinquiryfocusesonthe

individualandthusoverlooksthemany.Assuch,bothmethodswereutilisedto

directlyaddresstheirrespectivelimitationsandthusdevelopamore

comprehensiveunderstandingoftherelationshipbetweenmultipleriskexposure,

adaptiveprocesses,andemotionalsymptomswithinthispopulation.Greeneetal.

(1989)indicatedthatthisdesignmaybeenhancedbytheuseofmethodswithin

similarparadigms;however,theparticularfacetsbeingexploredinthetwostrands

ofthecurrentstudywarrantdifferingparadigmaticperspectivesinordertobest

addresstherespectiveresearchquestions.Thisapproachreflectsthecurrent

study’sadoptionofpragmatismanditsadvocacyforcombiningmultiple

worldviewsinthisway.

Aparallelmixedmethodsdesignencompassesthecollectionofdatafor

bothstrandsconcurrentlyandindependently,asopposedtoasequentialdesignin

whichtheapproachtoonestrandisinformedbyfindingsfromtheother

(Onwuegbuzie&Teddlie,2003;Tashakkori&Teddlie,1998).Thisisconsistentwith

thestudy’suseofmixedmethodstoaddressdifferentresearchquestionsandis

recommendedbyGreeneetal.(1989)forcomplementaritydesigns.Assuch,the

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84

twostrandswereeachundertakenseparatelyandwerethenintegratedfollowing

analysisanddiscussiontocreatemeta-inferencesthatrepresentamore

comprehensiveunderstandingofthephenomenaofinterest(Creswell&Plano

Clark,2011;seeSection4.10fordetailsofintegration).Anequalweightapproach

wasutilised,whereineachstrandistreatedwithequalstatuswithinthe

overarchingstudy(Leech&Onwuegbuzie,2009;Moseholm&Fetters,2017).This

reflectstheequalprioritygiventobothstrandsinthecurrentstudyandthevalue

ofthedifferentinsightseachoffersinbuildingacomprehensiveunderstandingof

thephenomenonbeinginvestigated.Furthermore,ithasbeensuggestedthat

whereonestrandadoptsaphenomenologicallens,anequalweightapproachcan

beparticularlyvaluableincreatingabalancebetweeninductiveanddeductive

inquiry(Hefferon&Gil-Rodriguez,2011;Mayoh&Onwuegbuzie,2015).IPA

methodologistshavearguedthatitisvitaltoplaceequalorgreaterweightonan

IPAcomponentwithinmixedmethodsresearchinordertoreflectitsendeavourto

understandaphenomenonasexperiencedbytheindividual,ratherthanas

understoodbyothersorbytheory(Smith,2011a;Smithetal.,2009).Itshouldbe

notedthatalthoughthereisaproportionatelygreaternumberofresearch

questionsunderpinningthequantitativestrand(RQs1a–dand2a–b),thisisdueto

theirmoredeductivefocusondisaggregatedrelationships,whilethequestion

addressedwithinthequalitativestrand(RQ3)constitutesamoreinductiveinquiry

(seepage22forfullresearchquestions).

Ofcourse,mixedmethodsdesignsencompasssomechallengesand

limitations.Akeychallengeistheheighteneddemand,relativetomono-method

approaches,oftime,resources,andresearcherskills(Doyleetal.,2009),which

JohnsonandOnwuegbuzie(2004)havesuggestedcanbeexacerbatedwithin

concurrentdesigns.However,asbothstrandsinthecurrentstudydrewon

availabledatagatheredaspartoftheevaluationofHeadStart,thislessenedsuch

demandsindatacollectionandsoreducedtheoverallburdenoftheresearch.A

furtherlimitationoftencitedisthedifficultyinproducinganintegrated

representationoffindingsfrombothstrandsthatisaccessibleformixedaudiences

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85

(Sandelowski,2003);efforthasbeentakentoovercomethisinthepresentationof

meta-inferences,asdetailedinSection4.10.

4.4.2QuantitativeStrand

ThequantitativestrandaddressedRQs1a–dand2a–b(aspresentedon

page22)andmadeuseofacross-sectionalobservationaldesign.Observational

researchinvestigatesreal-worldphenomenaandthusexploresinteractions

betweennaturallyoccurringvariables,ratherthanintroducingexperimental

manipulation(Carlson&Morrison,2009;Fife-Schaw,2012;Stroupetal.,2000).This

designisfrequentlyutilisedwithinepidemiologytoexploretheeffectsofexposure

tovariousfactors(vonElmetal.,2008,2014;Woodward,2014),asinthecurrent

study.Inacross-sectionalobservationaldesign,exposureandoutcomedatais

collectedatasingletimepointandprovidesa“snapshot”oftherelationships

betweenvariables(Woodward,2014).Thisdesigndoesnotallowanalysisof

temporalrelationshipsbetweenvariablesandsothereisaneedforcautionin

inferringcausality(Szklo&Nieto,2014;Woodward,2014).

VariablesintheQuantitativeStrand

Table4.1(overleaf)outlinesvariablesalongsidetheirfunctionandpurpose

forinclusion,anddetailsthemeasure,datasourceandmeasurementtype.For

conceptualspecificity,thestudyhasadjustedthelabelsrelatingtotheStudent

ResilienceSurvey(SRS)subscales,whichareutilisedtomeasurepromotiveand

protectivefactors.Examinationofthefacevalidityofthismeasureindicatedthat

theoriginalsubscalenamesdidnotcloselyapproximateitemcontent(seeSection

4.6.1).Similarly,inflatedprevalencelevelsfortheself-reportquestionusedto

assessyoungcarerstatusindicatedthatresponseswerelikelynotrepresentativeof

youngcarersasanarrowcategory.Assuch,forthepurposesofthecurrentstudy

thisvariablewasconsideredtoindicateabroadercategoryofyoungpeoplewho

identifiedashaving“caregivingresponsibilities”tosomeextent;thisisoutlinedand

reflecteduponfurtherinSection4.6.1.

CHAPTERFOUR:METHOD

86

Table4.1

VariablesintheQuantitativeStrand

Variable Function Purpose Measure Data

source

Measurement

type

Relativeage Predictor Riskmodelling Monthofbirth NPD Continuous

Academic

attainment

Predictor Riskmodelling KeyStage2

National

Curriculumtest

results2015/2016

NPD Continuous

SEN Predictor Riskmodelling SENstatus NPD Categorical

Familyincome Predictor Riskmodelling Freeschoolmeal

eligibility

NPD Categorical

Caregiving

responsibilities

Predictor Riskmodelling Youngcarer

statusself-report

question

WMF Categorical

ACEs Predictor Riskmodelling Childinneed

(CIN)status

NPD Categorical

Neighbourhood

socioeconomic

deprivation

Predictor Riskmodelling Income

Deprivation

AffectingChildren

Index(IDACI)

NPD Continuous

Emotional

symptoms

Outcome Outcome,

qualitative

participant

selection

process

Strengthsand

Difficulties

Questionnaire

(SDQ)emotional

symptoms

subscale

WMF Continuous

with

categorical

indicators

Perceived

stress

Mediator

variable

Indirecteffects

modelling

Four-item

PerceivedStress

Scale4(PSS-4)

WMF Continuous

with

categorical

indicators

Familyadult

connection

Predictor

and

moderator

variable

Promotiveand

protective

variable

SRS:Family

support

WMF Continuous

with

categorical

indicators

Schooladult Predictor Promotiveand SRS:School WMF Continuous

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87

connection and

moderator

variable

protective

variable

support with

categorical

indicators

Community

adult

connection

Predictor

and

moderator

variable

Promotiveand

protective

variable

SRS:Community

support

WMF Continuous

with

categorical

indicators

Schoolpeer

connection

Predictor

and

moderator

variable

Promotiveand

protective

variable

SRS:Peersupport WMF Continuous

with

categorical

indicators

Active

engagementin

homeand

schoollife

Predictor

and

moderator

variable

Promotiveand

protective

variable

SRS:Participation

inhomeand

schoollife

WMF Continuous

with

categorical

indicators

Engagementin

extracurricular

activities

Predictor

and

moderator

variable

Promotiveand

protective

variable

SRS:Participation

incommunitylife

WMF Continuous

with

categorical

indicators

School/setting Cluster

variable

Promotiveand

protective

variable

Anonymised

schoolcode

NPD Nominal

Note.NPD=NationalPupilDatabase;SEN=specialeducationalneeds;WMF=WellbeingMeasurementFramework;SRS=StudentResilienceSurvey.

4.4.3QualitativeStrand

Thequalitativestrandofthecurrentstudyadoptedaninterpretive

phenomenologicaldesigntoaddressRQ3(aspresentedonpage22),specifically

guidedbyIPA,whichseekstounderstandthewayinwhichasmallnumberof

individualsmakesenseoftheirexperienceofaparticularphenomenon(Smith,

1996,2004,2011a).IPAisnotonlyananalyticaltechniquebutinsteadoffersan

overarchingframeworktoguidetheresearchprocess(Smithetal.,2009).Thus,use

ofIPAinformedmultipleelementsofthestudy,includingepistemology,

methodologyandmethodsusedtoaddressRQ3.

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88

IPAvaluesdepthratherthanbreadth;ittypicallyutilisesasmallnumberof

participantsinlinewithitsidiographicstanceandseekstodevelopasmallnumber

ofrich,complexthemes(Hefferon&Gil-Rodriguez,2011;Reidetal.,2005).Analysis

focusesonpersonalaccountsoflivedexperience;here,accountsweregenerated

throughinterviews(seeSection4.6.2).Findingsrelatenottothephenomenonof

interestitselfbutrathertotheparticularindividual’sexperiencesand

understandingofthephenomenon(Larkinetal.,2006).Theapproachisinductive

andinvolvesgatheringexpansivedatathatallowstheemergenceofunanticipated

findings;itis,therefore,wellsuitedtoaddressingbroadresearchquestionsrather

thanthoseinvestigatingpreconceivedhypotheses(Larkin&Thompson,2006;

Smith,2004).AnIPAdesignwasdeemedmostappropriateforaddressingRQ3

givenitsfocusondevelopingunderstandingsofgirls’ownexperiencesoflifeinthe

contextofriskexposureandemotionalsymptoms.Furthermore,IPA’sin-depth

approachisconsideredparticularlyusefulwhenexploringcomplexphenomena

(Smith&Osborn,2015b;Wagstaffetal.,2014)andsowasutilisedtoprovidea

complementaryperspectivealongsidethequantitativestrand.

4.4.4IntegrationofQuantitativeandQualitativeStrands

Theintegrationofstrandsisafundamentalstageofmixedmethods

research,asitisthepointatwhichfindingsdoindeedbecome“mixed”(Bryman,

2007;Brymanetal.,2008;Johnson,Onwuegbuzie,&Turner,2007).One

considerationisthestageatwhichintegrationoccurs;asthecurrentstudyutilised

aparalleldesign,thedatafromthequantitativeandqualitativestrandswere

analysedindependentlyandinrelationtotheresearchquestionstheyeach

addressed.Thefindingsfromeachstrandwereeachdocumentedseparatelyand

werethensynthesisedafterinterpretingeachstrandindividuallytodevelopmeta-

inferences,consistentwithguidanceonintegratingconcurrentmixedmethods

(Johnson&Onwuegbuzie,2004;Moseholm&Fetters,2017;Tashakkori&Teddlie,

2003).Thisaimstoalloweachstrandtodevelopfullyandtosubsequentlybuilda

morecomprehensiveunderstandingofthephenomenaofinterest(Creswell,2014;

CHAPTERFOUR:METHOD

89

Creswell&PlanoClark,2011).Furthermore,thisstyleofintegrationisconsistent

withthestudy’suseofmixedmethodstosupportcomplementarity(Brymanetal.,

2008;Greeneetal.,1989).Withinthisdesign,theaimisthatthemeta-inferences

thataredrawnbybringingthetwostrandstogetheroffergreaterinsightintothe

phenomenaofinterestthanwhentheyarepresentedseparately;inotherwords,

togethertheybecomegreaterthanthesumoftheirparts(Brymanetal.,2008;

Creswell&PlanoClark,2011;Greeneetal.,1989).TeddlieandTashakkori(2006)

haveobservedthatalignmentbetweentherationaleforutilisingmixedmethods

andtheactualintegrationproceduresadoptedisakeycomponentofmixed

methodsresearch,asthestatedpurposeshouldactasaclearfunctionofthe

integrationprocess.However,misalignmentbetweenthetwoisacommonissue,

withmanysocialsciencearticlesutilisingacomparativeprocessthatrepresents

triangulationincaseswherethiswasnotthestatedpurpose(Bryman,2006).Given

thecurrentstudy’suseofdifferentmethodstoinvestigatedistinctfacetsofthe

samephenomena,andthuscreatecomplementarityoffindings,thepurposeofthe

integrationstagewasnottoidentifysimilaritiesordivergencesinfindingsasis

prioritisedintriangulationdesigns(Greeneetal.,1989).Instead,theemphasishere

isuponbringingtogetherfindingstocreateamorecomprehensiveunderstanding

ofthesephenomena.Finally,visualrepresentationsofmeta-inferenceswere

utilisedasthisapproachcanincreasetheaccessibilityoffindingstoreaders,

includingresearchersfromvaryingmethodologicalbackgrounds(Mayoh&

Onwuegbuzie,2015;Moseholm&Fetters,2017;Sandelowski,2003).Throughout

theintegrationprocess,thecurrentstudydrewontheinterpretiverigour

componentofTeddlieandTashakkori's(2009)integrativeframework,whichis

concernedwithintegritywithintheprocessofdrawingmeaningfrommixed

methods,tosupportqualityandrigour(seeSection4.11.3).

4.5Participants

4.5.1QuantitativeSample

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90

Thequantitativesamplecomprisedearlyadolescentgirls,aged11–12years

atthetimeofdatacollection(March–July2017).Participantsweredrawnfromthe

largerHeadStartsamplebasedontheirageandrecordedsex(seeSection7.7.1for

reflectionuponsexandgenderinthecurrentstudy).Thetotalpossiblesamplefor

thecurrentstudywas8,327girlsfrom100educationsettingsacrossthesix

partnershipareas(Table4.2).Giventhatthesamplewasselectedfromthesix

HeadStartlocalauthority-ledpartnershipareas,varyingsociodemographic

backgroundswerecaptured;forexample,bothurbanandrurallocalitiesare

representedalongsidevaryingethnicandculturalareaprofiles.Thus,thesample

forthestudyisrepresentativeofarangeofsociodemographiccontextsanditwas

consideredlikelythatsomeparticipantswereexperiencinghighlevelsofrisk.

Educationsettingsincludedmainstreamsecondaryschoolsandasmallernumberof

specialschoolsandalternativeprovisionsettings(e.g.,pupilreferralunits)where

pupilsweredeemedabletoself-report.Thecurrentstudyincludedallgirlsaged

11–12yearsratherthanisolatingthosefromaparticulartypeofeducationsetting,

inlinewiththestudyaims,andeducationsetting-leveldemographicsarenot

exploredasthiswasnotofdirectinterest.However,clusteringiscontrolledforat

theschool/settinglevel(seeSection4.8).Clusteringattheschoollevel,ratherthan

attheclasslevel(i.e.,furtheraccountingforgroupingwithinschools),wastheonly

availableoptiongiventheavailabledatabutwasalsomostappropriategiventhe

focusonsecondaryschool-agedparticipants.Insecondaryschoolgroupingismore

fluidthaninprimaryschool,withpupilsengagingwithawiderangeofpeersand

adultsthroughouttheweek(West,Sweeting,&Young,2010).Assuch,accounting

forclusteringattheschoollevelwasconsideredmostappropriateforthissample.

CHAPTERFOUR:METHOD

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Table4.2

NumberofEducationSettingsandParticipantswithinEachLocalAuthorityPartnershipArea

Anonymisedpartnership Numberofsettings Numberofparticipants

LA1 31 2,322

LA2 7 740

LA3 11 1,351

LA4 9 469

LA5 35 2,863

LA6 7 582

Note.Partnershipnameshavebeenanonymised.

SampleCharacteristics

Thesociodemographiccharacteristicsofthesamplewereconsidered

alongsidenationalnormsamongthechildandadolescentpopulation,where

available,andarepresentedinTable4.3toaidtransparency.Thesampleshowed

lowerratesofacademicattainment,ethnicminorityidentification,andSENstatus

comparedtothegeneralpopulation.Aslightlyhigherproportionofindividuals

wereeligibleforFSM.Notably,14.7%moreindividualsidentifiedthemselvesas

youngcarerscomparedtothenationalnorm.Thismaybeduetothestudy’suseof

self-reportforthischaracteristic(seeSection4.6.1);theimplicationsofthisinflated

prevalence,bothforthestudyandmorewidely,arediscussedinSections4.6.1and

7.3.1.

CHAPTERFOUR:METHOD

92

Table4.3

ProportionsofSampleStatisticsComparativetoNationalNorms

Characteristic

Sample

proportion

(%)

National

norm

(%)

Differencebetween

sampleandnational

norms(%)

Identifiedasethnicminority 22.2 29.1*a -6.9

IdentifiedasspeakingEnglishasanadditional

language

18.6 18.4*a 0.2

IdentifiedashavingSEN(withorwithouta

statementorEducation,HealthandCarePlan)

8.3 14.4†b -6.1

Currentlyeligibleforfreeschoolmeals 17.2 14.0†a 3.2

Lookedafterbylocalauthority 0.5 0.62†c -.12

Identifiedasayoungcarer 16.8 2.1†d 14.7

Achievedexpectedstandardsorhigheracrossall

testsatKeyStageTwostatutoryassessmenttests

57.0 61.0e,f 4.0

Note.TheethnicgroupnotesutilisedbytheNPD(Asian,Black,Chinese,MixedRace,anyotherethnicgroup)havebeencollapsedintothecategory“ethnicminority”forthepurposesofthistable.*denotesanaveragethatreferstoadolescentsonly;†denotesanaveragethatisrepresentativeofbothchildrenandadolescents.aDfE&ONS(2017).Schools,pupilsandtheircharacteristics:January2017.Nottingham,UnitedKingdom:DfE.bDfE&ONS(2017).SpecialeducationalneedsinEngland:January2017.Nottingham,UnitedKingdom:DfE.cDfE&ONS(2017).ChildrenlookedafterinEngland(includingadoption),yearending31March2017.Nottingham,UnitedKingdom:DfE.dONS(2013).Asummaryofunpaidcareby5to17-yearoldsinEnglandandWales.Retrievedfromhttp://webarchive.nationalarchives.gov.uk/20160107224205/http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/provision-of-unpaid-care-in-england-and-wales--2011/sty-unpaid-care.htmleDfE&ONS(2017).Nationalcurriculumassessmentsatkeystage2inEngland,2017(revised).Nottingham,UnitedKingdom:DfEfThenationalnormutiliseddidnotprovideclearinformationastohowthisstatisticwasreached;specificallywhetherthisfigurereflectedpupils’averageachievementacrossallsubjectsorwhetherthisistheproportionofpupilswhoachievedexpectedstandardsacrosseachindividualsubject.Thecurrentstudyutilisedtheformerapproach.

Giventheuseofacommunitysample,participantsvariedintermsoftheir

levelsofemotionalsymptomsasmeasuredbytheStrengthsandDifficulties

Questionnaire(SDQ)emotionalsymptomssubscale.Ofthetotalsample,68.4%(n=

5,353)reportedexperiencingnormallevelsofsymptoms,10.9%(n=855)reported

borderlinelevels,and19.5%(n=1,621)reportedabnormallevels(inlinewith

guidanceforself-reportedmeasureswhere0–5isnormal,6isborderline,and7–10

isabnormal;SDQInfo,2016).Theremaining6%hadmissingdataacrossallitems(n

=498).Notethattheselevelsofsymptomsarenotablyhigherthantheself-report

normspublishedforthissubscaleinrelationtoBritishgirlsaged11–15,where

CHAPTERFOUR:METHOD

93

86.5%reportednormallevels,6.5%reportedborderlinelevels,and7%reported

abnormallevels(SDQInfo,2000).Ofcourse,thesenormsaredatedandgiven

indicationsofacurrentincreaseinemotionaldistressamongearlyadolescentgirls

maynolongerberepresentativeofcurrentlevelsofsymptomatology.

Nevertheless,thoughthisisnotaclinicalsampleitappearsthattheseare

participantswithelevatedsymptoms,whichisperhapsunsurprisinggiventhat

HeadStartareasareinvolvedduetovaryingtypesoflocaldisadvantage.

4.5.2QualitativeSample

Thequalitativesampleincludedthreegirlsaged12yearsfromtheoriginal

HeadStartqualitativesample,whowereidentifiedasexperiencingemotional

symptomsandrisk.

ThemainHeadStartqualitativesamplecomprised63youngpeopleinthe

baselineyear,ofwhom23identifiedthemselvesasfemaleandaged11–12years.

Eachareainvitedyoungpeoplewithvaryinglevelsof“risk”totakepart;the

partnershipareaseachutiliseddifferentdefinitionsofrisktoselectparticipants,

whichlikelycreatedvariationacrossthewidersample.Assuch,inselectingthe

sampleforthecurrentstudy,possibleparticipantsweresystematicallyassessedfor

risk,ratherthanutilisingpartnershipareas’classifications(seefollowingsection).

Table4.4(overleaf)providesabriefoverviewoftheconceptualisationsofriskinthe

fourareaswhereparticipantswereaged11–12yearsin2016/2017,inorderto

demonstratetheinclusioncriteriafortheHeadStartsample.Participantsintwo

otherHeadStartareaswerenotconsideredforinclusioninthecurrentstudyasthe

sampleinLA6didnotinclude11–12yearoldsandthequalitativeevaluationinLA4

didnotbeginuntilthefollowingyear.Forethicalreasonsitwasnotpossibleto

disclosetheareaeachparticipantinthecurrentstudywasfrom;Table4.4is

includedonlytodetailthecharacteristicsofthelargersample.

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Table4.4

PartnershipAreas’ConceptualisationsofRiskusedtoSelectParticipants

Partnership Risklevel Conceptualisation

LA1 High Difficultiesidentified,suchasfamilyadversity,

anxiety,behaviourproblems

Low Nodifficultiespresent

LA2 High Engagedintargetedintervention

Low Nolowriskgroupwasengaged

LA3 High Engagedinintensivetargetedintervention

Medium Engagedinlessintensivetargetedintervention

LA5 High Difficultiesidentified,suchasfamilyadversity,

anxiety,behaviourproblems

Low Nodifficultiespresent

ParticipantSelectionProcess

Thecurrentstudyaimedtoengagethreetofiveparticipantsfromthe

broaderqualitativesample;aflexibleapproachwasadoptedasitwasnotknown

howmanyparticipantswereexperiencingemotionalsymptomsandrisk.Useofa

smallsampleistypicalinIPAduetoitsidiographiccommitmentandtheintensityof

analysis(Reidetal.,2005;Smithetal.,2009).Thissamplesizeisparticularlysmall,

thoughstillconsistentwithguidance,asIPAmethodologistshavehighlightedthat

focusingonaverysmallsampleallowsgreaterdepthinanalysisofeachcaseand

enablesrepresentationofmorenuancedfindings(e.g.,Brocki&Wearden,2006;

Reidetal.,2005;Smith&Osborn,2015).IPArequiresareasonablyhomogeneous

sample,limitedtothosewithsharedcharacteristicsorexperiencesrelevanttothe

researchquestion(Smith&Osborn,2015).Thus,additionalsamplingcriteriawere

utilisedtoselectHeadStartparticipantswithcharacteristicsandexperiences

consistentwiththefocusoftheresearchquestion:

1. Female,aged11-12years;

2. Experiencingemotionalsymptoms;and

3. Experiencingrisk.

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Aparticipantselectionprotocolwasdeveloped,withaclearrationaleand

parametersforeachcriterionalongsidestepstoassessthese,andwasutilisedto

guidetheselectionprocess(AppendixB).Duetoethicalconstraints,itwasnot

possibletoaccessdemographicdatatoassessriskthroughavariable-based

cumulativeriskindexsimilartothatusedinthequantitativestrandofthestudy.

However,HeadStartinterviewswerefocusedentirelyonyoungpeople’slivesand

emotions(seeSection5.6.2)anditwasthereforepossibletoassesswhether

participantsmettheseinclusioncriteriausingtheirownaccounts.Thisalloweda

moreinductiveapproach,lessconstrainedbypresuppositionsofwhatconstituted

riskand,additionally,wasnotdependentontheavailabilityofdatarelatingto

specificriskfactorsandemotionalsymptoms.Anoutlineofthisprocess,alongside

themeasurestakentosupportrigour,ispresentedbelow.

Toselecttheparticipantsincludedforassessment,HeadStartinterviewers

utilisedtheprotocolasaguidetonominateHeadStartfemaleparticipantsaged11-

12yearsthattheyfeltdisclosedemotionalsymptomsintheinterview,suchas

feelingsofsadnessorexcessiveworry.Sixparticipantswerenominatedby

interviewers.Theresearcherreviewedthesesixtranscriptsforthesecondcriterion,

“experiencingemotionalsymptoms”,andratedparticipantsontheSDQadult

reportemotionalsymptomssubscale(Goodman,1997),consideringthree

characteristics:(a)Intensityofsymptoms,(b)frequencyofsymptomsasdescribed

bytheparticipant,and(c)frequencyofmentionofsymptomwithintheinterview.A

totalscoreoffiveormorewasconsideredindicativeofborderlinesymptomatology,

consistentwiththeteacherreportthresholdsforUKnorms(SDQInfo,2016).The

researcherthenconsideredthisscorealongsidetheyoungperson’sself-reported

totalscorefromthequantitativedatasettoreachafinaldecisiononwhethera

participantcouldbeconsideredtomeetthiscriterion.

Toreflectthestudy’sfocusonmultipleriskexposure,participantswere

consideredtomeetthethirdcriterion,“experiencingrisk”,iftheydemonstrated

threeormoreindicatorsof“risk”intheirlives.Thiscutoffreflectsindicationswithin

cumulativeriskresearchthatexposuretothreeormoreriskfactorsmayhavea

quadraticeffectonoutcomes(e.g.,Biedermanetal.,1995;Forehand,Biggar,&

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Kotchick,1998;Jonesetal.,2002).Toassessthis,theresearcherreviewedeach

transcriptfortwotypesofriskindicators:(a)Mentionofriskfactorsestablishedin

theliteratureand(b)participants’self-perceivedsourcesofstress.

Theavailableevidencefortheinclusioncriteriawasthencollatedand

reviewedforeachparticipant.Itwasanticipatedthattheremaybeinstancesof

discrepanciesbetweendatasources,suchasmisalignmentbetweentheemotional

symptomsscoresgeneratedbytheresearcherandtheparticipant.Thiscouldoccur

forvaryingreasons,includinglimitationsofself-report,timelapsebetweenself-

reportmeasurecompletionandinterviewengagement,ortheresearcher’sown

perspectivesandunderstandingsinfluencingthewayinwhichtheyinterpreted

participants’disclosures.Itwasalsoanticipatedthattheremaybemissingdatafor

theself-reportscore.Assuch,thedecisiontoincludeagivenparticipantwasbased

onasummativejudgementoftheweightofevidence.Tosupportrigourwithinthe

selectionprocedure,theprocesswasdocumentedextensively,withwritten

justificationofhowparticipantsmetinclusioncriteria2and3alongsidesupporting

transcriptquotes(seeAppendixCforanexampledocument).Eachwritten

assessmentwasthenreviewedalongsidetheselectionprotocolbyasecondary

researcherwithknowledgeofriskandmentalhealthandbyanexternalpartywith

clinicaltraining,tosupporttheconfirmabilityofselectiondecisionsfrombotha

theoreticalandapracticalperspective,respectively.

Participants

OfthesixHeadStartparticipantsnominatedbyresearchersforassessment,

threewereidentifiedasmeetingtheinclusioncriteriaforthecurrentstudyandso

wereincludedforanalysis;theremainingthreeparticipantswereexcludedasthey

didnotmeetinclusioncriteria(seeTableD1,AppendixD).Thefollowingsections

presentabriefprofileforeachofthethreeincludedparticipants:Amelia,Jennifer,

andGrace(pseudonyms).

“Amelia”

Atthetimeoftheinterview,Ameliawasaged12yearsandninemonthsand

waslivingwithherparentsandherbrotherinadisadvantagedurbanareain

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England.SheidentifiedasWhiteBritish.Ameliadescribedfeelinganxiousonadaily

basisandexplainedthatthisfrequentlycausedhertofeeldistress.Shecommented

severaltimesthatheranxietyseemedtobeworsening.Thesesymptomsappeared

particularlypresentinrelationtospecifictasks,suchasschoolwork,buttheywere

alsoevidentacrosselementsofherdailylife,suchastheappearanceofherclothes.

Ameliafocusedheavilyonheranxietyintheinterviewanddialogueoftenmoved

backtothisarea.BasedonAmelia’sdisclosureofhersymptomsintheinterview,

theresearcherdesignatedaborderlinescoreof5;aself-reportscorewasnot

available,asAmeliadidnotcompletetheWMF.Theresearcheridentifiedthree

knownriskfactorsinAmelia’sinterview:(a)Epilepsy(Daviesetal.,2003;Kariukiet

al.,2016),(b)academicdifficulties(McCarty,2008;Panayiotou&Humphrey,2018)

and(c)ObsessiveCompulsiveDisorder(OCD;NHS,2016).Inaddition,Amelia

describedoneself-perceivedsourceofstress;namely,herparentworkingin

London.

Thesecondaryresearcheragreedwiththeauthor’sjudgementsofAmelia’s

symptomsandrisk.TheclinicalrevieweragreedthatAmeliawasexperiencing

emotionalsymptoms,concludingthatshepresentedas“averytroubledgirlwith

lifelimitingworries.”

“Jennifer”

Atthetimeoftheinterview,Jenniferwasaged12yearsandthreemonths

andwaslivingwithherparentsandtwoyoungersiblingsinadisadvantagedurban

areainEngland.SheidentifiedherselfasAsian.Jenniferdisclosedthatshe

frequentlyhad“negativethoughts”,explainingthatshehaslowself-esteemand

self-confidence,andoftenfeelsdistressedinrelationtothesethoughts.She

describedfrequentanxietyaroundacademicworkandthesesymptomswerealso

presentinwideraspectsofherlife,suchasherfriendships.Jenniferdescribed

cryinginresponsetothesenegativethoughtstoletherfeelingsout.Muchofher

interviewwasfocusedonnegativethoughtsandthedialoguefrequentlymoved

backtothis.BasedonJennifer’sdisclosures,theresearcherdesignatedaborderline

scoreof5.Jennifer’sself-reportscorewas1,whichindicatesnormallevelsof

symptomatology.Asnotedabovethereareseveralpossibleexplanationsforsucha

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discrepancy;howeveritshouldalsobenotedthatJenniferexpressedconsiderable

discomfortwithdisclosingfeelingstootherpeopleanditisplausiblethatshedid

notwishtoself-reportthis.Theresearcheridentifiedthreeknownriskfactors:(a)

Increasedacademicdemandsinsecondaryschool(Ryan,Shim,&Makara,2013;

Westetal.,2010),(b)lowself-esteem(Orthetal.,2008;Sowislo&Orth,2013),and

(c)perfectionisticbehaviours(Miloseva&Vukosavljevic-Gvozden,2014;Shafran&

Mansell,2001).Inaddition,Jenniferdescribedoneself-perceivedsourceofstress;

namely,difficultywithsiblingrelationships.

Thesecondaryresearcherwasinagreementwiththeauthor’sjudgements

ofJennifer’ssymptomsandrisk.TheclinicalrevieweragreedthatJenniferwas

experiencing“minorpsychologicalsymptoms”includinganxietyandsuggestedthat

whileshewouldnotmeetthresholdsforChildandAdolescentMentalHealth

Services(CAMHS),shewouldbeconsideredeligibleforschool-basedinterventions.

Givenuseofayoungcommunitysample,thecurrentstudydidnotprioritiseclinical

symptomatologyandinsteadfocusedonparticipantsexhibitingborderline

symptomsorgreater.Thus,Jenniferwasconsideredappropriateforinclusionwith

considerationoftheauthorandreviewers’judgements.

“Grace”

Atthetimeoftheinterview,Gracewasaged12yearsandfourmonthsand

waslivingbetweenherparents’separatehomesinadisadvantagedurbanareain

England,withherfatherashermainguardian.SheidentifiedasWhiteBritish.

Gracedescribedfeelingupsetandanxiousonadailybasis.Shefrequentlytalked

aboutthisinrelationtofeelingunsafeatschoolduetobullyingvictimisation.Grace

describedmultipleincidentsofdistressinherhomelifeduetofamilyconflict.She

disclosedthatshehadrecentlyhadabreakdowninalessonandreportedthatshe

hadoncetriedtoself-harm.Gracetalkedconsistentlyaboutdistressandanxiety

throughouttalkofherfamilyandschoolexperiencesandthisconstitutedalarge

proportionoftheinterview.BasedonGrace’sdisclosures,theresearcher

designatedanabnormalscoreof6;Gracereportedanabnormalscoreof9.The

researcheridentifiedfiveknownriskfactorsinGrace’sinterview:(a)Inter-parental

conflict(Brock&Kochanska,2015;HiuYapetal.,2014),(b)poormaternal

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relationship(Branjeetal.,2010;Kim&Cicchetti,2004),(c)lowfamilyincome(Glied

&Pine,2002;Morrisonetal.,2014;Santiagoetal.,2011),(d)maternalalcohol

abuse(Christensen&Bilenberg,2000;McCauleyOhannessian,2012),and(e)

bullyingvictimisation(Bond,Carlin,Thomas,Rubin,&Patton,2001;Menesini,

Modena,&Tani,2016;Stapinski,Araya,Heron,Montgomery,&Stallard,2015).In

addition,Gracedescribedthreeself-perceivedsourcesofstress:(a)Safeguarding

issuesinwiderfamily,(b)argumentsandlackofprivacywithmother’sboyfriend,

and(c)extendedfamilybereavement.

Thesecondaryresearcheragreedwiththeauthor’sjudgementsofGrace’s

symptomsandrisk.TheclinicalrevieweragreedthatGracewasexperiencing

emotionalsymptoms,concludingthat“shedefinitelyhasunderstandableemotional

symptomswhich[cannot]improvewithoutaninterventionathome.”

4.6Materials

4.6.1QuantitativeMaterials

ThestudydrewonquantitativedatacollectedfortheHeadStartevaluation.

Thisincludeddemographicdataforriskmodellingandself-reportdatafromthe

WMFinrelationtoemotionalsymptoms,perceivedstress,andprotectivefactors

(asoutlinedinTable4.1,Section4.4.2).

ProxyRiskFactorIndicators

YoungRelativeAge

Thiswasmeasuredusingmonthofbirth,obtainedfromtheNPDand

expectedtobereliablegiventhatthisisroutinelycollectedandnotsubjectto

changeovertime.Consistentwithpastresearch(Goodmanetal.,2003;Patalayet

al.,2015),participantsweredividedintothreegroupsreflectingEnglishschool

entrydates;thoseborninSeptember–December(eldest),January–April(middle)

andMay–August(youngest).

LowandHighAcademicAttainment

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100

Lowandhighacademicattainmentweremeasuredusingparticipants’

outcomesontheirmostrecentstatutoryassessments,theKeyStageTwoStatutory

AssessmentTests(SATs),completedbypupilsaged10–11yearsinEnglandduring

theirfinalyearinprimaryschool,approximatelyoneacademicyearpriorto

administrationoftheWMF.Thestudyutilisedscaledscores,convertedtestscores

reflectingstandardisedexpectations,whichrangefrom80–120,withascoreof100

orabovesignifyingexpectedstandards(DfE,2016b).Thestudycreatedacomposite

averagepointscore,reflectingoverallattainment;firstthemeanofparticipants’

EnglishreadingandGrammar,punctuationandspellingscoreswascalculatedand

thenthiswascombinedwithMathematicsscoretoobtainanoverallmean,

consistentwithguidance(DfE,2016a).Participantsinthelowestquartileofthe

averagepointscorewereconsideredtohavelowattainmentwhilethoseinthe

upperquartileweredesignatedashavinghighattainment.

SpecialEducationalNeeds(SEN)

SENstatuswasdesignatedforthoseidentifiedbytheNPDashavingSEN

withorwithoutastatementoranEducation,HealthandCare(EHC)plan.Atthe

timeofdatacollection,a“statement”wasaformaldiagnosisofSENinEngland,

whileEHCplanswereutilisedforchildrenandyoungpeopleconsideredtorequirea

greaterlevelofsupportthanthatofferedthroughstandardSENsupportavenues

(UKGovernment,n.d.).Here,SENstatushasbeendesignatedforparticipantsboth

withandwithoutastatementorplan,asindividualscanalsoberecognisedas

requiringSENsupportwithoutbeingformallyrecognisedinthisway(DfE,2018c).

Notethatpoliciesonidentificationandassessmenthavechangedsincethistime,

withallpupilswithastatementbeingtransferredtoEHCplansbyApril2018.

ParticipantswhowereidentifiedbytheNPDashavingSENduetomentalhealth

needswereremovedfromthisclassification(thatis,codedasnothavingSEN)given

thatthiswouldoverlapwiththeoutcomevariable,potentiallydrivinganyobserved

association.DuetothepointatwhichSENassessmentgenerallyoccurs,olderage

groupsaremorelikelytobeidentifiedandassessedashavingSEN,whichismost

prevalentamong11-15yearolds(DfE&ONS,2017).Assuch,itwasexpectedthata

highproportionoftheparticipantsinthecurrentstudywhotrulydohaveSEN

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wouldhavebeenidentifiedassuchbythisage.However,itshouldbenotedthat

thisinformationmightnotbeaccurateforallparticipants,assomemayhave

undiagnosedneeds.

LowFamilyIncome

Participantswereidentifiedasbeingoflowfamilyincomeiftheywere

knowntohavebeeneligibleforfreeschoolmeals(FSM)atanypointsinceMay

2011upuntilthemostrecentcensus(Spring2017).PupilsinEnglandareeligibleif

theirparentsareclassifiedashavinglowincome,designatedbasedonthereceipt

ofincome-relatedsupportorreceiptofChildTaxCreditwithanannualincome

lowerthan£16,190(DfE,2012).NotethatFSMisusedasanindicatoroflowfamily

incomeratherthanofbroadersocioeconomicdisadvantageasthisinformation

cannotcapturepupilsexperiencingwiderdisadvantagedespitehigherincome

levels(Ilieetal.,2017;Taylor,2018).Bothcurrentandpreviouseligibilitywere

includedgivenevidenceoflong-termeffects(e.g.,Eamon,2002;Najmanetal.,

2010;Santiagoetal.,2011),thoughitshouldbenotedthateffectscanbemore

profoundforthosecurrentlyinreceiptofFSMrelativetothosepreviouslybutno

longereligible(Gorard,2016a).Here,bothcurrentandprioreligibilitywere

integratedintoasinglebinaryvariable(eligibleatsomepointintheprevioussix

years,ornevereligible)giventhatincumulativeriskresearch,riskisnotweighted

basedonsuchconsiderations.NotethatNPDinformationdenotesonlythosewho

haveclaimedFSM;researchhasestimatedthatanadditionalthreepercentof

pupilsareentitledtoFSMbutdonotclaimitandarethereforenotidentifiedin

censusdataaseligible(DfE,2012).Assuch,itislikelythatthereareasmallnumber

ofparticipantsincorrectlyidentifiedinthisstudyasnoteligibleforFSMand,thus,

notclassifiedasbeingoflowfamilyincome.

CaregivingResponsibilities

Thisriskfactor,initiallyconceptualisedas“youngcarerstatus”,was

measuredusingaself-reportquestionintheWMF.Participantsrespondedtoan

age-appropriatedefinitionofyoungcarerstatus,developedbyHeadStart

evaluatorsandCommonRoomyoungadvisors:“Youngcarersarechildrenand

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youngpeopleunder18whoprovideregularorongoingcaretoafamilymember

whohasanillness,disability,mentalhealthconditionordrug/alcoholdependency.

Areyou,orhaveyoueverbeen,ayoungcarer?”Useofadefinitionaimedto

facilitateaccuracy,asitwasanticipatedthatparticipantsmightbeunfamiliarwith

theterm“youngcarer”.Researchsuggeststhatbroadquestionsaboutcaregiving

statusinflatesprevalenceestimates,whilespecifyingadefinitionalongside

examplesofconditionsorcircumstancescanproducestatisticssimilartomore

detailedmeasures(Banksetal.,2001).Thisapproachwaspreferabletolonger

measurestoavoidburdengiventhatyoungcarerstatuswasnotacentralfocus

withintheevaluationofHeadStart.

Here,16.8%ofparticipantsrespondedaffirmatively,substantiallysurpassing

bothconservative(2.1%;ONS,2013)andliberal(ca.8%;BBC,2010)UKprevalence

estimates.Whilesomeofthosewhorespondedaffirmativelymaybeyoungcarers,

andindeedgiventhefocusondisadvantagehigherratesmaybeexpected,it

appearedlikelythatalargeproportionoftheseparticipantsarenottrulyyoung

carersastypicallydefined,butidentifiedwiththedefinitioninsomeway.Given

this,thisvariablewasre-conceptualisedascapturingabroadercategoryof

individualswhoconsideredthemselvesashaving“caregivingresponsibilities”to

someextent.ThiswasalsoinformedbyfieldnotesfromWMFpiloting,asyoung

peoplefrequentlyaskedresearcherswhatconstitutedyoungcarerstatus,including

questioningaboutcaregivingresponsibilitiessuchascaringforsiblingsor

supportingaparentactingasacarer.

AdverseChildhoodExperiences(ACEs)

ACEsweremeasuredusingCINstatus.UnderSection17oftheChildrenAct

(1989),achildoradolescentisconsideredinneedifitisdeemedthat:(a)Theyare

notlikelytoachieveortomaintainreasonablehealthanddevelopmentwithout

localauthorityservicesandsupport,(b)theirhealthanddevelopmentislikelytobe

substantiallyimpairedwithoutlocalauthorityservicesandsupport,or(c)theyhave

adisability.Suchissuesareidentifiedthroughnarrowercriterion;thecategories

recordedintheNPDare(a)Abuseorneglect,(b)child’sdisability/illness,(c)

parentaldisability/illness,(d)familyinacutestress,(e)familydysfunction,(f)

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sociallyunacceptablebehaviour,(g)lowincome,(h)absentparenting,(i)cases

otherthanchildreninneedand(j)notstated.Thoughsomeofthesecategories

overlapsomewhatwithotherriskfactorsinthestudy(SEN,lowfamilyincome,and

caregivingresponsibilities),inspectionindicatedlimitedvariableoverlap,indicating

differentialriskgroups.Forexample,of17participantsidentifiedasinneeddueto

childdisability/illness,onlyfourwereidentifiedashavingSEN,suggestingthatCIN

identifiedseparatecircumstances.

CINstatusisdesignatedthroughassessmentbyasocialworker,typically

followingreferralbyaneducation/caresetting,andsoisanescalatedresponse

goingbeyondearlyintervention(Walker,2018).ACINplanisthendeveloped,

detailingservicestobeprovidedforaminimumofthreemonths,andisreviewed

afterthreemonthsandthenatleasteverysixmonthsuntilthechildisnolonger

consideredinneed(ChildLawAdvice,2018;HMGovernment,2015).CINstatusis

recordedannually,withinformationinthecurrentstudyrecordedtoreflect

whetherCINstatuswasinplaceasof31stMarch2017(DfE,2018a,2018b).

ACEsaretypicallymeasuredusingachecklist-stylequestionnairewherein

participantsdisclosureexposuretospecificexperiences,oftenincluding“childhood

physicalabuse”,“householdsubstanceabuse”,“householdmentalillness”,and

“exposuretodomesticviolence”(Hughesetal.,2017).Suchdisaggregated

informationwasnotsoughtasitwasnottheprimaryconcernwithintheevaluation

ofHeadStart;furthermore,suchquestionnairesaretypicallydesignedforadultsor

olderadolescentsandposeethicalissueswithyoungerparticipants.AsACEs

essentiallycaptureparticularelementsoffamilydysfunctionandchildhood

maltreatment(Hughesetal.,2017;Youssefetal.,2017),CINstatuswasconsidered

anappropriateproxy,offeringcurrentinformationratherthanrelyingonrecall

throughhistoricalself-disclosure.

NeighbourhoodSocioeconomicDeprivation

ThiswasmeasuredutilisingIDACIscores,whichmeasurethelocal

proportionofchildrenandyoungpeopleaged0–15yearsinlowincomefamilies,

includingthoseinreceiptofincome-relatedbenefits(DepartmentforCommunities

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104

andLocalGovernment&ONS,2015).Scoresarecalculatedforeachofthe32,844

Lower-LayerSuperOutputAreasinEngland,whicharelocalisedareas

correspondingtopostalcodes(ONS,2012).TheIDACIscorerangesbetweenzero

andone,withgreaterscoresindicatinggreaterneighbourhoodsocioeconomic

deprivation.Thisstatisticisupdatedseveraltimesayear;thecurrentstudyutilised

scoresrecordedinSpring2017,immediatelypriortoadministrationoftheWMF,so

scoreslikelyreflectcompositionatthetimeofsurveycompletion.TheIDACIisa

somewhatnarrowproxyasitmeasuresonlyonedimensionofneighbourhood

socioeconomicdeprivation,howeveritisfrequentlyusedinthiswayforchildand

adolescentresearch(e.g.,Emerson,2012;HowardWilsheretal.,2016;Rasbashet

al.,2010).

Self-ReportMeasurement

Self-reportdatawasdrawnfromHeadStartforparticipants’emotional

symptoms,perceivedstress,andprotectivefactors(measuresareshownin

AppendicesG–I).Thisapproachreflectsgrowinguseofself-reportmeasureswith

childrenandadolescents,givenrecognitionthatthispopulationhasunique

knowledgeoftheirownsymptomsandexperiences(Deightonetal.,2014;Riley,

2004),particularlyforinternalisingdifficulties(e.g.,DeLosReyes&Kazdin,2005;

Kaurin,Egloff,Stringaris,&Wessa,2016).Participantscompletedthesemeasures

aspartofthebroaderWMF,whichincludedanumberofsurveysfocusedon

wellbeing,mentalhealth,andresilience,inlinewiththekeyaimsoftheHeadStart

programmeandevaluation.TheWMFwaspilotedineighteducationsettings(both

mainstreamandalternative)priortoitsrolloutforthemainevaluation,toexplore

recommendationsforimprovementfromyoungpeopleandtoconfirmthevalidity

andreliabilityofmeasures(AppendixEdescribeschangesmadefollowingpiloting).

TheWMFwascompletedinteacher-facilitatedclasses,ausefulapproach

givenindicationsthatclassroomcompletioncanyieldmorevalidprevalence

responsescomparedtoathome(Breneretal.,2006).Supportingmaterialswere

developedtoaidthisprocess,includingashortvideoinwhichyoungpeople

explainedkeyinformationtobeshowntotheclassbeforehand,alongsideguidance

forteacherscontainingkeyinformation,answerstofrequentlyaskedquestions,

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andacompletionchecklist(seeAppendixF).TheWMFwascomputer-

administered,offeringgreaterresearchercontrol,collectionoflarge-scaledata,and

reducedhumanerror(Patalayetal.,2016).Participantswererestrictedtoone

responseoptionandcouldaccessdefinitionsofcommonlymisunderstoodwords

(e.g.,optimistic).Anaudioaccompanimentwasavailabletoallowparticipantswith

readingdifficultiestotakepartwithoutsupportfromanadditionalpersonandthus

reduceviolationsofprivacy.Evidencegenerallyindicatessimilarlevelsofsocial

desirabilityacrosscomputer-andpaper-administratedsurveys(Dodou&De

Winter,2014),thoughthisgenerallyrelatestoadultsatpresent.Itremainsunclear

howconsistentpsychometricpropertiesareacrossadministrationmodes(Patalay

etal.,2016);thus,theinternalconsistencyandfactorstructureofeachmeasureis

exploredandpresentedherealongsidepriorevidence.Themeasuresutilisedhere

wereadministeredaspartofawiderinventoryofmeasureswithintheWMF(i.e.,

wellbeingsurvey,widermentalhealthsubscales,emotionregulationscale,and

internalprotectivefactorsubscales).Toreduceordereffects,random

counterbalancingwasimplementedbypresentingthewellbeingsurveyfirstand

protectivefactorquestionslast,orviceversa.Thoseinspecialistprovisionsalways

accessedthewellbeingmeasurefirstforethicalreasons.

Thefollowingsubsectionsoutlinetheself-reportmeasuresusedalongsidea

briefsummaryofexistingevidencefortheirpsychometricproperties,drawingon

guidancefromTerweeetal.(2007).

TheStrengthsandDifficultiesQuestionnaire(SDQ):EmotionalSymptomsSubscale

Emotionalsymptomswereassessedusingthecorrespondingsubscaleofthe

SDQ,a25-itemself-reportmentalhealthmeasurewithafive-factorstructure

comprisingemotionalsymptoms,conductproblems,hyperactivity,peerproblems,

andprosocialbehaviour(Goodman,Meltzer,&Bailey,1998).Theemotional

symptomssubscale(AppendixG)includesfiveitems(e.g.,“Iamoftenunhappy”;

Goodmanetal.,1998).Participantsrespondonathree-pointscaleof“nottrue”,

“somewhattrue”,and“certainlytrue”;thesearescoredas0,1,and2,respectively,

andsummedtocreateatotalscoreof0–10,where10denoteshighlevelsof

emotionalsymptoms.Theself-reportversionisdesignedforadolescentsaged11+

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106

yearsandresearchdemonstratessuitabilityforthisagegroup(e.g.,Goodman,

Ford,Simmons,Gatward,&Meltzer,2000;Muris,Meesters,Eijkelenboom,&

Vincken,2004).

TheSDQsatisfiescriteriaforcontentvaliditysetoutbyTerweeetal.(2007);

itemdevelopmentwasguidedbydiagnosticcriteriaandexistingmentalhealth

measures,andthemeasurehasacleartargetpopulationandcandistinguish

betweencommunityandclinicalsamples(Goodmanetal.,1998).Themeasure

demonstratessatisfactoryconstructvalidity,correlatingwellwithothermental

healthindices(Goodman,2001;VanRoy,Veenstra,&Clench-Aas,2008)and

measuresofpsychopathologyanddisorder(Goodmanetal.,2000;Murisetal.,

2004).Initialresearchshowedsatisfactoryinternalconsistencyfortheemotional

symptomssubscale(α=0.75;Goodmanetal.,1998).

TheFour-ItemPerceivedStressScale(PSS-4)

Perceivedstresswasassessedusingthefour-itemPerceivedStressScale

(PSS-4;AppendixH),aself-reportmeasurecomprisingfouritems(e.g.,“inthelast

month,howoftenhaveyoufeltthatyouwereunabletocontroltheimportant

thingsinyourlife?”;Cohen,Kamarck,&Mermelstein,1983).Participantsrespond

onafive-pointscale,marking0for“never”,1for“almostnever”,2for

“sometimes”,3for“fairlyoften”and4for“veryoften”.Themeasureincludestwo

reverse-wordeditems,withallscoresthencodedadditivelytocreateatotalscore

of0–16,whereahighscoreindicateshigherperceivedstress.ThePSS-4was

designedforadultsbutresearchhasusedlongerversionsofthescalewith

adolescents(e.g.,Martin,Kazarian,&Breiter,1995;Siqueira,Diab,Bodian,&

Rolnitzky,2000).

ThePSS-4isashort-formderivedfromthelonger14-itemPSS,a

unidimensionalglobalmeasureofself-reportedappraisalofnonspecificlifestress

(Cohenetal.,1983).Themeasureshowscontentvalidityasitalignswiththeory

thatthedegreetowhichlifeeventsinfluenceoutcomesfluctuatesbasedonhow

oneperceivestheirstressfulness(Cohenetal.,1983).Arangeofstudieshave

identifiedanassociationbetweenthePSS-4andconcurrentemotionalsymptoms

CHAPTERFOUR:METHOD

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(e.g.,Herrero&Meneses,2006;Karametal.,2012),indicatingconstructvalidity.

However,findingsregardingthefactorstructureofbothshorterandlongerforms

ofthePSShavebeenmixed,withsomereportingsupportfortwofactors,

“perceiveddistress”and“perceivedcoping”,correspondingtothepositively

wordedandreversedwordeditems,respectively(González-Ramírezetal.,2013;

Leungetal.,2010;Wu&Amtmann,2013).Arecentstudyalsoidentifiedsupport

fora2-factorstructureamonganadolescentcohort(Demkowicz,Panayiotou,

Ashworth,Humphrey,&Deighton,2019).Thoughinitialresearchshowed

satisfactoryinternalconsistency(α=.72;Cohenetal.,1983),researchhasnot

consistentlysupportedthis(Lee,2012).Assuch,thefactorstructureandinternal

consistencyofthismeasurewasassessedpriortothemainanalysistoexamine

whetheraunidimensionalor2-factorstructureshowedbestfittothedata(see

Sections4.8and5.2).

TheStudentResilienceSurvey(SRS)

Hypothesisedpromotiveandprotectivevariableswereassessedusingsix

subscalesfromtheSRS(Sun&Stewart,2007;AppendixI).Theoverallmeasure

showscontentvalidityasitexploresempiricallyestablishedprotectivefactors(Sun

&Stewart,2007),consistentwithcurrentunderstandingsofresilience(Lereyaet

al.,2016;Sun&Stewart,2007).Typically,thisisa47-itemmeasurewitha12-factor

structure;however,toreduceburdenthecommunicationandpro-socialpeers

domainswerenotincludedintheWMFgivenissueswithcontentvalidityand

similaritywithotherdomains.Thecurrentstudywasfocusedonexternalprotective

factorsrelatingtosocialconnectionandactiveengagementanddrewonsubscales

relatingtothesedomainsonly;assuch,theinternallyfocusedself-esteem,empathy

andproblem-solvingsubscaleswerenotutilised.

Assuch,31itemsacrosssixsubscaleswereincludedinthecurrentstudy:

Familyadultconnection,schooladultconnection,communityadultconnection,

schoolpeerconnection,activeengagementinhomeandschoollife,andschoolpeer

support.However,examinationoftheitemsindicatedthattheoriginalsubscale

namesdonotconsistentlyreflectrespectiveitemcontent.Thecurrentstudyhas

thereforeadjustedthenamesofsubscalestomorecloselycapturethenatureof

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theitemsthereinandimprovecontentvalidity,achievedthroughongoing

discussionwiththesupervisoryteam(seeTable4.5).

Table4.5

StudentResilienceSurveyAdjustedSubscaleNamesandRationale

Originalname

(Sun&

Stewart,

2007)

Adjusted

name

Itemcontent Rationaleforadjustedname

Family

support

Familyadult

connection

Fouritems(e.g.,“athome,

thereisanadultwho

believesthatIwillbea

success”)

Foritemsacrossfamily,school,and

community,contentgenerally

capturessocialconnectionrather

thanconsistentlyfocusingonactive

supportbehaviours(seeitem

content);givenaconceptual

distinctionbetweentheseconstructs

(Barrera,1986)allnameshavebeen

adjusted.Furthermore,items

specifiedadultsandsonameshave

beenclarifiedtoreflectthis.

School

support

Schooladult

connection

Fouritems(e.g.,“at

school,thereisanadult

wholistenstomewhenI

havesomethingtosay”)

Community

support

Community

adult

connection

Fouritems(e.g.,“away

fromschool,thereisan

adultwhoItrust”)

Peersupport Schoolpeer

connection

Thirteenitems(e.g.,“are

therestudentsatyour

schoolwhowouldinvite

youtotheirhome?”)

Asbefore,itemsrelatetoconnection

ratherthansupportandask

specificallyaboutstudentsatschool

ratherthangeneralpeers(e.g.,

neighbourhoodpeers).

Participation

inhomeand

schoollife

Active

engagement

inhomeand

schoollife

Fouritems(e.g.,“Ihelp

myfamilymake

decisions”)

Thiswasadjustedtoactive

engagementtomorecloselyreflect

itemcontentfocusedonagency,

decision-making,andactive

contributions,thusemphasising

beingactivelyembeddedwithin

theseareasofliferatherthansimply

takingpart.

Participation

incommunity

Engagement

in

Twoitems(“Itakelessons

inmusic,art,sports,or

Itemsdidnotconsistentlycapture

“community”astheyincluded

CHAPTERFOUR:METHOD

109

life extracurricular

activities

haveahobby”) examplespotentiallyrelatingtoone-

to-onelessonsorunaccompanied

hobbies(e.g.,drawing).Thiswasthus

reconceptualisedasengagementin

extracurricularactivities.

Participantsrespondonafive-pointscale,marking1for“never”upto5for

“always”.Subscalesaresummedtogeneratetotalscores,withhigherscores

indicatinggreaterperceivedfactorexposure.TheSRSisdesignedforindividuals

aged11+yearsandevidenceindicatessuitabilityforthisagegroup(Lereyaetal.,

2016;Sun&Stewart,2007).TheSRSshowssatisfactorycontentvalidityasitwas

guidedbytheoryandexistingmeasuresofprotectivefactorsforadolescentsand

underwentpilottestingforitemdevelopment(Sun&Stewart,2007).Themeasure

showsconstructvalidityhavingbeennegativelyassociatedwithemotional

symptoms(Lereyaetal.2016).TheSRShasshownasatisfactorylevelofinternal

consistency,withpaststudiesreportingα=0.92fortheoriginaloverallscale(Sun&

Stewart2007)andalphasrangingfrom0.74to0.93fortheculturallyadapted

subscalesincludedinthecurrentstudy(Lereyaetal.2016).

4.6.2QualitativeMaterials

Interviews

Thestudydrewonqualitativedatacollectedfortheevaluationof

HeadStart.Dataweregatheredthroughin-depthinterviews,inwhichthe

researcherfacilitatesdiscussionoftheparticipants’experiencesandperceptionsof

agivenphenomenontoelicitarichfirst-personaccount(Patton,2015).Interviews

weresemi-structured,whereinresearchersareguidedbyaninterviewschedulebut

areabletoberesponsivetoparticipants’narratives(Brinkmann,2014;Harding,

2013;Langdridge,2007).ThisisthepreferreddatacollectionmethodforIPAasit

facilitatesdetailedandcomprehensiveaccountsofparticipants’livedexperience

(Smithetal.,2009;Smith&Osborn,2015a)andoffersparticipantsgreatercontrol

overthediscussion(Eatough&Smith,2008).Theapproachalsoallowsresearchers

toclarifytheirunderstandingofparticipants’responsesthroughout,whichsupports

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110

thecollectionofhighqualitydata(Brinkmann&Kvale,2015;Britten,1995)andis

particularlyimportantinresearchwithchildrenandyoungpeople(Smith&

Dunworth,2003).However,methodologistshaveidentifiedchallengesacrossthe

method;forinstance,althoughtheflexibilityforresponsivenesstotheparticipant

canbevaluable,thisrequiresahighlevelofskill(Brinkmann&Kvale,2015).Inthe

evaluationofHeadStart,allinterviewershadpriorexperienceofinterviewing

childrenandyoungpeopleandhadundertakenappropriatetraining.Theuseofa

flexibleinterviewschedulecanalsolimitthescopeforcomparisonacross

participants’responses(Patton,2015),thoughthiswasnotproblematicheregiven

theidiographicnatureofIPA.

Allinterviewswerecarriedoutinaone-to-oneformat,asispreferredinIPA

research,asthissupportsrapportandenablesalevelofpersonaldiscussionthat

elicitsrichexperientialdata(Reidetal.,2005).Interviewswereconductedface-to-

faceasthisfacilitatesnaturalnessandtrust,whichisimportantwhenexploring

sensitivetopicssuchasmentalhealth,andcangeneraterichdatabyenabling

nonverbalandparalinguisticcommunication(Irvineetal.,2013),particularlyfor

youngerparticipants(Vogl,2013).

InterviewSchedule

AninterviewschedulewasdevelopedbytheHeadStartevaluationteam

(seeAppendixJ)withsupportfromCommonRoomyoungadvisors.Thekeyaimsof

theinterviewschedulefortheevaluationofHeadStartweretounderstand:

1. Howtheparticipantwasexperiencinglife;

2. Howtheparticipantexperiencedandcopedwithemotions;

3. Howtheparticipantexperiencedandcopedwithproblems;and

4. Theparticipant’sperceptionsandexperiencesofsourcesofsupport.

Theseaimsshapedthetopicsintheinterviewschedule,withquestionsdesignedto

elicitparticipants’perceptionsandexperiencesoftheseareas.Thirteenquestions

weredeveloped,eachwithsuggestedpromptsfortheinterviewer.Questionswere

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111

designedtobeopen-endedandneutral,avoidingassumptivephrasingthatmay

leadtheparticipant(DiCicco-Bloom&Crabtree,2006;King&Horrocks,2010).

Differentkindsofquestionswereutilisedtoelicitdifferenttypesofaccountsand

reflections;(Patton,2015)outlinedsixbroadcategoriesofinterviewquestions,all

ofwhichwereutilisedintheinterviewschedule:(a)Experienceandbehaviour

questionsaimingtoelicitaccountsofbehaviours,actionsandexperiences,(b)

opinionandvaluequestionsfocusingonunderstandingsandinterpretations,(c)

feelingquestionsexploringemotions,(d)knowledgequestionsinquiringabout

knowledgeonagivensubject,(e)sensoryquestionsbuildingonexperienceand

behaviourquestionsbyelicitingaccountsofsensorystimuliand(f)

background/demographicquestionsidentifyingandexploringtheparticipant’s

characteristicsandunderlyingperceptionsofthese.Forexample,a“feelings”

questionthatrelatedtothe“emotions”topicwas“whatsortsoffeelingsor

emotionsdoyouexperiencewhenyouarenotfeelinghappy?”Possibleprompts

hereencouragedtheparticipanttounpacktheemotionbyaskingformoredetail,

orexploringexamples,forinstance“Howdoesthisaffectyourlife/makeyoufeel?”

and“Canyouthinkofanexampleofwhenyouwerefeeling[namedemotion]

recently?Whathappened?”Useofpromptsprovidesadditionalguidanceonthe

typeofinformationthatthequestionseekstoelicitandfacilitatesahighlevelof

detailandcomprehensiveness(King&Horrocks,2010).

Furtherconsiderationwasgiventothesequencingoftopicsandquestions

withintheschedule.Whileuseofasemi-structuredinterviewnecessitatesflexibility

intheorderinwhichtopicsareaddressed,guidancesuggeststhatparticular

elementsshouldremainrelativelyfixedtosupportdataqualityandtoavoidburden

ordistress(Patton,2015).Therefore,thebeginningandendsectionsofthe

scheduleaddressedmoreneutraltopics,whilesensitivetopicswereexploredinthe

middleportionoftheinterview.Toeasetheparticipantintotheprocess,itis

advisabletobeginbyaskingparticipantstodescribearecentactivityorexperience

(Patton,2015);here,thefirstquestionwas“whatdoyoulikeaboutbeingat

school?”Theconcludingquestionaskedtheparticipanttoreflectonwhatadvice

theywouldgivetoafriendexperiencingabroadhypotheticalissue,suchasa

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112

problemathome,toallowparticipantstocreatedistancefromthetopicsjust

discussed.

WhiletheaimsoftheHeadStartqualitativeevaluationdifferfromthatof

thecurrentstudy,thetopicsaddressedininterviewsreflectthefocusofRQ3andit

wasexpectedthatthiswouldgenerateappropriatedataintermsofcontentand

depth.Assuch,participants’overarchingaccountswereutilisedinanalysis,rather

thanisolatingdatafromaspecificsubsetofquestions.Furthermore,theinclusion

ofvaryingtypesofquestionsandtheuseofopen-endedandneutralphrasing

reflectguidancefordesigningascheduleforuseinIPAinterviews(Smithetal.,

2009;Smith&Osborn,2015).Itshouldalsobenotedthattheauthorofthecurrent

studywaspartofthequalitativeevaluationteaminHeadStartandsowasinvolved

inthedevelopmentoftheinterviewschedule.Assuch,therewasongoing

considerationanddiscussionthroughoutthedesignprocessoftheuseofIPAwithin

thecurrentstudyinordertoensurecompatibilitywiththisapproach.

4.7Procedure

4.7.1QuantitativeProcedure

DataCollection

Atleasttwoweekspriortoquantitativedatacollectionparents/carerswere

providedwithaninformationpack(AppendixK)containinganinformationsheet

andanopt-outconsentform(seeSection4.12.1).Participantswerepresentedwith

thisinformationinage-appropriatelanguagepriortobeginningtheWMFandgave

informedassentbytickingaboxtoproceed(AppendixL).

ParticipantscompletedtheWMFinMarch–July2017andsociodemographic

datawasprovidedfromtheNPDinAugust2017(seeSection4.12.1fordetailsof

theconsentprocess).ParticipantscompletedtheWMFthroughasecureonline

systemoncomputersorsimilardigitaldevicesinteacher-facilitatedclassesintheir

educationsettings.Duetothelargesamplesize,itwasnotfeasibleforresearchers

tobepresentforthecompletionofsurveysbut,aspreviouslynoted,education

staffreceivedguidancetoaidtheminfacilitatingcompletion.

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DataManagementandPreparation

ParticipantsaccessedtheWMFusingarandomlygeneratedcodeassociated

withparticipants’pupilmatchingreferencenumber,auniqueanonymisedcode

allowingresponsestobelinkedwithdemographicdata.Anonymiseddatawasthen

extractedforthecurrentstudyandpreparedforanalysis;rawitemscoreswere

reversedwhererequired,specificallytwoitemsonthePSS-4,andtotalscoreswere

calculatedforeachscaleorsubscaleused.

4.7.2QualitativeProcedure

InterviewProcedure

HeadStartinterviewparticipantsreceivedanage-appropriateinformation

sheet(AppendixM)andapackforparents/carers(AppendixN)includingan

informationsheetandaparentalconsentformandwereinformedthattheywould

receivea£10shoppingvoucheraftertheinterviewasathankyou(seeSection

4.12.1forethicalconsiderations).BetweenMayandJuly2017,participants

engagedinaone-to-oneinterviewinaprivateandquietspaceintheireducation

setting,carriedoutbyoneofthreeHeadStartresearchers(includingthecurrent

author).Theinterviewerintroducedthemselvesandengagedinsmalltalktobuild

rapportandmaketheparticipantfeelcomfortable,animportantprocessin

interviews(DiCicco-Bloom&Crabtree,2006;Smithetal.,2009).Theinterviewer

reviewedtheinformationsheetwiththeparticipant,checkingunderstandingand

providingopportunitiestoaskquestions,consistentwithguidance(Edmond,2005).

Participantswerethenaskedtogivewrittenassent(AppendixO)iftheywishedto

beinterviewed.

First,theinterviewerreiteratedkeyinformation,detailingthetopictobe

addressed,howdatawouldbeused,areminderthatparticipantsdidnotneedto

answerquestionsandcouldstopatanytime,andareminderofconfidentiality

procedures.AsoutlinedinSection4.6.2,theinterviewbeganwithpreliminary

nonthreateningquestions(e.g.,whatparticipantslikeaboutschool),beforemoving

ontothemainbodyofthescheduleandendingwithneutralquestions.Interviews

CHAPTERFOUR:METHOD

114

lastedapproximately30-45minutes,withamaximumpossibletimeofonehourto

avoiddisruptiontotheschoolday;theinterviewsincludedinthecurrentstudy

rangedfrom40minutestoonehour.Finally,interviewersthankedparticipants,

reiteratedkeyinformation,andprovidedfurtheropportunitiesforquestions.

Participantsthencompletedademographicformdisclosingtheirsex,age,

andethnicbackground(AppendixP).Theywereprovidedwithinformationon

nationalandlocalservicestheymaywishtoaccessafterdiscussingsensitivetopics,

alongsidethenameofamemberofstaffintheirschooltheycouldspeakwith,and

avoucher.Participantswereinvitedtoselectapseudonym,consistentwith

guidanceontreatingyoungpeopleasactiveresearchparticipants(Harcourt&

Conroy,2011).

AdditionalConsiderations

Interviewersutilisedstrategiesthroughoutthisprocesstoprioritise

participants’activeengagementandwellbeing,developedincollaborationwith

CommonRoomyoungadvisors.Giventhepotentiallysensitivenatureofthetopics

discussed,interviewerswereattentivetosignsofdiscomfortanddistressandin

suchinstancesgavetheparticipanttimetocalmdownbeforeaskingwhetherthey

wouldliketoresumetheinterviewand,ifso,howthiscouldbemadeeasier.Adult

colouringsheets,paper,anddrawingequipmentwasavailabletoprovideafocal

pointwhilediscussingdifficulttopicsifnecessary.Interviewerssoughttoverbally

establishseparatenessfromtheschoolandinterventionpractitionerstoreduce

perceptionsoftheinterviewerasanauthorityfigure(Cohen,Manion,&Morrison,

2011;Eder&Fingerson,2003).Interviewerssoughttoconsistentlyreiterateto

participantsthattheirinvolvementwasvalued,conveyingtheirpositionasactive

participants.

DataManagementandPreparation

Withparticipants’permission,interviewswererecordedwithanaudio

deviceforaccuracyandtofacilitatefocusontheparticipant(Patton,2015).Data

weretranscribedverbatimusinganaturalisedapproach,whereinutterancesand

noisessuchaspausesandstutters,nonverbalsoundssuchaslaughterorcoughs,

CHAPTERFOUR:METHOD

115

andnon-standardisedportrayalofparticipants’grammarusageandaccentsare

included(Oliveretal.,2005).Thisapproachwasusedtofacilitateanalytical

interpretationoflanguageusageandverbalandnon-verbalfeaturesaswellas

informationalcontent,asisimportantinIPA(Smithetal.,2009).Transcriptionwas

undertakenbyexternaltranscriptioncompaniesandcheckedforaccuracyby

interviewers.Accountswereanonymised,includingparticipantnamesandthe

namesofanypeopleorplaces;forthecurrentstudy,nameswereanonymised

usingparticipants’selectedpseudonymstopreservethehumanelementafforded

byaname.Audiodataandtranscriptswerestoredelectronicallyonpassword-

protectedcomputerserversaccessibleonlytoHeadStartresearchers.Papercopies

oftranscriptsutilisedinanalysisforthecurrentstudywerestoredinalockedfiling

cabinetaccessibleonlytotheauthor.

4.8QuantitativeAnalysis

4.8.1StructuralEquationModelling(SEM)

SEMisabroadtermdescribingarangeofstatisticalprocedureswherein,

amongotherthings,researcherscanspecifytheory-informeddirectionalpathways

betweenvariablesandexplorehowwellthisfitstheobserveddata(Kline,2016;

Pearl,2012).Thiscapacitytospecifythedirectionandnatureofrelationships

allowsinvestigationoftheunderlyingmechanismsandpossibleadaptiveprocesses

foremotionalsymptoms.SEMalsoenablesmodellingoflatentvariables,consistent

withadistinctionbetweenameasureandtheconstructitseekstocapture,an

advantagenotaffordedinothersmethodssuchasmultipleregression(Kline,2016).

SEMisalignedwiththestudyepistemologicallyasitassumesprobabilistic,not

deterministic,causality,focusingonlikelihoodofeffectsratherthananassumption

ofuniformchange(Kline,2016;Pearl,2012).SEManalysiswascarriedoutusing

Mplusversion8.1andinlaterstages8.3(Muthén&Muthén,1998-2010).

LatentVariableModels

ThedistinctionbetweenmanifestandlatentvariablesiscentraltoSEM;as

discussedinSection3.3.2,alatentvariable(orfactor)cannotbedirectlyobserved

CHAPTERFOUR:METHOD

116

andisinsteadinferredfromseveralmanifestvariables(orindicators)basedon

sharedvarianceamongindicators(Brown,2015;Kline,2016).Itisassumedthata

givenconstructcausesparticipantstorespondinparticularwaystoindicators

capturingassociatedcharacteristics/symptoms,thusprovidinginsightintothe

construct.Here,forexample,theconstructofemotionalsymptomswasnotdirectly

measured;rather,participantsrespondedtoasetofspecificstatementsthat

collectivelyrepresentindicatorsofemotionalsymptoms.SEMalsoestimatesthe

varianceofeachindicatornotexplainedbythelatentvariable(i.e.,common

variance),alsoknownasresidual(measurementerror)oruniquevariance,which

alsorepresentsalatentvariableasitisindirectlyinferred.Accountingforthisoffers

amorereliableformulationofconstructsand,thus,morerobustestimatesof

relationships(Gefenetal.,2011).Here,thestructureofeachlatentfactorandthe

fitoftheoverallmeasurementmodelwereexploredpriortothemainanalysisto

confirmtheirsuitability(seeSection4.8).

Estimators

Inestimatingmodels,theweightedleastsquaremeanandvariance

adjusted(WLSMV)estimatorwasutilised.Thiswasdeemedappropriategivenuse

oflatentfactorsinferredfromcategoricalindicators,asitproduceslessbiased

factorloadingsthanotherrobustestimatorswhereindicatorsareordinalrather

thancontinuous(Brown,2015;Brown&Moore,2012;Flora&Curran,2004;Li,

2016).WLSMVdoesnotassumeindicatornormalitybutinsteadassumeslatent

normaldistribution,thoughsimulationshaveindicatedthatmodestviolationsdo

notgenerallyaffectperformance(Flora&Curran,2004;Liang&Yang,2014).A

drawbackofWLSMVisitsuseoflistwisedeletionwhencovariatesarepresent,

whichislessrobustrelativetoestimatorsusingfullinformationmaximum

likelihood(FIML).Assuch,althoughWLSMVwasconsideredmostappropriategiven

itsadvantagesinmodellingcategoricalvariables,asensitivityanalysiswascarried

outformainanalysismodelsusingmaximumlikelihoodwithrobuststandarderror

(MLR),whichusesFIML.SimilarlytoWLSMV,MLRisabletohandlenon-normality

withinvariablesandthusproducerobustestimates(Wang&Wang,2012).

CHAPTERFOUR:METHOD

117

SensitivityanalysisusingMLRallowedassessmentofwhetherresultsobtained

throughWLSMVwereaffectedbymissingness.

ModelFitIndices

Overallgoodnessoffitwasassessedusingrootmeansquareerrorof

approximation(RMSEA),withvaluesbelow.60andanupper90%confidence

intervalsmallerthan1indicativeofgoodparsimonyfit(D.Hooperetal.,2008;Hu

&Bentler,1999),andComparativeFitIndex(CFI)andTucker-LewisIndex(TLI)

values,comparativefitindicesinwhichvaluesgreaterthan.95indicategoodfit(Hu

&Bentler,1999).Chi-squareisreportedforreferencebutnotconsideredindicative

ofmodelfit,asthisstatisticisstronglyaffectedbysamplesizeandthesizeof

parameterestimates(Brown,2015;Kline,2016).Localisedstrainwasexamined

using(a)Standardisedandnon-standardisedresiduals,withstandardisedvalues

above2.58indicatingpoorfit;(b)theresidualcorrelationmatrix,withvaluesabove

.10indicatingdisagreementbetweentheestimatedmodelandthedata(Kline,

2016);and(c)jointinspectionofmodificationindices(MI)andstandardised

estimatedparameterchange(SEPC),whereMIvaluesgreaterthan10andSEPC

valuesgreaterthan.20indicatethatthecorrespondingparametershouldbefreely

estimated(Wang&Wang,2012;Whittaker,2012).Re-specificationsbasedonpoor

fitweremadeonlywheretherewasatheoreticaljustificationfordoingso,rather

thanbasedpurelyonempiricalinformation,inlinewiththeepistemologicalstance

ofSEM(Brown,2015;Kline,2016).

InterpretingParameters

A.05alphathresholdwasutilisedtoindicatestatisticalsignificance;

however,p-valuethresholdscanbearbitraryandthisvalueissensitivetolarge

samplesize(Durlak,2009;Kline,2016;Sullivan&Feinn,2012).Thus,parameter

significancewasgivencontextualconsiderationalongsidedirectionandmagnitude.

Standardisedfactorloadings(λ)above.40wereconsideredsalient,though

consistentwithguidancethiswasconsideredcontextuallyforeachmodel(Brown,

2015).StandardisedbivariatecorrelationcoefficientsIwereinterpretedusing.10,

.30,and.50asthresholdsforsmall,moderate,andlarge,respectively(Cohen,

1988).FollowingMacKinnon,Lockwood,andWilliams(2004)ininterpreting

CHAPTERFOUR:METHOD

118

standardisedbetaregressioncoefficientpathways(β),.14,.39,and.59were

consideredindicativeofsmall,moderate,andlargeeffectsizesasoutlinedby

Cohen(1988).Itisgenerallyconsideredbetterpracticetointerpretthe

meaningfulnessofaparameterbasedonthemagnitudestypicallyobservedina

givenfield(Keith,2015),howeversuchnormshavenotyetbeenidentifiedwithin

mentalhealthresearchandsothecurrentstudyappliescautionandinsteadmakes

useofthesestandardguidelines.

DataClustering

AsparticipantsengagedwiththeWMFwithineducationsettingsdueto

HeadStartinvolvement,dataclusteringwasanticipatedattheschoollevel,wherein

aportionofvarianceisattributabletosimilaritieswithinthesample.Data

clusteringviolatestheassumptionofdataindependenceandsocanbiasstandard

errors(Hoxetal.,2018).Thedegreeofclusteringcanbeassessedusingthe

intraclustercorrelationcoefficient(ICC).Thedesigneffect(deff)canalsobe

determined,avalueassessinghowmuchclusteringmayaffectstandarderrors

(Kish,1965);however,itscalculationassumesthatclustersareofequalsizeandso

isnotadvisedacrossunequalclusters(Muthén&Satorra,1995).Clustersizeshere

wereunbalancedandrangedfrom1to244(average=83)andthusdeffwasnota

suitableindicator.However,Hoxetal.(2018)havearguedthatregardlessofsuch

statistics,anyexpectedviolationofdataindependenceisproblematicandshould

becontrolledfor.Thus,dataclusteringattheschoollevelwascontrolledforinall

SEManalyses,usingtheType=ComplexcommandinMplus,whichaccountsfor

non-independenceoftheobservationsbyadjustingthestandarderrors(Muthén&

Muthén,1998-2010).

4.8.2Pre-Analysis

DatawerereviewedtoensureconsistencywiththeassumptionsofSEM.

Thefactorstructureofeachmeasurewasexploredthroughconfirmatoryfactor

analysis(CFA),withinspectionofgoodnessoffitindices,areasoflocalisedstrain,

andparameterestimates.InternalconsistencywasinvestigatedusingCronbach’sα

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119

(usingSPSSversion23)andMcDonald’sω(usingMplusversion8.1)toprovidea

balancedevaluation,aseachstatisticpresentslimitations.Cronbach’sαproduces

inflatedvaluesintheabsenceoftau-equivalence(Brown,2015;Cronbach&

Shavelson,2004)andlowervaluesformeasureswithfeweritems(Kline,2016;

Raykov,1997),whileMcDonald’sωcanbeaffectedbynon-normalityor

multidimensionality(Trizano-Hermosilla&Alvarado,2016;Zhang&Yuan,2015).A

cutoffof.70iscommonlyusedforCronbach’sα(e.g.,Terweeetal.,2007),however

thisthresholdisgenerallyindicativeofapproximateadequacyratherthanagold-

standardcutoffandshouldactasguidanceratherthananinclusioncriterion(Dunn

etal.,2014;Kline,2016;Lanceetal.,2006).ThereisnocutoffforMcDonald’sωand

thisisgenerallyreportedfortransparency.

Priortoestimatingstructuralmodelswithmorethanonelatentvariable,a

measurementmodelwasexamined,whichisessentiallythefactorstructureacross

allvariablesunderpinningthestructuralmodelsthatarethemainfocusofanalysis

(Brown,2015;Kline,2016;Muthén&Muthén,1998-2010).Inameasurement

model,alllatentvariablesinter-correlatefreelytoallowinspectionofinter-

relationshipsandensureviability(Brown,2015;Kline,2016;Muthén&Muthén,

1998-2010.;Schreiberetal.,2006).Thisallowsmoreaccuratejudgementsabout

thefitofstructuralmodels,asobservedpoorfitcanbeattributedtoamis-specified

measurementmodel(Brown,2015;Kline,2016).

4.8.3MainStatisticalAnalysis

Thissectiondescribestheanalyticalstrategyforeachresearchquestion.A

sequentialapproachwasadopted,withsomeresultsinformingelementsof

analyticalproceduresforsubsequentquestions;forinstance,riskfactorsidentified

inRQ1ainformtheconstructionofriskconstructsusedinRQs1b–dand2b.

ResearchQuestion1:RiskFactorsandProcesses

RiskFactors

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120

7. Oftherisksidentified,whatisthemagnitudeoftheirassociationwithearly


AlinearmultipleregressionSEMmodelwasspecifiedwithallhypothesised

riskvariablespredictinglatentemotionalsymptoms.Variableswereclassedas

confirmedriskfactorswheretheirrespectivepathwayontoemotionalsymptoms

wasstatisticallysignificant(p<.05)andintheexpecteddirection.However,as

outlinedintheprevioussection,parametermagnitudewasalsoconsideredin

determiningriskfactorstatus,withparticularlysmallparametervalues(inlinewith

thresholdsof.14,.39,and.59;Cohen,1988)givenadditionalcontextual

consideration.

CumulativeRiskEffects

b.Isthereevidenceforacumulativeriskeffectinrelationtoearlyadolescentgirls’

emotionalsymptoms?

Acumulativeriskindexwascreatedbysummingconfirmedriskfactors,with

eachonecodedas“1=riskpresent”and“0=riskabsent”,tocreateascorefor

eachparticipant.Ifidentifiedforinclusion,thecontinuousvariable,neighbourhood

socioeconomicdeprivation,wouldbedichotomisedusingreceiveroperating

characteristicanalysistoisolatewhereinitsrange“risk”occurs,consistentwith

guidance(Kraemeretal.,2005).

Next,alinearregressionSEMmodelwasspecifiedwiththecumulativerisk

indexpredictinglatentemotionalsymptomstoidentifywhethercumulativerisk

effectswerepresent.Observedeffectswouldbefurtherassessedbyaddingeach

individualconfirmedriskfactorasacovariate,oneatatime,toconfirmeffects

werenotdrivenbyasinglefactorintheindex,consistentwithguidance(Evanset

al.,2013).

RiskMeasurementModels

c.Whichriskmeasurementmodelbestexplainstheeffectsofexposuretomultiple

riskfactorsinrelationtoearlyadolescentgirls’emotionalsymptoms?

Multipleregression,cumulativerisk,andlatentconstructmeasurement

approacheswereexploredaspredictorsofemotionalsymptomsthroughseparate

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linearregressionSEMmodels(Figure3.1,Section3.3.2).Modelfitindiceswere

inspectedtoestablishgoodnessoffit,thoughthiswasnotusedtoselectthemost

appropriatemodel,asthefocusisonexplanatorypowerandthereisnowayto

empiricallyusemodelfitindicesformodelcomparisonwhenmodelsarenon-

nested.Toassesswhichmodelshowedthegreatestpredictiveutility,thecentral

interestforthisresearchquestion,regressionbetacoefficientswereinspected

alongsidethevarianceofemotionalsymptomspredictedwithineachmodel.

IndirectEffectsofPerceivedStress

d.Arethereindirecteffectsofperceivedstressintherelationshipbetweenmultiple

riskexposureandemotionalsymptoms?

Amodelwasspecifiedwithbothdirectandindirecteffectsofperceived

stressintherelationshipbetweenmultipleriskexposureandemotionalsymptoms.

ThespecificwayinwhichthePSS-4wasmodelledinthismodel(thatis,as

unidimensionalorasatwo-dimensionalmeasureofperceiveddistressand

perceivedcoping)wasdeterminedbasedontheresultsofCFA,whichare

presentedatthebeginningofChapterFive.Theterm“indirecteffects”isusedhere

ratherthan“mediation”,inlinewithguidanceforinterpretingsuchpathways

withincross-sectionaldata(Kline,2016).Specifyingindirecteffectswithinamodel

resultsinnon-normalityinthedistributionofthesamplealongthesepathways,

necessitatingtheuseofbootstrappingtoovercomeassumptionsofnormality

(Hayes,2013,2017).Here,bias-correctedbootstrapswereutilised,consistentwith

guidance(Hayes,2017),with1,000draws.Thisanalysiswasconductedinthelatest

versionofMplus(8.3),whichallowedbootstrappingwhilealsocontrollingfor

clustering.

ResearchQuestion2:FactorsandProcessesforPositiveOutcomes

PromotiveFactors

7. Ofthepromotivefactorsidentified,whatisthemagnitudeoftheir

associationwithearlyadolescentgirls’emotionalsymptoms?

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AlinearmultipleregressionSEMmodelwasspecifiedincludingthesixlatent

SRSsubscalesaspredictorsoflatentemotionalsymptoms.Hypothesisedpromotive

variableswereclassedasconfirmedwheretherespectiveregressionpathwayonto

thelatentemotionalsymptomsoutcomevariablewasstatisticallysignificantatthe

.05alphalevelanddemonstratinganinverserelationship,thoughaswithrisk

factorsparametermagnitudewasalsoassessed(inlinewiththresholdsforβof.14,

.39,and.59;Cohen,1988).

ProtectiveFactors

b.Towhatextentarethedirectand/orindirectrelationshipsbetweenmultiplerisk

exposure,perceivedstress,andemotionalsymptomsconditionaluponaccessto

protectivefactors?

Anindirecteffectmodelwithconditionalpathwayswasinvestigatedto

assesswhetherthenatureofanydirectand/orindirectpathways(asidentifiedin

RQ1d)dependsuponthelevelofone’sperceivedsocialconnectionsandactive

engagement.Notethat“conditionalindirecteffects”canbethoughtofas

conceptuallysimilartomoderatedmediation;however,inmoderatedmediation

theentireunderlyingmechanismismoderated,whileconditionalindirecteffects

focusesonspecificpathwayswithinthatmechanism(Hayes,2017);thecurrent

studyfocusesonthelatter.

Conditionaleffects,ormoderation,occurwhenonevariableaffectsthe

relationshipbetweentwoothervariables;thismoderatorvariablespecifiesthe

conditioninwhichaneffectoccursandcaninfluenceitsstrengthanddirectionality

(Baron&Kenny,1986;Hayes,2013,2017;Holmbeck,1997).Toinvestigateasingle

moderatorinalinearregressionmodel,threecausalpathwayspredictthe

outcome:(a)Thepredictor;(b)themoderator;and(c)theinteractionorproductof

thepredictorandmoderator(Baron&Kenny,1986;seeFigure4.2).Wherethe

interactionisfoundtobestatisticallysignificant,thevariableisidentifiedasa

moderator(Hayes,2013,2017).

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Figure4.2.Conceptualandstatisticalmoderationmodels.Theconceptualmodelshowsthe

moderatorinfluencingtherelationshipbetweenpredictorandoutcome.Thestatisticalmodel

presentscausalpathwaysusedtoinvestigatemoderation:(a)Thepredictor,(b)themoderator,and

(c)theinteractionbetweenthetwo.

Inamediationmodel,amoderatorcanbespecifiedalonganystatistically

significantindirectand/ordirectpathway,asdeterminedwithconsiderationof

theory,existingresearch,andone’sresearchquestions(Hayes,2013,2017).Figure

4.3(overleaf)showsconceptualandstatisticaldiagramsforasimpleindirecteffects

modelwithonemoderatormoderatingthefirstpathwayoftheoverarchingindirect

pathway.

Figure4.3.Conceptualandstatisticalconditionalindirecteffectsmodel.Theconceptualmodel

showsonemediator(M),withonemoderator(W)influencingthefirstindirectpathway.The

statisticalmodelpresentsfivecausalpathways:a1andbshowthemediationpathways,c’showsthe

directpathway,a2showstheinfluenceofthemoderatorWonM,anda3showstheeffectsofthe

interactionbetweenthepredictorXandthemoderatorW(XW)onM.Moderationisconsidered

presentwheninteractionpathwaya3issignificant.

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Thisdiagramexpressestwoequations,oneforY(theoutcome)andoneforM(the

mediator;Hayes,2013,2017):

Y = b0+ b1M+ c!X

(Equation1)

M = a0+ a1X+ a2W+ a3XW

(Equation2)

Here,moderationwasexaminedforanydirectand/orindirectpathwaysidentified

asstatisticallysignificantinRQ1d,allowingexaminationofwherehypothesised

moderatorvariablesfunctioninrelationtostressmechanisms.Whereanindirect

effectwasobserved,itwasplannedthatmoderationwouldbeexaminedforboth

stagesofindirecteffects,wherethefirststageistheeffectsofriskuponstressand

thesecondstageistheeffectofstressuponemotionalsymptoms.

ThestudydidnotexamineallsixSRSsubscalesaspossiblemoderators,as

thiswouldcreateanunnecessarilycomplexmodel.Thisreflectsthepostpositivist

principleofparsimony,whereinasimplermodel,withfewerparametersandmany

degreesoffreedom,ispreferredwheretheoreticallyplausible(Kline,2016;

Preacher,2006).However,thereisno“ruleofthumb”forthemostappropriate

numberofvariablesorparameterstoincludeinamodelandnoempiricalmethod

toassessthiscontextually.Instead,availableoptionsshouldbereviewedtoidentify

andprioritisethoseexpectedtobemostsalient,withconsiderationoftheoryand

priorempiricalresults(Hayes,2013;Kline,2016).Thus,theoryandpriorresearch

regardingthesixconstructsinrelationtoemotionalsymptomswasexaminedto

identifythosethataremosttheoreticallyrelevant.Thesubscaleswerealsotested

aspredictorsoftheoutcomeandofrelevantmediators(dependingonfindings

fromRQs1d)toassesswhetheramoderationeffectwouldbelikelyinrelationto

eachoftherelevantpathways,asadvisedbyHayes(2013,2017).Thatis,ifa

variableisnotsignificantlyassociatedwiththemediatorsoroutcome,itisunlikely

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thatitwouldinteractwithpredictorstomoderateeffects.Finally,with

considerationofboththeoryandtheseempiricalresults,asubsetofvariableswas

selectedforinclusion.TheselectedvariablesarepresentedanddiscussedinSection

5.4.2,inlightoffindingsfromRQ1d.

Totestconditionaleffects,thestudyadaptedexampleMpluscoding

developedbyStride,Gardner,Catley,andThomas(2015),whichhasbeen

configuredbasedonHayes's(2013,2017)theoryandprocedures.Interactions

betweenpredictors/mediatorsandeachofthehypothesisedmoderatorswere

definedasadditionalpredictors,withthemoderatorvariableitselfalsoincludedas

apredictor(asillustratedearlierinFigure4.2).TheMODELCONSTRAINToptionwas

thenutilisedtoassesswhethereffectsvaryasafunctionofthelevelofthe

moderator.Todoso,moderatorvariablesarespecifiedasoccurringatthreevalues

oflow,moderate,andhigh,definedbytheirmean-1SD,mean,andmean+1SD,

respectively(Hayes,2015;Strideetal.,2015).Itshouldbenotedthattofurther

reducethenumberofparameterswithinthismodel,theselectedSRSsubscalesand

PSS-4subscales(wherefoundtobesignificantmediators)weretreatedasmanifest

ratherthanlatent.Assuch,themaximumlikelihood(ML)estimatorwith

bootstrappingwasutilisedforthisanalysisinlinewithuseofcontinuoustotal

scores,giventhattheWLSMVestimatorusedinpreviousanalysesisgenerallymore

robustwheretherearecategoricalindicators(Brown,2015;Brown&Moore,2012;

Flora&Curran,2004;Li,2016).

4.9QualitativeAnalysis

4.9.1InterpretativePhenomenologicalAnalysis(IPA)

ForRQ3,IPAwasutilisedtoexploreparticipants’livedexperienceandthe

waysinwhichtheymakesenseofthisexperience.Aspreviouslydiscussed,inIPA

theresearcherdevelopsaninterpretativeaccountofaparticipant’sexperiential

claimsandconcernsaroundaphenomenon.Analysisisaniterativeandinductive

process,whereintheresearcherenterstheparticipant’s“lifeworld”andengagesin

aclose,systematicanalysisoftheiraccounttodevelopexperientialthemes.Thisis

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carriedoutseparatelyforeachparticipantbeforeexploringconvergencesand

divergencesacrossthesample,orcorpusofcases(Smithetal.,2009).Theaimisto

developoverarchingthemescapturingbothanidiographicfocusonthatwhichis

uniquetoeachindividualalongsideawiderfocusonsharedfeatures(Smithetal.,

2009;Smith&Osborn,2015a;Willig,2013).Thefollowingsectionsoutlinespecific

analyticalstagesinmoredetail.

AsdiscussedinSections4.3.2and4.4.3,IPArequiresahermeneutic

interactionbetweentheresearcherandeachparticipant’slifeworldand,thus,both

areconsideredpresentinfindings(Larkin&Thompson,2006;Mayoh&

Onwuegbuzie,2015;Pietkiewicz&Smith,2014;Smithetal.,2009).However,itis

importanttoretainaclosefocusonparticipant’saccounts(Larkinetal.,2006;

Smithetal.,2009;Willig,2013).Thus,thecurrentstudysoughttoembedreflexivity

throughouttheanalyticalprocess;sucheffortsarehighlightedbelowacross

analyticalstagesandalsodiscusseddiscretelyinSections4.11.2and5.4.

4.9.2StagesofIPA

Analysisfollowedthesix-stageframeworkoutlinedbySmithetal.(2009),

withconsiderationofguidancefromarangeofothermethodologicalarticles.

However,IPAguidancedoesnotofferaprescriptiveframeworkastheessenceof

analysisisitsinterpretativefocusandsoresearcherflexibilityisencouraged(Larkin

etal.,2006;Smithetal.,2009;Smith&Osborn,2015a;Smith,2004).Thesixbroad

stagesutilisedwere:

1. Immersion;

2. Initialsystematiccoding;

3. Developmentofemergentthemes;

4. Connectionsacrossemergentthemes;

5. Completionacrosscorpusofcases;and

6. Lookingforpatternsacrosscases.

Thefirstfourstepswerecarriedoutiterativelyforeachparticipantandthisprocess

wasthenrepeatedacrossallcases.Eachtranscriptisapproachedafresh,rather

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thanbeinginfluencedbytheanalysisofthepreviouscase,consistentwithIPA’s

idiographicapproach(Smithetal.,2009).Finally,theresearcherreviewedthecases

collectivelyandexploredhowtheyrelatetooneanother.Itshouldbenotedthat

althoughthesestagesaredetailedsequentially,theycompriseacyclicalprocess

andwererevisitedasneededthroughouttheanalyticalprocess.Analysiswas

undertakenbyhandusingpenandpaperratherthansoftware,asthisencourages

closenesswiththedata(Pietkiewicz&Smith,2014;Smithetal.,2009).Eachof

theseanalyticalstepsisdetailedinthefollowingsubsections.Priortobeginningthe

analyticalprocess,theresearcherengagedininspectionoftheirownvaluesand

experiencestoexplorehowthesemightrelatetotheareaofstudyandresearch

questionand,inturn,toreflectonhowthesemayinfluencetheirengagementwith

thedata(seeSection6.4).

StageOne:Immersion

First,theresearcherreadtheparticipant’stranscriptseveraltimesand

listenedtotheaudiorecording.Theaimistobecomeimmersedinthedataand

centrethefocusontheparticipantandtheiraccount,aswellastobecomefamiliar

withthestructureandcontextoftheinterview(Pietkiewicz&Smith,2014;Smithet

al.,2009).Immersionalsofacilitatesexplorationoftheresearcher’spreconceptions

priortosystematicanalysis(Larkin&Thompson,2012).Anyinitialthoughtsthat

arosewerenotedandsetaside(anexampleforAmeliaisshowninAppendixQ).

Thesenotesdonotrepresentformalanalysisandsoarenottakenintoaccountin

laterstages(Smithetal.,2009).

StageTwo:InitialSystematicCoding

Theresearcherthensystematicallycodedthetranscript.Thisisan

exploratoryprocessaimingtoidentifytheexperiencesparticipantsdescribeandthe

waytheymakesenseofthem.Theresearchernotesanythingofinterestwithinthe

data,attendingtobothsemanticcontentandlanguageuse(Reidetal.,2005;Smith

etal.,2009;Willig,2013).Thisistypicallyundertakenincolumns,withdatainone

columnandcodinginaparallelareatoencouragecross-checkingbetweendataand

interpretations(Smithetal.,2009).Multiplecodingcolumnscanbeusedfor

differentkindsofcomments,toencourageattentiontodifferentdatafeaturesand

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facilitateseparatenessbetweendescriptivecommentsreflectingdatacontentand

interpretivecommentsthatgobeyondthedataintomoreabstractterritory(Larkin

&Thompson,2012;Smithetal.,2009).Here,columnsfor“content”and“concept”

wereutilisedtoreflectthisdistinction,alongsidea“streamofconsciousness”

columntodocumentmoretentativecomments.Anexamplepageshowingthese

columnsandinitialcodingforAmeliacanbeseeninAppendixR.Inaddition,

decontextualisationstrategieswereutilisedtoencourageattentiontolinguistic

featuresaswellasnarrativeelements,suchasreadingfragmentedlineswithout

considerationofthelargersectionoftext,orreadingthelinesofasectionin

reverse(Smithetal.,2009).

Ongoingreflexivenotesweredocumentedatthebottomofeachpage,to

encourageactivedocumentingofanyinstanceswheredataresonatedinsomeway

orfeltchallengingtointerpretinamorebracketedway.Typicallythiswasnoted

downandreflectedonbrieflyandthensetasidetofocusonanalysis,andreturned

tolatertomoreextensivelyexplorehowthismighthaveinfluencedinterpretation

ofacaseoraproportionofthedata.Thisalsomeantthatanysuchinstanceswere

documentedinthelongterm,sothatinrevisitingdataandcodingatalaterstage

therewereclearnotesshowingwheredatahadresonatedandperhapsbeenmore

substantiallyinfluencedbytheresearcher.

StageThree:DevelopmentofEmergentThemes

Atthisstage,theresearcherdevelopsemergentthemes,consideringboth

thetranscriptandtheinitialcodingjustdeveloped,whicharenowconsideredin

unisonasanexpandeddataset(Smithetal.,2009).Thefocusisprimarilyonthe

initialcodesandsobeginstomoveslightlyawayfromtheparticipant’swords,

thoughtheseshouldstillbeconsideredandindeedshouldbereflectedintheinitial

codinginthefirstinstance(Larkinetal.,2006;Reidetal.,2005;Smithetal.,2009).

Theresearcherbeginsto“zoomout”,consideringlargerfragmentedsectionsof

dataandmovingbeyondthepreviousline-by-lineapproach.Themesarenotedin

thefinalcolumnastheyappearchronologicallyinthetext,thoughthereis

considerationoftheaccountasawholeintermsoftheinterrelationshipsand

connectionsacrossthetranscript(Biggerstaff&Thompson,2008;Smithetal.,

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2009).Itisnecessarytoexercisecautioninmovingtoofarfromparticipants’

accounts;inthecurrentstudy,emergentthemeswerecontinuallycheckedagainst

theparticipant’swordstoensurethatinterpretationsweregroundedinthedata.

AnexamplepagefromthisstageofanalysisisinAppendixSforAmelia,showinga

sampleofemergentthemesalongsidedataandcoding.

StageFour:ConnectionsacrossEmergentThemes

Next,theresearcherexploredconnectionsacrosstheparticipant’s

emergentthemes(Smithetal.,2009).Emergentthemesaregroupedtogetherinto

themesordiscardedinlinewiththescopeoftheresearchquestion,andthemes

arethenclusteredtogetherwithinsuperordinatethemes(Biggerstaff&Thompson,

2008;Pietkiewicz&Smith,2014;Smithetal.,2009).Tofacilitatethisprocess,

emergentthemesasidentifiedchronologicallyweretypeduptoallowthemtobe

viewedandexploredsimultaneously.Themeswerefirstlygroupedtogetherbased

onsimilarity,followedbyexplorationofoppositionalconnections,andwerethen

organisedintoastructureofsuperordinatethemes.Variousstrategieswerethen

usedtodevelopthisthematicstructure,includingconsiderationofeachtheme’s

context,frequencyandfunctionwithintheinterview,asrecommendedbySmithet

al.(2009).Suchstrategiesareemployedinunisonratherthanassingulardecision-

makingtools;forexample,athemewouldnotnecessarilyberemovedduetolow

frequencyifitappearedparticularlymeaningfulinaparticipant’slifeworld.To

encouragetheshapingofthemesinaccordancewithparticipants’words,

supportingexcerptsfordevelopingthemeswerecompiledonanongoingbasis,

consistentwithguidance(Pietkiewicz&Smith,2014;Smithetal.,2009;Willig,

2013).Furthermore,theresearcherdevelopedwrittendescriptionsofthemes

duringthisprocesstoencouragefurtherexaminationofhowthemessittogether

withinthethematicstructure(Pietkiewicz&Smith,2014;Smithetal.,2009).Each

participant’sthemesarepresentedatthebeginningofChapterSix,priorto

explorationofthemasterthemesspanningthecorpusasawhole.

StageFive:CompletionacrossCorpus

Stagesonetofourwererepeatedforallthreeparticipants,witheach

transcriptanalysedindividually.Theresearchersoughttobracketanalysisof

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previouscasestolimittheirinfluenceoneachindividualaccountasmuchas

possible,inlinewithIPA’semphasisontheidiographic.However,thiscanbe

challengingduetothelevelofimmersionnecessaryinanalysingeachcase(Larkin

etal.,2006;Smithetal.,2009;Wagstaffetal.,2014).Thus,theresearcher

exercisedcautioninthisareaandkeptareflexivecommentaryofthisbracketing

process,alongsideongoingdiscussionwiththesupervisoryteam.

StageSix:LookingforPatternsacrossCases

Finally,thethemesdevelopedforeachcasearebroughttogetherinto

higher-orderthemesrepresentingtheexperiencesandsense-makingofthecorpus

asawhole.Themesshouldcapturebothcommonalitiesanddivergencesacross

cases,tocapturerepresentationofwhatissharedbutalsowhatisdifferentacross

cases(Reidetal.,2005;Smithetal.,2009).Todevelopoverarchingthemes,the

researcherfirstreviewedeachparticipant’sthemesandtherespectivequotes

underpinningthemandnotedinitialthoughtsonpatternsanddifferencesacross

thecases.Severalstrategieswereutilisedtofacilitatethisprocess,suchas

developingavisualdisplayofthemesandcreatingwrittensummariesforemerging

themestoexploreandinspecttheircomposition.Duringthisprocess,the

researcherdevelopedaninitialsetofthemesforthecorpus,retainingasmuch

detailaspossibleatthisearlystage.Asinpreviousphasesofanalysis,themeswere

tentativelyorganisedwithinsuperordinatethemesandthisstructurewasthen

refinedtodevelopamoreunifiedandsynthesisedrepresentationofthecorpus.

Thereisnofixedruleastohowmanythemesshouldbeinthefinalthematic

structure;rather,thegeneralideaisthat“lessismore”and,assuch,asmallerand

moresuccinctsetofthemesispreferred(Pietkiewicz&Smith,2014;Reidetal.,

2005;Smithetal.,2009;Smith&Osborn,2015a).Furthermore,attentiontoboth

uniqueandsharedfeaturesmeansthatnotallparticipantsneedtoberepresented

ineachthemeandindeedathememayincorporatetheexperiencesofjustone

participantwherethiscapturesexperiencesthatappearparticularlysalientintheir

lifeworld.

Theresearcherdocumentedthisprocesscarefullyandengagedinregular

discussionswithmembersoftheresearchsupervisionteamandpeersfamiliarwith

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theuseofIPA,inordertobothguidetheprocessandfacilitatereflexivethinking.

Throughoutthisprocess,theresearcherregularlyreviewedthethemesagainstthe

originaltranscriptsandcodingalongwiththeindividualtrackingdocuments

describedinpreviousstagesinanefforttoensurethatthemesweregroundedin

participants’accountsandwords.Themenameswerealsogivenattentionandin

somecaseskeywordsorphrasesfromparticipantswereadoptedaslabelswhere

thesewereconsideredtoencapsulatetheessenceofthetheme;Smith(2011b)

describessuchutterancesinthiscontextas“gems”.Thenuancesandsalient

featuresofthemesareexploredwithinthefinalwrittennarrativeandsowhilethe

thematicstructureshouldfacilitatethiskindofrepresentation,thenuancesand

divergencesdonotnecessarilyneedtobemadeovertinnamingandorganising

themes.Forinstance,oppositionalthemesmaysitalongsideoneanotherandthus

bevisiblesimplyfromtheirnames,butitispossibleforasinglethemeto

encapsulateverydifferentperspectivesorexperiencesandthismaynotbe

immediatelyevidentthroughthethemenamealone.

FinalthemesarepresentedinChapterSixalongsideanindicationofwhich

participantsarerepresentedwithineachtheme,consistentwithguidance(Larkin&

Thompson,2012;Smithetal.,2009).Awrittennarrativedescribesandexplores

eachtheme,notingsalientfeaturesandcommonpatternsaswellasindividual

differencesacrosscases,clarifyingtothereaderwherediscussioniscentredaround

thevoiceoftheparticipantversustheinterpretativevoiceoftheresearcher(Larkin

etal.,2006;Larkin&Thompson,2006;Smithetal.,2009).Findingsarethen

discussedinrelationtopsychologicaltheoryandwiderresearchinChapterSeven,

consideringhowfindingsreflectexistingliteratureaswellaswhatfreshinsightsand

meaningtheyoffer.

4.10MixedMethodsStrategy

InChapterSeven,quantitativeandqualitativefindingsarefirstdiscussed

independentlyofoneanothertoexploretheinferencesofferedbyeachstrand,

consistentwithguidance(Tashakkori&Teddlie,2008a;Teddlie&Tashakkori,

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132

2009).Inferencesandlearningacrossthetwostrandsarethendrawntogetherto

developmeta-inferences,representingamorecomprehensiveunderstandingofthe

phenomena,inlinewithuseofmixedmethodsforcomplementarity(Brymanetal.,

2008;Creswell&PlanoClark,2011;Greeneetal.,1989).Inferencesacrossthe

strandswereconsideredjointlywithattentiontohowfindingsenhancedand

elaboratedupononeanotheraswellasareasofsimilarityandcontrast.This

approachisconsistentwithTashakkoriandTeddlie's(2008)principleofintegrative

efficacy,ortheextenttowhichfindingsareeffectivelyintegratedintotheoretically

coherentmeta-inferences.Avisualrepresentationillustratinghowmeta-inferences

integratelearningacrossthetwostrandsispresentedinChapterSeven,bothto

demonstratethisintegrationtothereaderandtofacilitateaccessibilityfor

audiencesfromvaryingmethodologicalbackgrounds(Mayoh&Onwuegbuzie,

2015;Moseholm&Fetters,2017;Sandelowski,2003).Finally,eachmeta-inference

isdiscussedandexploredwithattentiontoimplicationsanddirectionsforfuture

research.

4.11QualityandRigour


Thequantitativeresearchprocesswasguidedbythepostpositivistprinciples

ofreliability,validity,replicability,andgeneralisability(Mertens,2015)and

attentiontogeneralreportingstandardsfromtheAPAPublicationsand

CommunicationsBoardTaskForce(Appelbaumetal.,2018)andstandardsfor

reportingobservationalepidemiologicalresearch(vonElmetal.,2008,2014).

ReliabilityandValidity

Reliabilityandvalidityreflecttheextenttowhichmeasuresreliablycapture

thespecificconstructofinterest(Mertens,2015).Internalconsistency(both

Cronbach’sαandMcDonald’sω)isreportedforallmeasuresandpreviousevidence

ofvalidityandreliabilityisoutlinedwithattentiontocontentvalidity,construct

validity,andinternalconsistency,inlinewithguidancefromTerweeetal.(2007).

ReplicabilityandGeneralisability

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133

Replicabilityrelatestoprovidingsufficientinformationtoallowresearch

conditionstobere-created,whilegeneralisabilityistheextenttowhichresults

couldbeappliedwithinothersituations,bothofwhichnecessitatetransparent

reporting(Appelbaumetal.,2018;OpenScienceCollaboration,2015).Cleardetails

havebeenprovidedregardingthesample,datacollectionmaterialsand

procedures,andanalyticalprocedures,whileunstandardisedandstandardised

resultsarereportedformainanalysisalongsidesensitivityanalysis.


ThequalitativestrandwasguidedbykeyprinciplesfromYardley(2000,

2015),namelysensitivitytocontext,commitmentandrigour,transparencyand

coherence,andimpactandimportance,alongsidespecificIPAguidance(Smith,

2011a;Smithetal.,2009).

SensitivitytoContext

Thisprinciplereflectssensitivitytotheresearchcontext,includingwider

theoryandliterature,thedataandtheirsocioculturalcontext,participants’

perspectives,andethicalconsiderations.Theresearchersoughttoimmerse

themselvesinparticipants’lifeworldsandtoensureinterpretationsandthewritten

narrativewereembeddedwithintheiraccounts(Larkinetal.,2006;Smithetal.,

2009).Illustrativequotesareincludedforeachparticipantincludedinagiven

theme,consistentwithguidanceonIPAstudiesfocusingonthreeorfewer

participants(Smith,2011a).Indiscussingfindingsallpossibleavenuesof

explanationwereexamined,ratherthanadoptingasingletheoreticallensor

narrowlyaligningfindingswithquantitativeresults.

CommitmentandRigour

Thisrelatestocreatinganin-depth,completestudy(Yardley,2000,2015).

Here,stepsweretakentoincludeapurposivesamplewithrichandrelevant

experience.Theresearcherundertookeffortstodevelopcompetenceandskillin

IPAthroughtrainingandpeersupporttoensurecommitmenttothemethod

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(Smith,2011a).Theresearcherworkedtoundertakeanin-depth,systematic

analysisthatcouldpushbeyondsurface-levelconclusionsanddevelopmeaningful

themesencompassingbothindividualandsharedexperiences(Larkinetal.,2006;

Smithetal.,2009;Wagstaffetal.,2014).

TransparencyandCoherence

Thisprinciplecapturesclarityandcoherenceinreporting(Yardley,2000,

2015).Effortwastakentodevelopacoherentdesign,withtheresearchquestion

andadoptedepistemologiesinformingtheentireprocess(Yardley,2000,2015).A

cleardescriptionofeachanalyticalstagehasbeenprovidedandarichnarrativeof

findingsispresentedinChapterSix,withclarityindistinguishingdescriptionsof

experiencesfrommoreinterpretivecomments(Smithetal.,2009;Smith,2011a).

Severalstrategieswereutilisedtofacilitatereflexivity,akeyconsiderationwithin

IPA(Larkinetal.,2006;Smithetal.,2009;Wagstaffetal.,2014),throughongoing

documentationofreactionstothedata,useofbracketingtechniquesduring

coding,anddiscussionwiththesupervisorandpeers.Abriefappraisalofthe

reflexivityprocessisofferedinChapterSix.Theanalyticalprocesswas

systematicallydocumentedinamannerthatwouldfacilitateanaudit,whereinan

independentpersoncouldfollowthejourneyfromtherawdatathroughtothefinal

report(Smithetal.,2009;Yin,1989)andthiswasconsistentlysharedanddiscussed

withthemainsupervisortoexplorecredibilityandplausibility.

ImpactandImportance

Thisprincipleemphasisestheneedforfindingstobedeeplyconsideredand

exploredwithconsiderationofimportanceandimpact(Yardley,2000,2015).

DiscussionoffindingsinChapterSevendoesnotsimplyconsiderwhetherfindings

alignwithanexistingmodel,butaspirestoexplorefindingsdeeply,examining

connectionswithwidertheoryandliteratureanddrawingoutnewanduseful

insights(Larkin&Thompson,2012;Pietkiewicz&Smith,2014;Smithetal.,2009).

Tofacilitateimpact,bothpracticalimplicationsandfutureresearchdirectionsare

considered.

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4.11.3MixedMethods

Qualityandrigourinmixedmethodsstudiesrelatestothecoherencyofthe

overalldesignandtheextenttowhichmeta-inferencesoffermeaningfulinsight

(Brymanetal.,2008;Tashakkori&Teddlie,2008b).Theparticularmethodsused

areconsistentwiththestudy’saimsandeachoffersinsightintothesamebroad

phenomenawithinthesamepopulation,withconsiderationofeachapproach’s

respectiveepistemologiesthroughout.IntegrationwasguidedbyTashakkoriand

Teddlie's(2008)principleofintegrativeefficacy,withattentiongivento

completeness,elaboration,comparison,andcontrastinbringingtogetherfindings.

Consistentwithguidance,thecontributionsofeachstrandarediscussed

independentlybeforeconsideringwhatthetwostrandsofferjointly(Tashakkori&

Teddlie,2008a;Teddlie&Tashakkori,2009).

4.12EthicalConsiderations

Ethicalconsiderationsarediscussedherewithattentiontoresponsibilities

to(a)Participants,(b)researchsponsors,(c)theeducationalresearchcommunity,

and(d)educationalprofessionals,policymakers,andthegeneralpublic,consistent

withguidancefromtheBritishEducationalResearchAssociation(2011).Ethical

approvalfortheHeadStartevaluation,whichextendstothisstudy,wasgrantedby

theUCLResearchEthicsCommittee,forthequalitativestrandonSeptember30th

2016(ref.7963/002)andforthequantitativestrandonNovember30th2016(ref.

8097/003).

4.12.1ResponsibilitiestoParticipants

VoluntaryInformedConsent

Duetoparticipants’age,parent/carerconsentwassoughtinadditionto

informedassentfromparticipants.Forthequantitativestrand,opt-outconsentwas

utilisedgiventhattheprojectisconsideredapublictaskdesignedtobenefitthe

widerpopulation.Aspreviouslyoutlined,parents/carerswereprovidedwithan

CHAPTERFOUR:METHOD

136

informationpack(AppendixK)containinganinformationsheetoutliningdetailsof

theresearch,thenatureofparticipation,thedatatobeaccessed,datastorageand

usage,andcontactdetails,aswellasanopt-outconsentform.Educationsettings

wererequiredtoissuethisinformationpackatleasttwoweeksbeforedata

collectiontoprovidetimeforreturnofopt-outforms.Priortomeasurecompletion,

participantswerepresentedwithaninformationsheetoutliningthesame

informationinage-appropriatelanguage(AppendixL)andwereaskedtogive

informedassentbytickingaboxtoproceed.

Forthequalitativestrand,opt-inconsentwasused.Parents/carerswere

providedwithaninformationpack(AppendixN)containinganinformationsheet,

outliningtheresearch,thenatureofparticipation,thebenefitsandrisksoftaking

part,datastorageanduse,privacyboundaries,withdrawalinformation,and

contactdetails,alongsideaparentalconsentformtobecompletedandreturned.

Participantswereprovidedwithinformationsheetsoutliningthisinformationin

age-appropriatelanguage(AppendixM).Priortoeachinterview,interviewers

reviewedtheinformationsheetwiththeparticipanttoconfirmunderstandingand

providedopportunitiestoaskquestionsbeforeseekingwrittenassentfrom

participants(AppendixO).

RighttoWithdraw

Participantsmaintainedtherighttowithdrawfromtheresearchatany

time.Thiswasclearlyoutlinedinbothresearchstrandsalongsideassurancethat

participantscouldwithdrawforanyornoreason.

ChildrenandVulnerableYoungPeople

Giventhatparticipantsinthecurrentstudywereaged11–12years,several

measuresweretakentoensureappropriateengagement.Forinstance,all

interviewersheldup-to-dateDisclosureandBarringServiceschecks,age-

appropriateinformationwasprovidedtofacilitateinformedparticipation,and

appropriatedatacollectionmaterialswereusedthroughoutallstagesofthestudy.

Considerationwasalsogiventothesensitivetopicsdiscussedininterviews,

ensuringwellbeinginthisprocessandsignpostingrelevantinformationafterwards,

CHAPTERFOUR:METHOD

137

asdetailedinSection4.7.2.Potentialburdenforquantitativeparticipantswas

minimisedthroughuseofshortformsofmeasureswhereavailableand

appropriate.

Incentives

Qualitativeparticipantsweregivena£10shoppingvoucherfollowing

interviews.Whilethiswasintendedasatokenofthanks,participantswereaware

ofthisbeforetheinterviewandthereforeitcouldbeconsideredanincentive.One

concernisthatafinancialincentivemaycauseyoungpeopletooverlooktherisksof

participation(Seymour,2012),howeverresearchsuggeststhatyoungpeoplecan

viewfinancialincentivesasabonus,ratherthantheirmainreasonforparticipation

(CooperRobbinsetal.,2012).Consistentwithguidelines(CooperRobbinsetal.,

2012;Seymour,2012),this“incentive”wassmallandage-appropriateand

participationremaineddependentonparentalconsent.

Privacy

Dataweretreatedwithconfidentialityandanonymity.Compliantwiththe

DataProtectionAct1998(TheStationeryOffice),participantswereprovidedwith

clearinformationregardingdatastorageandusageandmaintaintherighttoaccess

datarelatingtothem.Researchersstoredelectronicdataonasecurepassword-

protectedserverandwrittenconsentformsinlockedcabinets.Datasetswere

anonymisedpriortousagehere,includingnamesofpeopleorplacesdiscussedby

qualitativeparticipants.

Disclosure

Interviewswerecarriedoutwithadherencetosafeguardingandchild

protectionpoliciesandprocedures.Ifaninterviewerperceivedariskofharmtothe

participantortoothers,thiswassharedwiththesetting’ssafeguardingofficerand

theprincipalinvestigator.Bothparents/carersandparticipantsweremadeaware

ofthisprocedurepriortodatacollection.Whereverpossible,interviewersinformed

participantsofintendeddisclosures.Safeguardingconcernsandactionstakenwere

loggedandstoredsecurely.

CHAPTERFOUR:METHOD

138

4.12.2ResponsibilitiestoSponsorsoftheResearch

Thisresearchwasfacilitatedthroughaccesstodatagatheredforthe

evaluationofHeadStartandtheNCLFarethereforesponsorsofthecurrentstudy.

Thestudyhasbeencompletedinaccordancewiththeagreementsrelatingto

sponsorshipoftheHeadStartevaluationandtheNCLFwillbemadeawareof

findings.

4.12.3ResponsibilitiestotheCommunityofEducationalResearchers

Findingswillbedisseminatedamongtheeducationalresearchcommunity,

tosharecontributionstoknowledgeandfortransparency.

4.12.4ResponsibilitiestoEducationalProfessionals,Policymakers,andthe

GeneralPublic

Findingswillbedisseminatedatvariouslevels,includingeducational

professionals,policymakersandthegeneralpublic.Thiswillbefacilitatedpartly

throughexistingrouteswithinHeadStart,suchasthroughpublicationofevidence

briefingsandpresentationatworkshopswithpartnershipleads,andthrough

publicationstargetingprofessionalsandyoungpeople.

4.13ChapterSummary

Thestudyusedamixedmethodsdesigntodevelopacomprehensive

understandingofemotionalsymptomsamongearlyadolescentgirls.The

quantitativestrandincluded8,327participants,usingSEMtoinvestigateriskeffects

andmechanismsaswellasfactorssupportingpositiveoutcomes.Inthequalitative

strand,IPAwasusedtoexplorethelivedexperienceofthreeearlyadolescentgirls

experiencingemotionalsymptomsinthecontextofriskexposure.Strategieswere

utilisedtofacilitatequalityandrigourandethicalconsiderationshavebeen

addressed.

CHAPTERFIVE:QUANTITATIVERESULTS

139

Chapter5:QuantitativeResults

5.1.ChapterOverview

Thischapterpresentsquantitativeresultspertainingtotheoverarching

researchquestions1and2.Itpresentsanoverviewofpreliminaryanalysesbefore

addressingspecificresearchquestions.Theriskfactorsassociatedwithemotional

symptomsarepresented,followedbyevidencerelatingtomultipleriskeffectsand

indirecteffectsviastressappraisalprocesses.Finally,resultsforpromotiveand

protectivefactorsarepresented.

5.2PreliminaryAnalyses

Preliminaryanalysisinvolvedexploringmissingness,reviewingdataagainst

analyticalassumptionsforSEM,andassessmentofeachmeasure’sfactorstructure

andpsychometricproperties.Abriefsummaryofresultsispresentedhereanda

moredetailedaccountofthisprocesscanbefoundinAppendixT.

Allsurveyitemshadmissingvalues(2.3–5.9%)andalldemographic

variablesexceptCINstatuscontainedmissingvalues(0.4–7.2%).Thisisan

acceptablelevelofmissingnessgivenuseofalargesample(Cheema,2014).32.3%

ofparticipants(N=2,681)hadatleastonemissingvalueacrossitemand

demographicvariables.Little's(1988)missingcompletelyatrandom(MCAR)test

wassignificantatthe.05αlevel(p<.001)andmissingnesswaspredictedby

participantcharacteristicsincludinglowacademicattainment,SEN,ethnicity,

Englishasanadditionallanguage,andneighbourhoodsocioeconomicdeprivation;

thus,missingnesswasassumedtobemissingatrandom(MAR).

Table5.1(overleaf)summarisesresultsfromthereviewofdataagainst

analyticalassumptions(seeAppendixTformoredetailedthresholdandprocedural

details).Thereweresomedeparturesfromnormaldistributionalassumptions,but

thesearelessproblematicinlargersamples(Kline,2016).Furthermore,theWLSMV

estimatorusedformuchofthemainanalysisdoesnotmakedistributional


140

assumptionsaboutordinalfactorindicators(Li,2016)andtheMLRestimatorused

insensitivityanalysesproducesstandarderrorsrobusttonon-normality(Muthén&

Muthén,1998-2010).

Table5.1

SummaryofDataAssumptionReviewacrosstheDataset

Assumption Summaryofdatareview

Outliers 16SRSitemscores,allfamilyadultconnectionandcommunityadult

connectionitems,andeightschoolconnectionitemsidentifiedasoutliers

Multicollinearity üBivariatecorrelationcoefficientsdidnotexceed.70

Skewness üSkewnessdidnotexceedanabsolutevalueof2

Kurtosis üKurtosisdidnotexceedanabsolutevalueof7

Flooreffects ObservedforallSDQitems(24.2–52.1%),thetwopositively-wordedPSS-4

items(21.1–28.4%),oneschooladultconnectionitem(19.2%),andone

engagementinextracurricularactivitiesitem(26.3%)

Ceilingeffects ObservedforallSDQitems(17.4–42.0%),andallbutoneSRSsubscaleitems

(27.9–87.1%)

Linearity üResidualsclusteredaroundthezerolineinaresidualplot

Homoscedasticity üDatapointswereevenlydistributedaroundthezerolineinaresidualplot

Note.SRS=StudentResilienceScale;SDQ=StrengthsandDifficultiesQuestionnaire

ExplorationofmodelfitandfactorloadingsfortheSDQemotional

symptomssubscaleshowedsupportforaunidimensionalstructurewithfactor

loadingsrangingbetween.51–.78andacceptableinternalconsistency(α=.72;ω=

.80).Resultsalsosupporteda6-domainmultidimensionalstructureacrosstheSRS

withfactorloadingsbetween.66–92andgoodinternalconsistencyforallscales(α

=.71–.93;ω=.81–.96).

ExaminationofthePSS-4showedpoorfitfortheunidimensionalmodel

proposedbyCohenetal.(1983),whereasthe2-factorstructurecomprising

perceiveddistressandperceivedcopingshowedgoodfit.Althoughinternal

consistencyforperceiveddistresswasacceptable(α=.71;ω=.76),lowvalues

wereobservedforperceivedcoping(α=.57;ω=.62),likelybecausethis


141

multidimensionalstructureappearsinparttobetheresultofreversewording

effects(Demkowiczetal.,2019),indicatinganeedforcautionininferences.

Cautionisalsonecessarygiventhatthesesub-factorscompriseonlytwoitems

each,as2-itemfactorscanbeunstableandproducelessreliableresultsthanthose

comprisedofagreaternumberofitems(Brown,2015;MacCallum,Widaman,

Zhang,&Hong,1999;Raubenheimer,2004).However,thiswasnotwithinthe

controlofthecurrentstudygivenuseofsecondarydata;thus,thestudysoughtto

offeranexploratoryexaminationofthestresshypothesisthatshouldbe

investigatedinfutureworkusingmorerobustmeasurementapproaches.

Finally,Table5.2presentsdescriptivestatisticsforthecontinuousvariables

utilisedacrossanalysis.Thereareveryfewstudiespublishingmeanscoresforthe

SDQemotionalsymptomssubscaleamongrecentcohortsinEngland,particularlyso

whenitcomestodistributionforgirlsspecifically.However,itshouldbenotedthat

themeanscoreinthecurrentstudyexceedsthatsharedbyFinketal.(2015),who

reportedameanscoreof3.49forgirlsina2014sample,whichwasfoundtobe

significantlyhigherthanscoresinapreviouscohortin2009.Assuchitappearsthat

thesampleisperhapsreportingelevatedsymptoms,ashighlightedinSection4.5.1.

Table5.2

DescriptiveStatisticsforContinuousVariables

Variable M SD Scorerange

Emotionalsymptoms(SDQ) 4.28 2.52 0–10

Perceiveddistress(PSS-4items1and4) 2.98 2.13 0–8

Perceivedcoping(PSS-4items2and3) 4.29 1.83 0–8

Familyadultconnection(SRS) 18.02 2.65 4–20

Schooladultconnection(SRS) 15.44 3.80 4–20

Communityadultconnection(SRS) 17.61 3.37 4–20

Schoolpeerconnection(SRS) 54.87 10.53 13–65

Activeengagementinhomeandschoollife(SRS) 13.81 3.57 4–20

Engagementinextracurricularactivities(SRS) 7.24 2.79 2–10

Neighbourhoodsocioeconomicdeprivation(IDACI) .24 .14 .01–.81

Note.SDQ=StrengthsandDifficultiesQuestionnaire;PSS-4=four-itemPerceivedStressScale;SRS=

StudentResilienceSurvey;IDACI=IncomeDeprivationAffectingChildrenIndex.


142

5.3ResearchQuestion1:RiskFactorsandProcesses

1.Whataretheriskfactorsandprocessesassociatedwithemotionalsymptoms


5.3.1RiskFactors

a.Oftherisksidentified,whatisthemagnitudeoftheirassociationwithearly


StageOne:Pre-Analysis

Table5.3(overleaf)presentsICCvaluesandbivariatecorrelationcoefficients

forvariablesinthisanalysis.

143

Table5.3

IntraclusterCorrelatio

nCo

efficientsa

ndBivariateCorrelatio

nCo

efficientsforVariablesinRQ1a

10

—

Note.IC

C=intraclustercorrelatio

ncoefficient;SEN

=sp

ecialedu

catio

nalneeds;A

CEs=

adversechildho

odexperiences.

*p<.05.**p<.01.***p<.001

.

9 —

.15*

**

8 —

.10*

**

.11*

**

7 —

.15*

**

.21*

**

.37*

**

6 —

.12*

**

.07*

**

.05*

**

.10*

**

5 —

-.13*

**

-.17*

**

-.10*

**

-.07*

**

-.15*

**

4 —

-.32*

**

-.28*

**

-.17*

**

.10*

**

-.07*

**

-.15*

**

3 —

.01

.01

.01

-.01

-.02

-.02

-.01

2 —

-.49*

**

.06*

**

-.08*

**

.03*

*

.00

.03*

.03*

.01

1 —

.01

-.02

.07*

**

-.05*

**

.06*

**

.07*

**

.12*

**

.02*

**

.03*

ICC

.02

.00

.00

.25

.26

.14

.22

.03

.12

.40

Varia

ble

1.Emotiona

lsym

ptom

s

2.You

ngre

lativ

eage(you

ngest)

3.You

ngre

lativ

eage(m

iddle)

4.Low

acade

micattainm

ent

5.Highacad

emicattainm

ent

6.SEN

7.Low

familyincome

8.Caregivingrespon

sibilitie

s

9.ACE

s

10.N

eighbo

urho

od

socioe

cono

micdep

rivation


144

StageTwo:MainAnalysis

Eachhypothesisedriskvariablewasassessedbasedonthedirection,

statisticalsignificance,andmagnitudeoftheregressionpathwayontoemotional

symptoms.Positivebetaswereexpectedforallpathways.Betaregression

coefficientsareshowninTable5.4(below)andFigure5.1(overleaf).Modelfit

indicesshowedgoodfit:χ2(41)=321.03,p<.001;RMSEA=.03,90%CI[.03,.03],p

=1.00;CFI=.97,TLI=.95.SensitivityanalysisutilisingMLRyieldedsimilarresults.

Table5.4

UnstandardisedandStandardisedRegressionBetaCoefficientsandStandardErrorsforHypothesised

RiskVariablesasPredictorsofSymptoms(n=7,326)

Unstandardised Standardised

Hypothesisedriskfactor B SE β SE

Youngrelativeage(youngest)a -0.01 0.02 -.02 .04

Youngrelativeage(middle)a -0.04 0.02 -.07 .04

Lowacademicattainment 0.06** 0.02 .11** .04

Highacademicattainment -0.01 0.02 -.03 .04

SEN 0.08** 0.02 .15** .05

Lowfamilyincome 0.05** 0.02 .10** .03

Caregivingresponsibilities 0.17*** 0.02 .33*** .04

ACEs 0.01 0.03 .02 .06

Neighbourhoodsocioeconomicdeprivation -0.11* 0.05 -.03* .02

Note.SEN=specialeducationalneeds;ACEs=adversechildhoodexperiences.aEldestyoungrelativeagegroup(bornSeptember–December)utilisedasreferencecategoryfor

dummyvariables.

*p<.05.**p<.01.***p<.001.

Resultsindicatedfourconfirmedriskfactorsthatwerestatisticallysignificant,inthe

expecteddirection,andmeaningfulinsize:(a)Lowacademicattainment,(b)SEN,

(c)lowfamilyincome,and(d)caregivingresponsibilities.Thefirstthreeweresmall

inmagnitude,whileamoderateassociationwasobservedbetweencaregiving

responsibilitiesandemotionalsymptoms.Theseriskfactorsformthebasisfor


145

subsequentanalysesinresearchquestionsfocusedonriskprocesses(RQs1b–dand

2b).

Onefurtherhypothesisedriskvariable,neighbourhoodsocioeconomic

deprivation,wasfoundtobestatisticallysignificant(p=.04).However,the

parameterestimateshowedthatthiswasintheoppositedirectiontothat

theoreticallyexpectedandwasnearingzeroinsize(β=-.03).Assuch,thiswas

discountedasariskfactor.Theremainingthreehypothesisedriskvariableswere

alsorejectedasriskfactors,astheywerenotstatisticallysignificant:(a)Young

relativeage(bothyoung[p=.58]andmiddle[p=.06]referencegroups);(b)high

academicattainment(p=.41);and(c)ACEs(p=.60).

Figure5.1.Riskfactorsmodel.Standardisedbetacoefficientswithconfirmedriskfactorsinbold

type.SEN=specialeducationalneeds.

*p<.05.**p<.01.***p<.001.


146

5.3.2CumulativeRiskEffects

b.Isthereevidenceforacumulativeriskeffectinrelationtoearlyadolescentgirls’

emotionalsymptoms?

StageOne:CreationofaCumulativeRiskIndex

ThefourriskfactorsidentifiedinRQ1aweresummedtocreatea

cumulativeriskindex,namelylowacademicattainment,SEN,lowfamilyincome,

andcaregivingresponsibilities.Initially,acumulativeriskindexincludingallfourrisk

factors(0–4)wascreated.Forinstance,aparticipantwithascoreof4isrecorded

asexposedtoallfourriskfactors,whileaparticipantwithascoreof0isrecorded

asexposedtonone.However,lessthanonepercent(n=69)ofparticipantshada

scoreof4.Inspectionofalinechartbetweenthecumulativeriskindexand

emotionalsymptomsindicatedstabilityintheeffectsbetweenthreeandfour

factors(Figure5.2,overleaf).Assuch,theuppertwocategorieswerecollapsedto

captureparticipantsexposedtothreeormoreriskfactors,creatinganindex

spanning0to3+.AsoutlinedinSection3.3.1,thisisconsistentwithapproachesin

previousstudies(e.g.,Oldfieldetal.,2015;Panayiotou&Humphrey,2018;Rutter,

1979)andindicatesthepointatwhichparticipantsareconsideredsaturatedwith

riskfactors.


147

Figure5.2.Linechartforemotionalsymptomsandthecumulativeriskindex.Emotionalsymptomsis

onthey-axisandtheoriginal0–4cumulativeriskindexisonthex-axis.

Thelargestproportionofthesamplepresentednoriskfactors,withincrementally

fewerparticipantsrepresentedateachlevelofexposure(seeTable5.5).This

distributionisconsistentwithageneralpatternacrosscumulativeriskresearch,

whereinmostindividualswithincommunitysamplesareexposedtoveryfewrisk

factors,ifany,andfewareexposedtothespecificcombinationexaminedinany

onestudy(Evansetal.,2013).

Table5.5

DistributionoftheSampleAcrosstheCumulativeRiskIndex(M=0.82,SD=0.90)

Numberofriskfactors n Proportionofsample(%)

0 3,771 45.3%

1 2,745 33.0%

2 1,304 15.7%

3+ 490 5.9%

Note.Theremaining0.2%(n=17)hadmissingdataacrossallfourriskfactors.

StageTwo:Pre-Analysis

Priortothemainanalysis,theadjustedindexvariablewasreviewedagainst

analyticalassumptionsandwasfoundtobeacceptable.Missingdataacrossthefull


148

indexwaslow(0.2%),whileskewness(0.84)andkurtosis(-0.23)absolutevalues

werebelowadoptedthresholds.Asistypicalinriskresearch,manyparticipants

werenotexposedtoanyriskfactors,resultinginflooreffects(45.3%)andsothis

variablewastreatedascategoricalratherthancontinuousininterpretingresults,

consistentwithMplusguidance(Muthén,2006).Bivariatecorrelationcoefficients

weregivenparticularattentiontoscreenformulticollinearity,giventhatthe

cumulativeriskindexisacompositevariableconstructedusingriskfactors;

correlationcoefficientswererelativelyhigh(Table5.6),aswouldbeexpected,but

didnotexceed.70.

Table5.6

IntraclusterCorrelationCoefficientsandBivariateCorrelationCoefficientsforVariablesinRQ1b

Variable ICC 1 2 3 4 5 6

1.Emotionalsymptoms .02 —

2.Lowacademicattainment .25 .07 —

3.SEN .14 .06 .28 —

4.Lowfamilyincome .22 .07 .16 .12 —

5.Caregivingresponsibilities .03 .12 .12 .07 .15 —

6.Cumulativeriskindex .12 .13 .66 .47 .69 .55 —

Note.ICC=intraclustercorrelationcoefficient;SEN=specialeducationalneeds.

Allcorrelationcoefficientssignificantatthe.001alphalevel.

StageThree:MainAnalysis

Modelfitindicesindicatedacceptablefit:χ2(9)=430.25,p<.001;RMSEA=

.08,90%CI[.07,.08],p<.001;CFI=.96;TLI=.93.TheTLIvaluewasslightlylower

thanthethresholdof.95;however,theresidualcorrelationmatrixandMIandSEPC

valuesdidnotindicatespecificlocalisedissues.Assuch,thiswasconsidered

acceptablebutprovidedfurtherjustificationforexploringalternativemodelling

approachesinRQ1c.Resultsshowedastatisticallysignificantrelationship(see

Figure5.3andTable5.7,overleaf).


149

Figure5.3.Statisticalmodelforcumulativeriskwithstandardisedregressionbetacoefficient.

***p<.001.

Consistentwithguidance(Evansetal.,2013),thiswasinvestigatedfurtherto

examinewhetherobservedeffectswereattributabletotheindexor,alternatively,

drivenbyasingleriskfactorcontainedwithinit.Totestthis,thismodelwas

repeatedfourtimeswitheachindividualriskfactoraddedinturn(seeFigure5.4).If

observedeffectswereattributabletoasingleriskfactorratherthantheindex,it

wouldbeexpectedthatincludingthatfactorasacovariatewouldaffectthe

significanceofthispathway.

Figure5.4.Conceptualmodelforcumulativeriskeffectswithcovariatemodel.SEN=special

educationalneeds.

ParameterestimatesforbothmainandcovariateanalysesareshowninTable5.7

(overleaf);sensitivityanalysesusingMLRyieldedsimilarresults.


150

Table5.7

UnstandardisedandStandardisedRegressionBetaCoefficientsandStandardErrorsforthe

CumulativeRiskIndexasaPredictorofSymptoms


Model:Predictorandcovariate B SE β SE

CRindexonly(n=8,185)

Cumulativeriskindex 0.09*** 0.01 .17*** .02

CRindex+lowacademicattainment(n=7,799)


Lowacademicattainment -0.03 0.02 -.06 .05

CRindex+SEN(n=8,061)


SEN 0.00 0.03 .00 .05

CRindex+lowfamilyincome(n=8,033)


Lowfamilyincome -0.05* 0.02 -.10* .04

CRindex+caregivingresponsibilities(n=7,720)


Caregivingresponsibilities 0.11*** 0.02 .21*** .05

Note.Parameterestimatesforthecumulativeriskindexareshowninboldtype.CR=cumulative

risk;SEN=specialeducationalneeds.

*p<.05.***p<.001.

Resultsindicatedthatthecumulativeriskindexremainedstatisticallysignificant

afterincludingeachriskfactorasacovariate,suggestingthateffectsare

attributabletotheindex.However,bothlowfamilyincomeandcaregiving

responsibilitieswerestatisticallysignificantcovariates.Furthermore,although

parameterestimatesfortheriskindexwererelativelysimilarinsizealongsidethe

firstthreecovariates(β=.17–.20),thiswascomparativelysmallerwhencaregiving

responsibilitieswasadded(β=.12)andindeedthiscovariatewaslargerin

magnitude(β=.21).Thus,thoughfindingsdidindicatecumulativeriskeffects,it

appearsthatspecificriskfactorsmaycontributetoadditionalvarianceormay

explainvaryingproportionsofcumulativeriskeffects.


151

5.3.3RiskMeasurementModels

c.Whichriskmeasurementmodelbestexplainstheeffectsofexposuretomultiple

riskfactorsinrelationtoearlyadolescentgirls’emotionalsymptoms?

Threeriskmeasurementmodelswereassessedaspredictorsofemotional

symptoms:(a)ModelAcomprisesamultipleregressionapproachwithindividual

riskpredictors,(b)ModelBincludesthecumulativeriskindexcreatedinRQ1basa

singlemanifestpredictor,and(c)ModelCexploresalatentriskconstructasa

predictor.Figure5.5(overleaf)showsconceptualmodelsforeachofthese

approachesinlightoftheriskfactorsidentifiedinRQ1a(lowacademicattainment,

SEN,lowfamilyincome,andcaregivingresponsibilities).


152

Figure5.5.Multipleriskexposuremeasurementmodels.ModelAshowsamultipleregression

approach,ModelBspecifiesthecumulativeriskindexasapredictor,andModelCcomprisesalatent

riskconstruct.SEN=specialeducationalneeds.


153


Table5.8presentsICCvaluesandbivariatecorrelationcoefficientsfor

variablesinthisanalysis.

Table5.8

IntraclusterCorrelationCoefficientsandBivariateCorrelationCoefficientsforVariablesinRQ1c

Variable ICC 1 2 3 4 5 6

1.Emotionalsymptoms .02 —

2.Lowacademicattainment .25 .07 —

3.SEN .14 .06 .28 —

4.Lowfamilyincome .22 .07 .16 .12 —

5.Caregivingresponsibilities .03 .12 .12 .07 .15 —

6.Cumulativeriskindex .12 .13 .66 .47 .69 .55 —


Allcorrelationcoefficientsaresignificantatthe.001level.

StageTwo:CreationofaLatentRiskConstruct

Priortothemainanalysis,CFAwasusedtoassessthelatentriskconstruct

andameasurementmodelwasexploredforthisfactorandtheemotional

symptomssubscale.Fitindicesdidnotindicateoptimalfit,withtheTLIvalue

substantiallylowerthantheadvised.95:χ2(2)=47.72,p<.001;RMSEA=.05,90%

CI[.04,.07],p=.35;CFI=.94,TLI=.81.MIvaluesexceeding10andSEPCvalues

exceeding.20indicatedthattheresidualcorrelationbetweenlowacademic

attainmentandSENshouldbefreelyestimated,alongsideresidualcorrelations

matrixvaluesexceeding.10.Factorloadingswereunequalandwide-ranging,with

largeloadingsforlowacademicattainmentandSENbutmuchsmallerestimatesfor

lowfamilyincomeandcaregivingresponsibilities(seeTable5.9,overleaf),

suggestingthatthesetwoitemswerebetterrepresentedbythelatentriskfactor.


154

Table5.9

UnstandardisedandStandardisedFactorLoadingsandIntraclusterCorrelationCoefficientsforthe

LatentRiskConstruct(n=8,310)

λ

Riskindicator Unstandardised Standardised ICC

Lowacademicattainment .76 .76 .25

SEN .71 .71 .14

Lowfamilyincome .44 .44 .22

Caregivingresponsibilities .33 .33 .03


Allparameterestimatesshownaresignificantatthe.001alphalevel.

Conceptually,thiswasunsurprisinggiventhatpupilswithSENinEnglandgenerally

showloweracademicattainmentthantheirpeers(Humphreyetal.,2013).Assuch,

followingbothpriortheoryandevidence,thefactormodelwasre-specifiedwith

theresidualcorrelationbetweenlowacademicattainmentandSENfreely

estimated,ratherthanconstrainedtozero.Thisadjustmentresultedinexcellentfit;

χ2(1)=1.33,p=.25RMSEA=.01,90%CI[.00,.03],p=1.00;CFI=1.00,TLI=1.00,

withacceptableMI,SEPC,andresidualcorrelationsthresholds.Factorloadings

wereobservedtobemoreconsistentinmagnitude,asshowninTable5.10.As

such,thismodelwasusedinsubsequentanalyses.

Table5.10

UnstandardisedandStandardisedFactorLoadingsfortheLatentRiskConstructwithCorrelated

Residuals(n=8,310)

λ

Riskindicator Unstandardised Standardised

Lowacademicattainment .49 .49

SEN .44 .44

Lowfamilyincome .60 .60

Caregivingresponsibilities .44 .44

Note.Allparameterestimatesshownaresignificantatthe.001alphalevel.


155

Finally,ameasurementmodelwasspecifiedincludingthelatentrisk

constructandthelatentemotionalsymptomsfactorpriortothemainanalysis(n=

8,324).Fitindicesshowedthatthemeasurementmodelhadgoodfittothedata:χ2

=(25)466.45,p<.001;RMSEA=.05,90%CI[.04,.05],p=.96;CFI=.96,TLI=.94.

ExaminationofmodificationindicesandSEPCvaluesindicatedsomelocalised

strain,howeverasthemodelshowedgoodoverallfitandCFIandTLIvalueswere

generallyacceptable,thesevalueswerenotconsideredtobeproblematicbutwere

noted.Thestandardisedlatentcorrelationbetweenthelatentriskconstructand

emotionalsymptomswas.30(p<.001),whichindicatesamoderateassociationin

theexpecteddirection.Assuch,resultsindicatedthatthemeasurementmodelwas

viableforuseinthesubsequentstructuralmodel(ModelC).


Thevarianceexplainedbyeachriskmeasurementapproachasapredictor

ofemotionalsymptomsispresentedoverleafinTable5.11alongsidemodelfit

indices,parametercoefficients,andstandarderrors.Figure5.6(overleaf)illustrates

keyinformationinthecontextofeachmodel.Itshouldbenotedthatasensitivity

analysisusingMLRdidnotproducesubstantiallydifferentestimatesthanthose

obtainedusingWLSMV;however,thevarianceexplainedbythelatentrisk

constructwasslightlysmallerinMLR(5.7%)relativetothatproducedinWLSMV

(8.8%).Inspectionofmodelfitindicesindicatedthatallmodelsshowedacceptable

fittothedata,althoughRMSEAvalueswereslightlyhighforModelB.Itshouldbe

notedthatnodirectcomparisonofmodelfitcanbemadeforthesemodelsgiven

thattheyarenon-nested.Thus,inspectionofmodelfitwasinsteadfocusedon

whethereachofthemeasurementmodelscouldbeconsideredanappropriate

representationofriskanditsrelationshipwithemotionalsymptomswithinthis

sample.

156

Table5.11

Unstand

ardisedan

dStan

dardise

dRe

gressio

nBe

taCoefficientsand

Mod

elFitIndicesforth

eMultip

leRisk

ExposureMod

els

Stan

dardise

d SE

.02

.01

.02

.02

.02

.03

Note.M

odelsa

resh

owninboldtype

.R2 =

varianceexplaine

d;SEN

=sp

ecialedu

catio

nalneeds.

**p<.01.***p<.001

.

β .06*

**

.03*

*

.04*

*

.12*

**

.17*

**

.30*

**

Unstand

ardised SE

0.02

0.02

0.02

0.02

0.01

0.01

B 0.08

***

0.07

**

0.05

**

0.17

***

.09*

**

0.16

***

R2

2.8%

2.4%

8.8%

Mod

elfitind

ices

χ2(2

1)=483

.10,p<.001

;RMSEA=.05,90%

CI[.05

,.06

],p=.27;CFI=.95,TLI=.92

χ2 (9)=

430

.25,p<.001

;RMSEA=.08,90%

CI

[.07,.08],p<.001

;CFI=.96,TLI=.93

χ2 (25)=466

.45,p<.001

;RMSEA=.05,90%

CI[.04

,.05

],p=.96;CFI=.96,TLI=.94

Mod

eland

predictors

Mod

elA:M

ultip

lere

gressio

n(n=8,324

)

Low

acade

micattainm

ent

SEN

Low

familyincome

Caregivingrespon

sibilitie

s

Mod

elB:C

umulativerisk(n=8,185

)

Cum

ulativeriskinde

x

Mod

elC:Laten

trisk

con

struct(n

=8,324

)

Laten

trisk

con

struct


157

Figure5.6.Statisticalmultipleriskexposuremeasurementmodelswithstandardisedbeta

coefficients.SEN=specialeducationalneeds.

**p<.01.***p<.001.


158

Intermsofexplanatorypower,thecumulativeriskindexinModelBpredictedthe

leastvarianceinemotionalsymptomsacrossthesample(2.4%).Comparatively,the

inclusionofallindividualriskfactorsaspredictorsinModelApredictedaslightly

higheramountofvariance(2.8%).Howeverofthethreemodels,thelatentrisk

constructinModelCpredictedasubstantialamountmorevarianceofemotional

symptoms(8.8%).Itshouldbenoted,however,thatthesearesmallproportionsof

variance;acrosstheliteratureitappearsthatthiscanvarywidely,withsome

studiesfindinglessthantenpercentofvariancebeingpredictedbymultiplerisk

exposureinrelationtochildandadolescentinternalisingoutcomes(Morales&

Guerra,2006)andothersfindinggreateramountssuchas20-30%(Bayeretal.,

2012;Gerard&Buehler,2004;Halletal.,2010)orabove(Patalay&Fitzimons,

2018).However,someofthesestudiesmakeuseoflargernumbersofriskfactors

thanwereavailableinthecurrentstudy.Givenexaminationofsuchsmallfiguresin

predictingvariance,then,theincreasefrom2.8%to8.8%isnotanegligible

increase.Indeed,ofthetwomodelsthatdirectlymodelmultipleriskexposureasa

singularconstruct,ModelB(cumulativerisk)showedasmallassociation(β=.17),

whileModelC(latentconstruct)showedasmalltomoderateassociation(β=.30).

InlightoftheresultsforRQ1c,itwasdeemedappropriatetomakeuseof

thelatentriskconstructinsubsequentanalysesthatincludemultipleriskexposure,

namelyRQs1dand2b,giventhatthisshowedthegreatestpredictivepowerin

relationtoemotionalsymptoms.

5.3.4IndirectEffectsofStress

d.Arethereindirecteffectsofperceivedstressintherelationshipbetweenmultiple

riskexposureandemotionalsymptoms?

Thisresearchquestionfocusesonthedirectandindirectpathways

operatingwithinmultipleriskeffects,focusingonperceivedstress.Givenearlier

CFAresultsthePSS-4wasmodelledusingtwofactors,“perceiveddistress”and

“perceivedcoping”,andthustwoindirectpathwaymechanismswerespecified.


159


Table5.12presentsICCvaluesandbivariate(leftdiagonal)andlatent(right

diagonal)correlationcoefficientsforvariablesinthisanalysis.

Table5.12

IntraclusterCorrelationCoefficientsandBivariate(leftdiagonal)andLatent(rightdiagonalandbold

type)CorrelationCoefficientsforVariablesinRQ1d

Variable ICC 1 2 3 4

1.Emotionalsymptoms .02 — .31 .74 -.56

2.Risktotalscore .11 .13 — .27 -.41

3.Perceiveddistress .01 .52 .11 — -.45

4.Perceivedcoping .01 -.36 -.17 -.29 —

Note.ICC=intraclustercorrelationcoefficients.

Allcorrelationcoefficientsshownaresignificantatthe.001alphalevel.

Ameasurementmodelwascarriedoutforallfourlatentvariablespriortothemain

analysis,whichshowedgoodfittothedata:χ2(58)=885.90,p<.001;RMSEA=.04,

90%CI[.04,.04],p=1.00;CFI=.96,TLI=.95.Resultsindicatedastrongassociation

betweenemotionalsymptomsandperceiveddistress,thoughthiswasbelowthe

suggested.85thresholdforextremecollinearityacrosslatentfactors(Brown,2015)

andsonotconsideredproblematic.

StageTwo:MainAnalysis

Table5.13(overleaf)presentsthedirect,indirect,andtotaleffectsof

multipleriskexposure,perceiveddistress,andperceivedcopingonemotional

symptoms.Modelfitindicesshowedacceptablefit:χ2(58)=885.90,p<.001;

RMSEA=.04,90%CI[.04,.04],p=1.00;CFI=.96,TLI=.95.Notethatthe

relationshipbetweenperceiveddistressandcopingwascontrolledforinthismodel

giventhattheyareconsideredinter-relatedconstructs.


160

Table5.13

UnstandardisedandStandardisedBetaCoefficientsforDirect,Indirect,andTotalEffectsofMultiple

RiskExposure,PerceivedDistress,andPerceivedCopingonEmotionalSymptoms(n=8,324)


Path B SE β SE R2

Totaleffect 0.41*** 0.05 .31*** .03 60.5%

Directeffect 0.05 0.03 .04 .03

Totalindirecteffects 0.36*** 0.04 .27*** .02

Indirectpathway1:Perceiveddistress

Indirecteffects 0.21*** 0.03 .16*** .01

Risk→distress 0.48*** 0.06 .27*** .02 7.2%

Distress→emotional 0.45*** 0.01 .61*** .01

Indirectpathway2:Perceivedcoping

Indirecteffects 0.14*** 0.02 .11*** .01 16.7%

Risk→coping -0.66*** 0.07 -.41*** .03

Coping→emotional -0.22*** 0.02 -.27*** .02

Note.R2=varianceexplained.

***p<.001.

Resultsindicatedthatafteraccountingforindirecteffectstherewasnostatistically

significantdirectassociationbetweenmultipleriskexposureandemotional

symptoms.Statisticallysignificantmoderateeffectswereobservedforbothofthe

indirectpathwaysspecified.Individualdirectpathwaysvariedinsizefrom

moderatetolarge,withthestrongesteffectspresentforthepathwaybetween

perceiveddistressandemotionalsymptoms(β=.61).Thetotalindirecteffects,or

thejointeffectofbothoftheseindirectpathways,wereobservedtobestatistically

significantandsmalltomoderateinsize.Forreference,theindirecteffectsmodelis

illustratedbelowinFigure5.7(overleaf)alongsidetheoriginaldirecteffectsmodel

testedinRQ1c,whereindirectpathwayswerenotincluded.


161

Figure5.7.Directeffectsandindirecteffectsmodels.Positiveparametersareshowninblocklines,

inverseparametersareshownindashedlines,andnon-significantparametersareshownindotted

lines.UpperandlowercurvedarrowsinModelB(.16and.11)showindirecteffectpathways

betweenriskandemotionalsymptomsviaperceiveddistressandperceivedcoping,respectively.

Notethattheperceiveddistressandperceivedcopingarecorrelatedinthemodeltoaccountfor

theirsharedvariance.

***p<.001.

AsshowninTable5.13,inclusionoftheseindirecteffectpathwaysalsoexplaineda

muchgreaterproportionofthevarianceinemotionalsymptoms(60.5%)compared

tothatexplainedbythelatentriskconstructasasingularpredictorofthisoutcome


162

asobservedinRQ1c(8.8%).Giventheabove,resultsindicatethatassociations

operateentirelythroughindirectpathwaysviaperceiveddistressandcoping,or

“fullmediation”(Hayes,2017).

5.4ResearchQuestion2:FactorsandProcessesforPositiveOutcomes

1.Whatarethefactorsandprocessesthatsupportpositiveoutcomesinemotional

symptomsamongearlyadolescentgirls?

5.4.1PromotiveFactors

a.Ofthepromotivefactorsidentified,whatisthemagnitudeoftheirassociation

withearlyadolescentgirls’emotionalsymptoms?


Table5.14showsICCvaluesandbivariate(leftdiagonal)andlatent(right

diagonal)correlationcoefficientsforvariablesinthisanalysis.

Table5.14

IntraclusterCorrelationCoefficientsandBivariate(leftdiagonal)andLatent(rightdiagonalandbold

type)CorrelationCoefficientsforVariablesinRQ2a

Variable ICC 1 2 3 4 5 6 7

1.Emotionalsymptoms .02 — -.31 -.20 -.26 -.39 -.31 -.17

2.Familyadultconnection .08 -.21 — .52 .64 .50 .40 .53

3.Schooladultconnection .07 -.16 .39 — .50 .40 .53 .18

4.Communityadultconnection .11 -.19 .48 .39 — .52 .54 .34

5.Schoolpeerconnection .06 -.30 .38 .33 .42 — .55 .26

6.Activeengagementinhome

andschoollife

.10 -.24 .44 .42 .41 .45 — .40

7.Engagementinextracurricular

activities

.07 -.13 .20 .14 .24 .19 .29 —

Note.ICC=intraclustercorrelationcoefficient.

Allcorrelationcoefficientsshownweresignificantatthe.001alphalevel.


163

Ameasurementmodelwithalllatentvariablesshowedacceptablefit:χ2(573)=

4,320.31,p<.001;RMSEA=.03,90%CI[.03,.03],p=1.00,CFI=.98,TLI=.97(see

Table5.14aboveforlatentcorrelations).


Hypothesisedpromotivevariableswereassessedbyspecifyinglinear

regressionpathwaysontoemotionalsymptoms.Pathwayswereassessedbasedon

directionandstatisticalsignificance,withadditionalconsiderationofmagnitude,

withallvariablesexpectedtoshowinverseassociationswithemotionalsymptoms.

Modelfitindicesshowedgoodfit:χ2(573)=4,320.31,p<.001;RMSEA=.03,90%

CI[.03,.03],p=1.00;CFI=.98,TLI=.97(seeTable5.15belowandFigure5.8

overleaf).

Table5.15

UnstandardisedandStandardisedRegressionBetaCoefficientsandStandardErrorsforHypothesised

PromotiveVariablesasPredictorsofSymptoms(n=8,280)


Hypothesisedpromotivevariable B SE β SE

Familyadultconnection -0.09*** 0.02 -.14*** .03

Schooladultconnection 0.02 0.01 .03 .02

Communityadultconnection 0.01 0.01 .01 .02

Schoolpeerconnection -0.19*** 0.01 -.28*** .02

Activeengagementinhomeandschoollife -0.06*** 0.02 -.09*** .02

Engagementinextracurricularactivities -0.02 0.01 -.03 .02

Note.***p<.001.

Threeofthesixhypothesisedpromotivevariableswerestatisticallysignificantand

intheexpecteddirection:(a)Familyadultconnection,(b)schoolpeerconnection,

and(c)activeengagementinhomeandschoollife.Betacoefficientsvariedin

magnitude,thoughallweregenerallysmallinsize.Theassociationbetweenschool

peerconnectionandemotionalsymptomswasgreatestinsize,withasmallto

moderateassociation,whileparticipationinhomeandschoollifefellbelowthe


164

thresholdforasmalleffect.Thethreeremainingvariableswerenotstatistically

significantandwererejectedaspromotivefactors,specifically:(a)Schooladult

connection(p=.25);(b)communityadultconnection(p=.37);and(c)engagement

inextracurricularactivities(p=.09).

Figure5.8.Promotivefactorsmodel.Standardisedbetacoefficientsareshownwithconfirmed

protectivefactorsinboldtype.

***p<.001.

5.4.2ProtectiveFactors



protectivefactors?

Aconditionalindirecteffectsmodelwasinvestigated,withmoderators

modelledontheindirectperceiveddistressandcopingpathwaysidentifiedinRQ


165

1d.Theaimherewastoassesswhethertheseassociationsweredependentupon

thelevelofone’sperceivedsocialconnectionsandactiveengagement.Conditional

effectswerespecifiedforindirectpathwaysonlygiventhatresultsfromRQ1d

indicatedthatthedirecteffectwasnotsignificant,thusmeaningthereisnoeffect

tobemoderated.

StageOne:IdentificationofVariables

First,thesixSRSsubscaleswerereviewedtoidentifythoseexpectedtobe

mostsalientandthusprioritisedforanalysis.Table5.16(overleaf)presents

considerationsforeachofthesixpossiblemoderatorvariables;first,ashort

summaryoftheoryandpriorresearchisoutlined(basedonthereviewofthe

literaturepresentedinSection3.4.2),alongsidestandardisedparameterestimates

obtainedthroughalinearmultipleregressionmodelwhereinallsubscaleswere

includedaspredictorsofemotionalsymptoms,perceiveddistress,andperceived

coping.Theinclusionstatusofeachvariableasahypothesisedmoderatorisalso

presented.Specifically,fourvariableswereselectedforinclusion,showninbold

typeinTable5.16:(a)Familyadultconnection,(b)schooladultconnection,(c)

schoolpeerconnection,and(d)activeengagementinhomeandschoollife.Two

variableswereexcludedatthisstagegivenlimitedtheoreticalandempirical

support,namely(a)Communityadultconnectionand(b)engagementin

extracurricularactivities.

166

Table5.16

SixPo

ssibleM

oderatorVariableswith

Sum

maryofTheoryan

dPriorE

videncean

dRe

gressio

nCo

efficients(n=6,62

8)

Inclusionstatus

Varia

bleinclud

ed

givenstrong

theo

reticaland

em

piric

alsu

pporta

sa

salientfa

ctorfo

rall

outcom

es

Varia

bleinclud

ed

giventheo

retical

supp

orta

ndgrowing

empiric

alsu

pportin

previousstud

ies,

alon

gsideane

edfo

rexam

inationdu

ring

tran

sition,th

ough

weakem

piric

al

supp

ortw

asobserved

forthe

sample

Varia

bleno

tinclude

dgivenlim

ited

theo

reticalsu

pport

β(SE)

Perceived

coping

.11(.0

1)***

.07(.0

1)***

.03(.0

1)**

Perceived

distress

-.13(.0

2)***

-.05(.0

2)**

-.02(.0

2)

Emotiona

lsymptom

s

-.11(.0

2)***

-.02(.0

2)

-.02(.0

2)

Summaryofth

eoryand

prio

revide

nce

Conn

ectio

nwith

familym

embe

rsinchildho

odand

ado

lescen

ce

isconsidered

critical(U

mbe

rson

eta

l.,201

0)and

isassociated

with

lowerlevelsofinternalisingand

emotiona

lsym

ptom

s(e.g.,Co

stelloeta

l.,200

8;Row

eetal.,201

6),including

protectiv

eeffectsforth

oseexpo

sedtorisk(C

onger&

Con

ger,

2002

;Willeetal.,200

8).

Broa

derschoo

lcon

nected

nesshasfreq

uentlybeenassociated

with

lowered

emotiona

lsym

ptom

s(e.g.,B

ondetal.,200

7;

Costelloeta

l.,200

8)and

ithasbeenargued

thatpositivepup

il-teache

rrelationshipsarecriticallyim

portan

tforpositive

developm

enta

ndoutcomes(Jen

nings&

Green

berg,200

9);

inde

ed,the

reisso

meeviden

ceofa

nassociationbe

tweensuch

relatio

nshipsand

lowered

emotiona

lsym

ptom

s(M

urray&

Green

berg,200

0;W

angetal.,201

3).Thism

aybeaffected

du

ringpe

riodsoftransition

(Lou

kase

tal.,201

6).

Qua

litativeresearchindicatestha

tado

lescen

tsvalue

positive

andcarin

grelatio

nshipswith

trustedad

ultsre

gardlessofthe

irdo

mainorro

le(M

unford&San

ders,201

6;Ungar,200

4b),

Varia

ble

Familyadu

ltconn

ectio

n

Scho

oladu

ltconn

ectio

n

Commun

ity

adult

conn

ectio

n

167

andlackofe

vide

nceof

empiric

allym

eaningful

foro

utcomes

Varia

bleinclud

ed

givenconsisten

ttheo

reticaland

em

piric

alsu

pporta

ssalientacrossa

llou

tcom

es

Varia

bleinclud

edas

thereissome

theo

reticalsu

pport

thatth

ismaybe

meaningful,alon

gside

empiric

alsu

pport

acrossoutcomesinth

esample

Varia

bleno

tinclude

dasth

eoryand

prio

reviden

ceislimite

dan

dthereislittle

empiric

al

supp

ortforth

isas

salientacross

outcom

es

Note.Stand

ardisedpa

rameterestim

atesonlyareshow

nhe

refo

reaseofcom

parison

given

thatth

isissupp

lemen

taryana

lysis

.

P<.01.***p<.001

.

.17(.0

1)***

12.(02

)***

.06(.0

1)***

-.18(.0

2)***

-.08(.0

2)***

.01(.0

1)

-.27(.0

2)***

-.10(.0

2)***

.03(.0

2)

indicatin

gthatth

eremayberelatio

nshipsbeyon

dthefamily

andho

mecontextsth

atarem

eaningful;ho

wever,the

reis

curren

tlylittleempiric

alevide

ncetosu

pportsuch

hypo

thesise

deffects.

Peersa

recon

sistentlyiden

tifiedasth

estrongestsocialfactor

pred

ictin

gad

olescenthealth

beh

avioursa

ndoutcomes(B

rown

&Larson,200

9;Umbe

rson

eta

l.,201

0)and

stud

iess

how

elem

entsofp

eerc

onne

ctioncorrespo

ndto

lowered

internalisingand

emotiona

lsym

ptom

s(Bo

sackieta

l.,200

7;

VanVo

orhe

eseta

l.,200

8)

Childrenan

dad

olescentsw

ithgreatercap

acity

ford

ecision

-makingan

dcontrolintheho

merepo

rtlowerlevelsof

emotiona

lsym

ptom

s(Be

ckereta

l.,201

0;Borellietal.,201

5),

whichm

ayre

lateto

increasedstressapp

raisa

land

cop

ing

capa

citie

s(Be

ckereta

l.,201

0;Borellietal.,201

5).Inascho

ol

contexte

vide

nceislim

itedasth

isisusua

llyexamined

asp

art

ofbroad

ersc

hoolcon

nected

ness.

Thereismod

este

vide

ncetosu

ggesttha

tado

lescen

textracurric

ularactivity

isassociatedwith

loweremotiona

lsymptom

s(Guè

vrem

onte

tal.,201

4;M

olinue

voeta

l.,201

0),

althou

ghth

esestud

iesh

avetypicallynotaccou

nted

forw

ider

form

sofsocialcon

nection,whichisoften

associatedwith

en

gagemen

tand

maycon

flateeffe

cts(Feldm

anFarb&

Matjasko,201

2;Kilm

ereta

l.,201

0).

Scho

olpee

rconn

ectio

n

Activ

een

gagemen

tin

homean

dscho

ollife

Engagemen

tin

extracurric

ular

activ

ities


168


Table5.17(overleaf)showsICCvaluesandbivariatecorrelationcoefficients

forthevariablesinthisanalysis.

169

Table5.17

IntraclusterCorrelatio

nCo

efficientsa

ndBivariateCorrelatio

nCo

efficientsforVariablesinRQ2b

8 —

Note.IC

C=intraclustercorrelatio

ncoefficient.

*p<.05.***p<.001

.

7 —

.45*

**

6 —

.33*

**

.42*

**

5 —

.39*

**

.38*

**

.44*

**

4 —

-.15*

**

.00

-.11*

**

-.02*

3 —

-.17*

**

.28*

**

.24*

**

.31*

**

.31*

**

2 —

-.29*

**

.11*

**

-.25*

**

-.20*

**

-.28*

**

-.23*

**

1 —

.52*

**

-.36*

**

.13*

**

-.21*

**

-.16*

**

-.30*

**

-.24*

**

ICC

.02

.01

.01

.11

.08

.07

.06

.10

Varia

ble

1.Emotiona

lsym

ptom

s

2.Perceived

distress

3.Perceived

cop

ing

4.Risk

totalscore

5.Fam

ilyadu

ltconn

ectio

n

6.Schoo

ladu

ltconn

ectio

n

7.Schoo

lpeercon

nection

8.Activeen

gagemen

tinho

mean

dscho

ollife


170


Figure5.9showsasimplifiedstatisticalmodelwiththeselectedmoderator

variablesmodelledonallindirectpathways,toillustratethewayinwhichthese

factorsandinteractionswithpredictorsaremodelled.

Figure5.9.Simplifiedstatisticalconditionalindirecteffectsmodel.Hypothesisedprotectivefactors

aremoderatingallindirectpathways.Therelationshipbetweenthemoderators,perceiveddistress

andperceivedcoping,iscontrolledfor.Directionality(+/-)isnotassumedgiventhatmoderationcan

influencedirectionality.Foreaseofillustration,parametersarelabelledusingletters,which

correspondtothekeyontherightbottomcornerofthefigure.


171

Multipleriskexposurewasmodelledhereusingacumulativeriskindex,ratherthan

thelatentapproachsupportedinRQ1c.Theapproachtomodellingresidual

correlationsbetweenindicatorswithinMLrequiresatleastfiveindicatorsforthe

factortobeidentified,meaningMLcouldnotfacilitatecorrelationofresidualsfor

SENandlowacademicattainmentgiveninclusionofonlyfourindicators.While

otherestimatorssuchasWLSMVdonothavethisissue,onlyMLcanspecify

interactionswithalatentvariableasisnecessarytoexamineconditionaleffects

withinthismodel(Muthén&Muthén,1998-2010).Thus,itwasnotpossibleto

utilisethelatentconstruct;theimplicationsofthischallengearereflecteduponin

Section7.3.3.GiventhatearlieranalysisofindirecteffectsinRQ1dmadeuseof

WLSMV,ratherthanML,andutilisedlatentvariablesforriskexposureand

perceiveddistressandcoping,asecondindirecteffectsmodelwasspecifiedusing

MLandmanifestvariablestoreflecttheapproachhere.Thisispresentedbelow

andisnotintendedtoactas“new”resultsregardingindirectstresspathways,but

insteadisshowntofacilitatereadersinobservingthechangesincurredwhen

conditionaleffectsareapplied.Figure5.10(overleaf)showsstandardisedindirect

effectparametersasobtainedwiththisadjustedindirecteffectsmodel.Notethat

thisrepeatedanalysisshowedlowerestimatesfromriskexposureontoperceived

distressandperceivedcopingthanpreviouslyfoundinRQ1d,alongwithlower

indirecteffectsacrossbothpathways.Thesechangesmayinpartbeattributableto

theestimatorbutitisalsolikelythatthisistheresultofusingmanifestvariables

ratherthanlatentfactors,includinguseofacumulativeratherthanlatentrisk

approach.


172

Figure5.10.Indirecteffectsmodel.Positiveparametersareshowninblocklinesandinverse

parametersareshownindashedlines.ThismodelrepeatsearlieranalysisconductedforRQ1dbut

wasspecifiedwithmanifestvariablesandestimatedusingML,ratherthanWLSMV,tomoredirectly

reflecttheconditionalindirectmodellingapproachandthusfacilitatemoreaccurateassessmentof

changewhereconditionaleffectsareadded.Upperandlowercurvedarrows(.07and.05)show

indirecteffectpathwaysbetweenriskandemotionalsymptomsviaperceiveddistressandperceived

coping,respectively.Notethattheperceiveddistressandperceivedcopingarecorrelatedinthe

modeltoaccountfortheirsharedvariance.

***p<.001.

Table5.18(overleaf)presentsparameterestimatesforthedirectand

indirectpathwayparameters,thecontributionofhypothesisedprotectivefactorsto

distress,coping,andemotionalsymptoms,andconditionaleffectspathways.54

parameterswerespecifiedwithinthismodel,with6,630casesincluded.This

satisfiesguidanceregardingsamplesizeinSEMmodels,whereatleasttwenty

participantsforeachparameterisadvisedinordertoachievebothpowerand

statisticalprecision(Jackson,2003;Kline,2016).


173

Table5.18

UnstandardisedandStandardisedBetaCoefficientsforSpecificConditionalEffectsforIndirectEffect

Pathways(n=6,630)


Path B SE β SE

Directpathwayc’1:Risk→emotional 0.04* 0.02 .03* 0.01

Indirectpathway1:Perceiveddistress

a1:Risk→distress -1.41*** 0.24 -.59*** .10

b1:Distress→emotional 0.20*** 0.05 .40*** 0.10

Indirectpathway2:Perceivedcoping

d1:Risk→coping 0.38* 0.15 .19* .07

e1:Coping→emotional -0.16* 0.07 -.29** .11

ModeratorA:Familyadultconnection

Familyadult→distress -1.46*** 0.18 -.18*** .02

Familyadult→coping 1.00*** 0.14 .14*** .02

Familyadult→emotional 0.04 0.23 .01 .06

Familyadult→a1(risk→distress) 0.48*** 0.14 .36*** .10

Familyadult→b1(distress→emotional) 0.00 0.03 .01 .10

Familyadult→d1(risk→coping) -0.24** 0.09 -.21** .08

Familyadult→e1(coping→emotional) -0.03 0.04 -.12 .14

ModeratorB:Schooladultconnection

Schooladult→distress -0.34** 0.11 -.06** .02

Schooladult→coping 0.35** 0.10 .07** .02

Schooladult→emotional -0.13 0.14 -.05 .05

Schooladult→a1(risk→distress) 0.05 0.05 .04 .06

Schooladult→b1(distress→emotional) 0.03 0.02 .09 .06

Schooladult→d1(risk→coping) 0.06 0.09 .05 .07

Schooladult→e1(coping→emotional) 0.03 0.03 0.09 .08

ModeratorC:Schoolpeerconnection

Schoolpeer→distress -0.41*** 0.04 -.20*** .02

Schoolpeer→coping 0.34*** 0.03 .20*** .02

Schoolpeer→emotional -0.15** 0.05 -.15** .05

Schoolpeer→a1(risk→distress) 0.07* 0.03 .17* .07

Schoolpeer→b1(distress→emotional) 0.00 0.01 -.00 .08

Schoolpeer→d1(risk→coping) -0.06* 0.03 -.16* .07

Schoolpeer→e1(coping→emotional) 0.00 0.01 .02 .12

ModeratorD:Activeengagementinhomeand

schoollife


174

Engagement→distress -0.64*** 0.11 -.11*** .02

Engagement→coping 0.75*** 0.11 .15*** .02

Engagement→emotional -0.30* 0.15 -.10* .05

Engagement→a1(risk→distress) 0.19 0.10 .11 .06

Engagement→b1(distress→emotional) 0.01 0.02 .03 .06

Engagement→d1(risk→coping) 0.00 0.08 .00 .06

Engagement→e1(coping→emotional) 0.03 0.03 .11 .09

Note.Statisticallysignificantconditionaleffectpathwaysarepresentedinboldtype.

*p<.05.**p<.01.***p<.001.

Inspectionofresultsindicatedthattheeffectsofmultipleriskexposureuponboth

perceiveddistressandperceivedcopingwereconditionaluponlevelsoffamily

adultconnectionandschoolpeerconnection.ConsideredagainstCohen's(1988)

thresholdsof.14,.39,and.59asindicativeofsmall,moderate,andlargeeffect

sizesforstandardisedbetacoefficients,schoolpeerconnectionshowedasmall

effectforbothpathways,whilefamilyadultconnectionshowedamoderateeffect

inrelationtoriskeffectsuponperceiveddistress(a1)andasmalltomoderateeffect

forperceivedcoping(d1).Resultsalsoshowedthatundertheconditionsofgreater

familyadultconnectionandschoolpeerconnection,theeffectsofmultiplerisk

exposureuponthemediatorsarereversedwhencomparedtofindingsfromRQ1d.

Thatis,riskeffectsuponperceiveddistresswereobservedtobeinverseandindeed

werelargeinsize(-.59,comparedto.11withoutconditionaleffects),whileeffects

uponperceivedcopingwereobservedtobepositivebuttostillbesmallinsize(.19,

comparedto-.17withoutconditionaleffects).Figure5.11(overleaf)shows

conditionalindirecteffectsforeaseofinterpretationinrelationtotheresearch

question.

Conditionaleffectswereonlyobservedforthefirststagesofbothindirect

mechanisms;thatis,thepathwaysbetweenmultipleriskexposureandperceived

distressandcoping,respectively.Noconditionaleffectswereobservedinthe

secondstageofindirectmechanisms;thatis,forpathwaysofeitherperceived

distressorperceivedcopinguponemotionalsymptoms.Schooladultconnection

andactiveengagementinhomeandschoollifewerenotfoundtomoderateany

pathwaysacrossthemodel.


175

Figure5.11.Specificconditionalindirecteffects.Familyadultconnection(FAMILY)andschoolpeer

connection(PEER)areshownmoderatingtheeffectsofmultipleriskexposureuponperceived

distressandperceivedcoping.Positiveparametersareshowninblocklinesandinverseparameters

areshownindashedlines.

*p<.05.**p<.01.***p<.001.

5.5ChapterSummary

Fourriskfactorswereidentified:Lowacademicattainment,SEN,lowfamily

income,andcaregivingresponsibilities.Cumulativeriskeffectswereobserved,

thoughalatentriskconstructshowedgreatestpredictiveutility(butwasnotviable

formorecomplexanalysis).Multipleriskexposurewasassociatedwithemotional

symptomsentirelythroughindirectpathways,viaperceiveddistressandperceived

coping.Threepromotivefactorswereidentified:Familyadultconnection,school

peerconnection,andactiveengagementinhomeandschoollife.Multiplerisk

effectsonperceiveddistressandcopingwereconditionaluponperceivedlevelsof

familyadultconnectionandschoolpeerconnection.

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Blankpage

CHAPTERSIX:QUALITATIVEFINDINGS

177

Chapter6:QualitativeFindings

6.1ChapterOverview

Thischapterpresentsfindingsfromthequalitativestrandofthecurrent

study.Thechapterfirstoutlinesthethemesdevelopedforeachparticipantbefore

goingontopresentandexplorethemasterthemesdevelopedacrossthecorpus.

Finally,abriefappraisalofthereflexivejourneyispresented.

6.2IndividualParticipantThemes

Itshouldbenotedthatthethemesforeachindividualarenotpresentedas

themainfindingswithinthecurrentstudy.Instead,theyconstituteananalytical

stepaspartofdevelopingthemasterthemesofcentralinterest,whichcapture

perceptionsandexperiencesacrossthesampleasawhole.Thus,individual-level

themesarepresentedheretoestablishtheindividualityofparticipantsandto

illustratethewayinwhichtheseconnectwiththemasterthemespresentedinthe

mainbodyofthischapter.

6.2.1ThemesforAmelia

MuchofAmelia’saccountcentredonher“worries”andthethemes

developedfromhertranscriptreflectthisfocus.Amelia’slifeworldwascentred

aroundherworriesandthesedominatedthewaysheviewedherrelationshipsand

thewaythatshesawherselfasmovingthroughtheworld.Fivesuperordinate

themesweredevelopedforher:(a)Myworries,(b)othershelpme,(c)worriesas

central,(d)powerlessness,and(e)somethingbadwillhappen.Eachofthese

superordinatethemesencapsulatesanumberofsmallerthemes.Table6.1

presentsthesethemes;superordinatethemesareshowninitalics,withrelated

themeslistedbeneaththemalongsidekeywords/phrasesthatillustratetheir

essence.


178

Table6.1

ThemesforAmelia

Superordinatethemes

Themes

Keyillustrativephrasesfrom

transcripts

Myworries

Worriesastangible

Worriesasseparatefromme

Worriesarepluralandcanmultiply

Worriesareintertwinedwithotherdisorders

myworries

Ihaveaworry

lotsofworries

dizzyoreitherworried

Othersassupportmechanisms

Othershelpme

Sharingemotionsasvaluable

Cumulativesupportnetwork

alotofpeoplehelp

let‘emout

alsohelps

Worriesascentral

Worryiscentralemotion

Worrydefinesrelationships

Worryasdominantthroughoutlife

happynotworried

they’rereallysupportive

worriedalot

Powerlessness

Lackofagency

Passiveemotionalregulation

Rumination

Responsibilityandself-blame

Idon’tknowwhy

takemyworryaway

justlikethinkaboutit

Iforget

Somethingbadwillhappen

Fearofnegativeconsequences

Difficultyconceptualisingthebadthing

Mismatchbetweenexpectationsandreality

somethingbadwillhappen

somethinglikethat

it’snotgonnahappen

6.2.2 ThemesforJennifer

Jennifer’saccountwasstronglydominatedby“negativethoughts”andher

feelingsofnotbeinggoodenough;therewereparticularissuesaroundthe

demandsplacedonherandhermethodsforcopingwiththis.AnalysisofJennifer’s

datawasmorechallengingthanthatoftheotherparticipantsforanumberof

reasons.Aparticulardifficultywasthatsheseemedverydetachedfromherfeelings

andactionsandassuchmuchoftheanalysiswasfocusedonimplicitfeaturesand

themes,requiringahighlevelofreflexivityonthepartoftheresearcher.


179

Furthermore,manyofthefeaturesinheraccountandtheresultingthemeswere

verycloselyinter-related,whichmeantitwasdifficulttoseparatetheseoutand

explorethemdiscretely;asaresult,someofherthemeshaveverynuanced

differences.FivesuperordinatethemeswereidentifiedforJennifer:(a)Negative

thoughts,(b)notgoodenough,(c)keepingitinside,(d)powerlessness,and(e)

internalconflict.Eachsuperordinatethemecapturesanumberofemergent

themes,whicharepresentedinTable6.2.

Table6.2

ThemesforJennifer

Superordinatethemes

Themes


transcripts

Negativethoughts

Negativethoughtsareaboutme anegativethoughtaboutmyself

Negativethoughtsareacollectivemass getitout

Negativethoughtsblockhappinessandpositivethoughts I’mnotsmiling

Negativethoughtsareirrational Iknowthat’snottrue

Notgoodenough

Idealised“goodness” [grades]says,itall

I’mnotgoodenough I’mnotgoodenough

Relativitytoothers otherpeoplearebetterthanme

Otherpeople’sexpectationsofme they’lljudgeme

Guiltandresponsibility Itrymybest

Keepingitinside

Negativethoughtsareinsideme Ikeepitinside

Negativethoughtsareprivateandsensitive don’twannatell

Lettingoutnegativethoughts speakingout

Unavailabilityofothers myparentsalwayshavework

Powerlessness

Accumulationofdemand alottodealwith

Lackofexternalcontrol Idon’tknowwhattodo

“Productivity”andadaptingtodemand trymybest

Lackofagencyoveremotions itdoesn’thelp

Internalconflict

Detachedfromfeelingsandnegativethoughts Idon’tknowwhy


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Detachedfromactions Idon’tlistentomyself

Negativethoughtsasseparatefromidentity notverymyself

6.2.3ThemesforGrace

Grace’saccountwascentredaroundthepeopleinherlifeandsheseemed

toperceiveahighlevelofconflictandthreatintheserelationships,withthemain

exceptionofherdad,whosheviewedasstableandprotectingher.WhileGracedid

describeexperiencingstrongemotions,thiswasnotacentralcomponentinher

accountandshefocusedmorestronglyonrelationshipswithothersand,

interestingly,onherphysicalsafety.ThethemesdevelopedforGracereflectthis

emphasisonherrelationshipswithothersandtheconflictinherlife.Six

superordinatethemesweredevelopedforGrace:(a)Self-careandmyneeds,(b)

whatweoweeachother,(c)feelinglovedandprotected,(d)threat,(e)lackof

control,and(f)lackofrelief.Eachofthesesuperordinatethemescapturesa

numberofemergentthemes,whicharepresentedinTable6.3.

Table6.3

ThemesforGrace

Superordinatethemes

Themes


transcripts

Self-careandmyneeds

Self-protection

Voiceandagency

Hidingandcontrollingemotions

Physicalsafety

trygetaway

stickupformyself

Ikeepitintomyself

amIsafe

Whatweoweeachother

Roleexpectations

Personalresponsibility

likeanothermum

don’twannahurtmymum

Feelinglovedandprotected

Dadasstable

Dadasaprotector

alwaysthereforme

dadwillstepin


181

Onegoodcancelsoutthebad

Singularsupport

Loveandpriorities

butmydad

theonlyone

allshethinksabout

Threat

OthersareirrationalandIamnot

Othersandsafety

Familysplitaspivotalmoment

Fearofnegativeoutcomes

forgod’ssake

Idon’tfeelsafe

itallstarted

what’sgonnahappen

Lackofcontrol

Voiceunheard

Stuckinthemiddle

Helplessness

shedon’tlistentome

whethertobelieveit

whatshouldIdo

Lackofrelief

Feelingsasanintensestate

Buildingimpactonemotions

Lackofemotionaloutlet

Constantconflict

Breakingpoint

Igetreallyupset

Icouldn’tcope

didn’tknowwhattodo

allthetime

I’vehadenough

6.3MasterThemes

3.Whatisitliketobeanearlyadolescentgirlwhoisexperiencingemotional


AsdescribedinSection4.9.2,theindividualthemesacrosstheparticipants

werethenconsideredcollectivelytodevelopasetofmasterthemesacrossthefull

corpus.Thesearepresentedheretoaddressthefinalresearchquestionforthe

currentstudy.Foursuperordinatethemesacrossthethreeparticipantswere

developedthroughthisprocess,namely:

1. Theexperienceoffeelings;

2. Internalgrappling;

3. Demandsandcontrol;and

4. Drawingonothers.


182

Eachofthesesuperordinatethemescapturesthreetofoursubthemes,whichare

presentedinTable6.4alongsideanoverviewofwhichparticipantsarerepresented

ineachone.Itshouldbenotedthatallindividual-levelthemeswereincorporatedin

thefinalmasterthemes,thoughtovaryingextents;amoredetailedoverviewof

thisintegrationispresentedinTableU1,AppendixU.

Table6.4

MasterThemesandRepresentationofParticipants

Themes Amelia Jennifer Grace

Superordinatetheme1:Theexperienceofsymptoms

Thenatureofsymptoms(objectorstate) Y Y Y

Symptomsareapluralmassthatcangrow Y Y Y

Symptomsascentralanddominantinemotionexperience Y Y N

Superordinatetheme2:Internalgrappling

Symptomsareconnectedtome Y Y Y

Symptomsareseparatefrommyidentity Y Y Y

Passiveexperienceofsymptoms Y Y Y

Mismatchbetweensymptomsandreality Y Y N

Superordinatetheme3:Demandsandcontrol

Demandsandresponsibility Y Y Y

Fearthatsomethingbadwillhappen Y Y Y

Voiceandcontrolovertheworld Y Y Y

Superordinatetheme4:Drawingonothers

Mappingtheemotionalsupportnetwork Y Y Y

Releasingsymptomsthroughtalk Y Y Y

Othersasprotectors N N Y

Thefollowingsectionsoutlineandexploreeachthemeindetail,with

considerationofbothdescriptiveandinterpretivefeatures,nuancesacrossthe

corpus,andinter-thematicconnectionsanddifferences.Thereareseveralfeatures

withinthiswrittennarrativeofwhichthereadershouldbemindful.Firstly,efforts

havebeenmadetobetransparentwherecommentsareinterpretive,throughthe

useoftermssuchas“seemed”or“appeared”whereappropriate.Illustrative

quotesfromparticipantsarepresentedbothtoprovidedirectaccountsoftheir


183

experiencesandtogroundtheresearcher’sinterpretationswithinparticipants’

wordsandaccounts,inlinewiththesharedcommitmenttobothphenomenology

andthehermeneutic(Larkinetal.,2006;Smithetal.,2009).However,giventhat

IPAshouldinherentlyofferaninterpretativeaccount,thereadershouldnotethat

suchquotesareoftenfeaturedlessheavilyinwrittenaccountsofthemesthanin

otherqualitativeapproaches.Indeed,giventhefocusonthemeaningfulnessof

participants’language,quotescanbeverybriefinsomecases,withsmall

utterancessometimesofferingagreatdealofmeaningandresonanceacrossthe

entirecorpus(Smith,2011b).Itshouldalsobenotedthatparticipants’useof

colloquialisms,suchas“mum”insteadof“mother”,havebeenadoptedwhere

possibletosupportamoreauthenticaccountofparticipants’experiences.

Considerationwasalsogiventoterminologyaroundthefeelingsassociated

withemotionalsymptoms.Theterm“emotionalsymptoms”representsaclinical

constructandthusdoesnotalignwiththefocusonthewayinsuchsymptomsare

experienced,whereinfindingsgobeyondintellectualised“emotions”or

“symptoms”andfocusonsubjectivefeelingsandthoughts.Furthermore,thisterm

wouldnotnaturallypresentitselfinayoungperson’saccount,necessitating

alternativelanguageinlinewiththestudy’sphenomenologicalapproach.However,

eachparticipantmadeuseoftheirownspecifictermsforthesefeelings(e.g.,

Jenniferdescribed“negativethoughts”),renderingitdifficulttodescribecollective

experiencesusingparticipants’ownwords.Whilepreviousemotionresearchhas

drawnonmorecommonlyusedtermslike“anger”(Eatoughetal.,2008;Eatough&

Smith,2006b,2006a),emotionalsymptomscapturesacollectiverangeof

depressiveandanxioussymptomsandhasnocommonwordortermthatcan

encapsulatetheseexperiences.Assuch,participants’owntermsareusedwhere

possibleindiscussingindividualexperience,whilemorecollectiveexperiencesare

describedas“symptoms”and,withinthis,“feelings”and“thoughts”asrelevantto

theparticularlanguageusedbytheindividual.Wherethediscussionreferstowider

emotionalorcognitiveexperiencesbeyondthoseassociatedwithemotional

symptoms(e.g.,happiness),thisismadeclear.


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6.3.1TheExperienceofSymptoms

Thissuperordinatethemecapturesthewaythatparticipantsmadesenseof

thethoughtsandfeelingsthatcomprisedtheirsymptoms.Specifically,itexplores

thewaythatparticipantsunderstoodthenatureofthesesymptomsthemselves,

thewaythattheypluralisedthesefeelingsandthoughtsand/orsawthemas

somethingthatcouldgrowandbuild,andhowtheywereseeninrelationtothe

broaderemotionallandscape.

TheNatureofSymptoms(ObjectorState)

Thereweretwomainconceptualisationsacrossthecorpusofwhatexactly

thenatureofthesesymptomsis;namely,eitheratangibleobjectthatcanbehad,

orastatewhichoneenters.Intermsoftheformer,bothAmeliaandJennifer

understoodandpresentedtheirsymptomsasdistinctandtangibleentitiesthat

couldbedefinedandnamed.Firstly,theyeachhadspecificnounsforthesetypesof

feelings,whichtheyusedconsistentlythroughouttheiraccounts.Ameliatalked

abouthaving“aworry”or“worries”,whichweregenerallyunderpinnedbyafear

thatsomethingbadwasgoingtohappen;“aboutmyworries,say,like,willthis

happenorwhatwillhappenifIdothis?”Jenniferinsteaddescribedhaving“a

negativethought”or“negativethoughts”,whichsheexplainedwereoftenabout

her:“Ikindofhavenegativethoughts,like,I’mnotgoingtodowellandstufflike

that[…]IthinkthatI’mnotgoodenough,andlike…that…mmm…yeah,I’mjustnot

goodenough.”Thislabellingofthesymptomssuggeststhattheycouldbedetected

andisolatedasasingularcomponentwithinthebroaderemotionalandcognitive

landscape.Indeed,thislanguageof“aworry”or“athought”offersasensethat

thesearethoughtofascognitionsthatintrusivelypresentthemselvesto

participantsratherthanbeinganaffectivestate.

Thespecificlabelsthattheseparticipantsused,particularlytheuseof

nouns,andthewayinwhichtheyusedthem,gaveasenseofobjectificationof

symptoms.Thatis,acentralfeatureoftheirtalkwasthattheyframedthese

thoughtsassomethingthatthey“have”.Inthisway,theytookonastatusofa

tangiblething;thatis,assomethingthatcanbehad,asopposedtosomethingthat

isfeltorembodied.Thiswasaddedtobythefactthatbothparticipantstalked


185

aboutthesethoughtsasoccurringbothsingularlyandpluralistically;forinstance,

Jennifertalkedabouthaving“anegativethought”aboutaspecificissuebutalso

talkedmoregenerallyaboutthesecollectivelyasher“negativethoughts”.This

pluralitystrengthenedtheperceptionofanapparentobjectificationofsymptoms

aswellastheideaoftheirbeingcognitionsratherthanaformofaffect.Thatis,it

differsfromthewayinwhichwemightunderstandsadnessoranxietyas

generalisedstates,whicharenottypicallythoughtofasbeingexperienced

singularlyorpluralisticallyinthismanner.

Thisobjectificationofsymptomswasparticularlyclearinthewaythat

Ameliatalkedabouther“worries”.Shedescribedsharingaworrywiththose

aroundherasthoughitwassomethingthatcouldbepassedalongorgivenaway,

withcommentslike“Itexthimaworry”.Thiswasparticularlyevidentwhereshe

explainedacopingstrategyinwhichyou“flick”awayaworry:“Ifit’sonyour

shoulder,like,justflickitoffandthentheworrywillgoaway.”Suchstatementsadd

tothesensethatthesethoughtsareseenastangibleentitiesinaveryrealway,in

thattheycanbepassedalongorquiteliterallyflickedaway.Indeed,this

conceptualisationandparticularlycommentsliketheonesAmeliamakeshere

suggestsomeseparationbetweenthesethoughtsandtheself.Thisapparent

divisionisexploredindetaillaterinthischapterintheinter-connected(though

contradictory)themes“symptomsareconnectedtome”and“symptomsare

separatefrommy“self””.However,thiscertainlyappearstobeanimportant

componentintheconceptualisationofsymptomsbeinghadratherthanfelt,inthat

onecannotfeelsomethingthatispositionedawayfromoneself.

ThisisnottosaythatAmeliaandJenniferexclusivelyusedthislanguage.

Indeed,atsomepointstheydidtalkaboutthesesymptomsasanaffectivestate

thatembodiedthemratherthanatangiblethoughtthattheyhad.Forinstance,

Jennifertalkedaboutgetting“upset”,whileAmeliadescribedtimeswhereshewas

“scared”or“nervous”.However,theseincidentswereanomalieswithinthe

broaderaccountsofbothparticipantsandstoodoutforthisquality,asinalmostall

instancestheyconceptualisedsymptomsasobjectsandmadeuseofcognitive

languageofthoughtsandworries.Grace,however,didnotusethiskindof


186

languagetodescribehersymptoms,andinsteadtalkedconsistentlyaboutthese

feelingsasastatethatshecouldbeinorcouldbecome,frequentlyreferringto

instanceswhere“Igetreallyupset”.Indeed,almostallcommentsthatGracemade

inregardtothesetypesoffeelingswereeitherintheformofanemotionalstateas

here,orinsomeotherinstancesshedescribedfeelingsomething,suchas“Iwas

feelingstressed”.ThroughthiskindoflanguageitseemedthatGracesawthe

feelingasbeingmuchmoreall-encompassing,saturatingthenatureofherbeingat

thatmomentratherthanhavingamoreseparateandisolatedquality.Thus,Amelia

andJenniferdescribedthoughtsthatwereexternaltothem,whileGracetalkedof

feelingsthatconstitutedadeeperalterationtothestateoftheself.

SymptomsareaPluralMassthatcanGrow

Asnotedinthelasttheme,bothAmeliaandJenniferdescribedhaving

multiple“worries”and“negativethoughts”.Thispluralismspeakstothewayin

whichthetwoparticipantsmadesenseofthesesymptomsasbeingtangibleand

distinct;however,itisalsointerestinghowtheymakesenseofthisasbeing

collective.Throughouttheiraccounts,thetwoparticipantsswitchedbetweenthe

singularconceptualisationof“aworry”and“anegativethought”andpluralised

descriptionsofthesethoughts.Thiscontrastisillustratedwellinthewaythat

Jennifer’sdiscussionofveryspecificnegativethoughtsaboutherself,suchasthat

peopledonotlikeherorthatsheisnotachieving,occursalongsidemoregeneral

commentaryonthesefeelingsasacollectionof“thesenegativethoughts”or

simply“them”.Furthermore,atseveralpointssheswitchestocallingthese

thoughts“it”;forinstance,whenaskedwhethershehasspokentoanyoneelse

aboutthesenegativethoughts,Jenniferreplies“erm…noIkeepitinside.”Thisuse

of“it”suggeststhatthesenegativethoughtsgobeyondsimplybeingacollectionof

multipleconcernsandinsteadactasagreater,singularmasswithinJennifer’slife

world.Inthisway,forbothAmeliaandJennifer,itseemedthatthesesymptoms

werenotsimplyasingularpartoftheirinternallifebutamultitudeofindividual

pointsofdistressorconcern.

ItalsoseemedtobethecaseforbothAmeliaandGracethattheir

symptomscouldbuildandgrow,thougheachofthemunderstoodthisindifferent


187

ways.ForAmelia,whotalkedaboutherselfassomeonewhohad“lotsofworries”,

thisprocessseemedtohappenthroughanalmostmitosis-likeway,whereinher

thoughtscouldmultiplyifleftunchecked:“Iforgottoflickit[theworry]offthat’s

whymoreworrieskeptoncomingandcoming.”Commentssuchasthesegavea

senseofinternalmultiplicationthatwasbeyondAmelia’scontrol.Similarly,

althoughGracedidnotmakesenseofthesefeelingsasbeingsingularorpluralbut

amoregeneralemotionalstate,shetoodescribedthisfeelingasbuildingwithin

her.OftenforGrace,thisheightenedemotionalstateseemedtobetheresultofan

increaseorpersistenceinthedemandsandstresssheperceivedinherlife.Thus,

whileforAmeliathiswasseenasbeingself-aggravated,witheachworrypotentially

spawningmoreworries,forGraceboththefeelingandtheexternaldemandwould

growtogether,attimesbecomingunmanageable.Forinstance:“Iwaspretty

emotional…andIwasalsobeingbulliedthatday,andIhadabreakdownina

lesson,Icouldn’tcope.”ThereweremultiplepointslikethisinGrace’saccount,

whereshedescribedtryingbutfailingtocopewiththisheightenedemotionalstate

andthedemandsinherexternalworld.Shereflectedthatitoftenbecomes“too

much”or“toohard”todealwith,suggestingthatthisincreasebecomes

overwhelmingandsurpasseshercapacitytocope.Indeed,Gracefrequently

describedthiscombinationasbuildinguntilitreached“acertainpoint”,wherethe

demandsandfeelingsshewasexperiencingwouldbecomeentirelyunmanageable

forhertocopewith.Indeed,sherelayedanumberofeventsinwhichshefeltthat

thishadledtoextremeconsequences,suchashavinga“breakdown”asaboveor,

inoneinstance,cuttingherself:

Iusedtoself-harmmyself,itusedtogetpretty,like…Iusedtogetsobad[…]

Ididn’tknowwhatelsetodo,Iwasjustgettingsomad[…]Iwasfeeling

angry,Iwasfeelingstressed…andlike,Ididn’tknowwhattodoanymore.

Grace’sstatementthat“Ididn’tknowwhattodoanymore”illustratesherfeeling

thatsheisunequippedtomanagethisheightenedlevelofemotionalturmoil.

Indeed,herusehereofseveral“feelings”words–mad,angry,andstressed–gives

afeelingofanintenseemotionalstateandprovidesinsightintohowoverwhelming

thisfeelingcanbeforher.Furthermore,itisnotableherethatGracechangesher


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phrasingpartwaythroughthisutterance;sheinitiallyexplains,“itusedtoget”and

thencorrectsherselfto“Iusedtogetsobad”.Thisswitchinlanguagefurtheradds

tothesensethatbothherexternalworldandherinternalworldareboundup

togetherinthisway,assheisnotalwayssurewhetheritistheeventsinherlifeor

heremotionalstatethatisbeyondhercontrol.

SymptomsasCentralandDominantinEmotionExperience

Thewaythatparticipantsmadesenseofthesesymptomswithintheir

broaderemotionallandscapedifferedslightly.ForAmeliaandJennifer,their

“worries”and“negativethoughts”dominatedtheemotionaldiscussionwithintheir

accountsandinsomewayswereseenasdefiningtheotheremotionstheyfelt.

Grace,however,didnotcentralisethesespecificfeelingsinthesamewayand

talkedmorewidelyaboutheremotionalexperience.

ForbothAmeliaandJennifer,therewasastrongsensethroughouttheir

accountsthattheir“worries”and“negativethoughts”werecentraltotheirgeneral

emotionexperience.Firstly,thisdominatedtheiroverallaccounts,withboth

participantsfocusingonthesesymptomsinresponsetoquestionsspecifically

relatingtotheiremotionexperience,aswellasquestionsaroundtheirbroaderday-

to-dayexperiences.Thisfocussuggeststhatthesesymptomsactasasubstantial

componentoftheirdailylives.Wheretalkwithintheinterviewbegantomoveaway

fromthesekindsofthoughtsandfeelings,bothparticipantsquicklymovedbackto

this.ThiswasillustratedwellinanimmediatediversionAmeliatookafterbeing

askedaboutherfamily:

Ilikebeinglike,withmyfamilyonanighttimeandjustrelaxingchilledout

withlikenostressandhomeworkthatI’malsoworriedaboutiflikeIgetit

wrongorifit’slate…because,erm,shallIgiveyouanexampleoflike

homeworkwhenIwasworried?

Indeed,thiskindofdominantfocusonthesesymptomsinparticipants’accountsis

partofthereasonthattheywereselectedforinclusioninthecurrentstudy.As

previouslynoted,theseinterviewswereconductedaspartoftheevaluationof

HeadStartandthustherewasnotnecessarilyanintentiontofocusdistinctlyon


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participants’emotionalsymptoms.Rather,discussionofgeneralemotionsfollowed

thefocusandflowoftheparticipantand,thus,thefocushereontheseparticular

kindsoffeelingsandthoughtsacrosstheiraccountsoriginatedfromAmeliaand

Jenniferthemselveswithintheinterviews,ratherthanbeingsoughtattheoutset

bytheinterviewers.Assuch,itisclearintheiraccountsthatthesesymptomswere

asubstantialcomponentoftheirday-to-dayexperiencesandinternallives.

Intermsof“negativeemotions”,neitherAmelianorJenniferfrequently

describedwiderfeelingsoutsideoftheirworriesornegativethoughts,thoughthere

wereveryoccasionalreferencestofeeling“scared”or“angry”.Grace,however,

talkedslightlymorewidelyaboutothernegativeemotionssuchasfeeling“mad”or

“angry”aswellasdiscussionoffeelingupset.Thus,whilethesefeelingswerepart

ofherday-to-daylife,theywerenotnecessarilyseenasthecentreofhernegative

emotionexperienceinthewaytheyseemedtobeforAmeliaandJennifer.Indeed,

forthesetwoparticipants,itseemedthatevenpositiveemotionslikehappinessor

feelingcalmweredefinedquiteliterallyastheabsenceofthesesymptoms,asin

thequotefromAmelia’saccountabove,whichwasaresponsetoaquestionabout

whyspendingtimewithherfamilymadeherfeelhappy.Indeed,whenaskedwhat

itisliketobehappy,Ameliastated,“reallylikehappynotworriedaboutanything”.

Jenniferseemedtoviewthisrelationshipbetweenthesedifferenttypesof

emotionsasthoughhappinesswasabaseline,oratrueself,thatwasinterrupted

bythepresenceofhernegativethoughts:

[Interviewer:Duringtimeswhenyouhaven’tthoughtthatyou’reafailure,

what’s,what’sbeendifferentaboutthosetimes?]Erm,I’mhappy,and…

yeahI’mjust,moremyself

Thus,thereappearstobeoppositionalconceptualisationofthesedifferenttypesof

emotions,inwhichhappinessistheabsenceofa“worry”ora“negativethought”

andcanberemovedordisruptedbythesesymptoms.Inthisway,forthesetwo

participantsthesetypesofemotionsseemtobemutuallyexclusiveandunableto

coexist,resultinginmoredifficultthoughtsandfeelingsdominatingtheiremotional

experiencequiteforcefully.


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6.3.2InternalGrappling

Thissuperordinatethemeexplorestheinternaltensionsandconflictsthat

participantswereexperiencinginmakingsenseofthesesymptomsasapartof

them.Firstly,itcapturesthewaythatparticipantslocatedthesesymptomsasbeing

somehowconnectedtothemwhilesimultaneouslybeingseparatefromtheircore

identity.Itexploresthegirls’viewsofthemselvesaspassivewithinboththe

occurrenceandresolutionofthesesymptoms,alongsidetheirapparentbeliefthat

theirthoughtsandfeelingsmaynotberational.Acrossthissuperordinatetheme,

thereisjuxtapositionbetweenabeliefthatthesesymptomsareoccurringinternally

butarenottrulycontrolledbyoneself.

SymptomsareConnectedtoMe

Inallthreecases,participantspresentedthesesymptomstobeconnected

tothemsomehow.Therewasageneralsensethatthesymptomswereconsidered

tooriginateandexistinternally,evenwheretheyaresimultaneouslyseenas

beyondtheparticipants’controlorcausedbyexternalprocesses.Despitetheway

thatAmeliaandJenniferinvokedseparatenessintheirtalkofhavingafeeling,they

stillpresentedthesymptomsasbeingtiedtotheminsomeway.Forboth

participants,therewasaconsistentuseofpossessionlanguage,indicating

ownershipofthesesymptoms.Forinstance,Ameliaestablishedaclearownership

oftheseworriesthroughoutheraccount,referringtothemas“myworries”.Inthis

way,thesethoughtsarethoughtofasbelongingtotheparticipants,evenifthey

arealsomadedistinctthroughtheirconceptualisationasobjects.Thistension

betweenseparationandconnectionwithsymptomsisexploredfurtherthroughout

thissuperordinatethemeasawhole.

Thisnotionofconnectionbetweenthesesymptomsandtheselfisalso

underpinnedbythewaythatallthreeparticipantsdescribedthesesymptomsas

being“inside”,withAmeliaandJennifertalkingspecificallyaboutthembeingin

theirhead:“sometimesIjustlikeforget,like,stillhavemyworriesinmyhead”

(Amelia).BothJenniferandGracediscussedthisinrelationtotheirurgestokeep

thesethoughtsandfeelingshiddenawaywithin;Jenniferexplainedthatthese

thoughtsaresomethingthatshefeelssheshould“keepinsideanddon’twannatell


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anyoneelse”.Sucheffortstokeepafeelinginsideindicatethatthisiswhereitis

believedtohaveoriginatedinthefirstinstance,suggestingsomeconnectedness

withtheself.Furthermore,atseveralpointswithinthesetwoaccounts,there

seemedtobeconsiderablediscomfortaroundlettingthesesymptomsout,with

bothparticipantsdescribinginstanceswheretheyhaveattemptedcontrolor

manipulationto“keep”theminside.Forinstance,Gracesawanydemonstrationof

herupsetasamarkerofvulnerabilitytoherbullies,andthusattemptedtocontrol

anyexternalisation:

Well,itdoesgettomequitealot,itishard…butItrynottoletthemsee

that[…]Ihadabreakdowninlesson,Icouldn’tcope,andtheteachersaw…

I,hetookmeoutside,andIwaslike,saying,Iwantedtogohomeandstuff

likethatcauseitwasreallyhard.AndIdidn’t,(sigh),Itriednottoletthe

bullies…seethatIwascrying.

Externalisationofthesesymptomsmaybeseenasuncomfortable,andeven

potentiallywithinone’scontrol,whiletheirinternalexistenceisseenasmore

naturalandlessmalleable.Thus,itseemsthattheyareseenverymuchasprimarily

takingplaceinternally.Thisiseventhecasewhenthefeelingisconsideredtobea

responsetoexternaldemands,andperhapseventheonlyrationalresponse(asis

oftenthecaseforGrace).Thatis,thedemanditselfmaybeexternal,butthefeeling

isaresponsethatisveryfirmlyplacedwithinoneselfandcanpotentiallybekept

there.

Overall,then,therewasanunderlyingfeelingacrossallthreeparticipants

thatthesesymptomsareseenasbeingconnectedtotheself,eitherthrougha

senseofbelongingorthroughabeliefthattheyoccur“inside”oneself.Notably,this

featureclasheswithotheraspectsofthewaythatparticipantstalkedabouttheir

symptoms,particularlywithhowtheyviewedthemasbeingseparatefromtheir

“true”self,asencapsulatedwithinthenexttheme.Thisspeakstothewaythat

differentareasoftheseparticipants’experiencesandsense-makingappearto

directlycontradictoneanother,butalsoreflectsanuancedexperienceintheway

thatthesethoughtsandfeelingscanhappeninsidewithoutdefiningwhatis“me”.


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Suchtensionsgiveanimpressionofconsiderableinternalgrapplingthatiscaptured

withinthissuperordinatethemeasawhole.

SymptomsareSeparatefromMyIdentity

Althoughtheparticipantsdiddescribetheirsymptomsasconnectedto

themandtakingplaceinternally,theyalsoestablishedsomelevelofdistancefrom

theircore“self”,oridentity.Onthesurface,itmayappearthatthesetwo

conceptualisationsarediametricallyopposed;however,adistinctionismadehere

betweenrecognisingaconnectionwithafeelingandactivelyincorporatingitinto

one’sidentity.ThewaythatAmeliaandJenniferobjectifiedtheir“worries”and

“negativethoughts”asthingsthatarehad,ratherthanfelt,givesanimmediate

senseofseparateness.Althoughthereareindicationsofpossessionovertheir

symptomsand,therefore,aconnectionwiththem,thisprimaryideaofthemasa

tangibleobjectleavesafundamentalundercurrentofseparation.Beingconnected

toafeelingbecauseitbelongstooneselfisnotthesameasviewingthefeelingasa

partofoneself.Inotherwords,tohaveandownanobjectified“worry”isvery

differentfrombeing“aworriedperson”.Throughthiskindoftalk,thesetwo

participantstookownershipofthesetypesofthoughtsandfeelingswhile

simultaneouslylocatingthemasseparatetothemselves.

Furthermore,allthreeparticipantssawthemselvesassomewhatpassive

withintheprocessofthesesymptoms.Thisnotionisexploredinmoredetailinthe

followingtheme,howeveritalsohasimplicationsinthecontextofidentity.

Specifically,acrossallthreeaccounts,participantsindicatedthatthesesymptoms

wereoperatingindependentlyofthemselves.Thatis,whilethesesymptomsmay

betakingplaceinternally,theparticipantshadnotactivelycreatedorchosenfor

themtotakeplace.Forinstance,Ameliatalkedaboutherworriesas“coming”from

somewhere:“moreworrieskeptoncomingandcoming”.Asaresult,these

thoughtsandfeelingsappearedtocircumventtheparticipantssomehow,meaning

thattheywerenotresponsibleforthethoughtsandfeelingsthemselvesorforthe

actionsthattheytookinresponsetothem;thesethingssimplyoccurred.Thus,

thesesymptomswereexperiencedasanelementoftheirlifeinwhichtheyhadno

activeroleor,indeed,control.Inanalysingandinterpretingthewaythatthese


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symptomsfittedintoparticipants’lifeworlds,then,therewasageneralsensethat

theywereunabletoreconcilethesethoughtsandfeelingswiththeircoreself,given

thattheywerebeyondtheirownchoicesandactions.

Therewereseveralwaysinwhichparticipantsdirectlyinvokedaseparation

betweentheirsymptomsandtheirself.Forinstance,Jenniferwasaskedatone

pointwhatwasdifferentaboutthetimeswhenshedidnothavenegativethoughts,

andsheresponded,“I’mhappy,and…yeahI’mjust,moremyself.”Thisparticular

statementwasoneofseveralinwhichJenniferestablishedtheideaof“myself”.

Jennifer’sconceptualisationofthisselfisahappyone;theuseof“just”givesthe

impressionthatthisisseenasafundamentalqualityofhertrueidentity.Assuch,

Jennifer’snegativethoughtsareseenasdisruptingherabilitytofullybethisreal

versionofherself.Inthiswaythereisnotonlyaseparationfromtheself,butsuch

strongimplicationsforfunctioningthatone’sabilitytobeatrue“self”isaffected.

Thisconceptualisationofthesesymptomsasdisruptingtheselfsuggests

thattheyhavenotnecessarilybeenincorporatedintoanewideaofwhattheselfis.

Thatis,whatcomprises“me”isnotchanged,butinsteadisinterruptedbya

separateforce.However,atsomepointsthislackofintegrationseemedtogosofar

astoextendtoadualidentity,inwhichthereisarealself,aswellasanotherself

thatisbeyondcontrol.BothJenniferandGraceconjuredupthisadditionalselfin

theiraccounts;Jennifer,forinstance,talkedabouthowshedidnot“listento

myself”orbelieveinherself.Intheseinstances,Jenniferhadsteppedoutsideofher

realselfandintoasecondselfthatisunreasonableandrefusestorespondtowhat

heroriginalselfisaskingofit.Itcannotlistenorbelieveherandisdrivenbythese

apparentlyirrationalthoughts.Similarly,Gracetalkedaboutanoccasionwhereshe

hadattemptedtohideherfeelingssoasnottoappearvulnerable,butexplained“I

didn’t,(sigh),Itriednot,toletthebullies…seethatIwascrying,butI,Icouldn’t

helpmyself.”Here,Gracealsomakesuseofasecondself.Forher,“I”isa

reasonableselfthatisabletoassessthesituationandattempttoretaincontrol,but

theother“myself”invokedhereislessrestrainedandcannotbecontrolled.Thus,it

appearsthattheexperienceofthesesymptomscancreateaninternaldivide,in

whichthereisarationalselfwithanappropriatesetofactionsandbeliefs,anda


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second,moreunreasonable,selfthatisruledbythesesymptomsandgives

unwantedresponses.

Assuch,thereisaconceptualisationacrosstheparticipantsthatthese

symptomsareoccurringwithinthem,butarenottrulyapartoftheircoreidentity.

Thus,althoughthisideaofsimultaneousconnectionandseparationseems

paradoxical,thetwoconceptualisationsdoappeartoco-exist.Theparticipants

appearedtohavesomedifficultymakingsenseofthesesymptomsinrelationto

theiridentityconstructions,andindeedthissimultaneousconnectionand

separationmaynotalwayssithappilytogether.Instancesofinternalconflict,such

astheneedtoformulateadualidentitythatcancapturethesedifferentselfhoods,

suggeststhatthismaynotalwaysbeacomfortablesolution,potentiallyintroducing

furtherdistressthroughaninabilitytoreconcilethesepartsoftheirlifeworlds.

PassiveExperienceofSymptoms

Thistensionbetweenconnectionandseparationwascloselylinkedwiththe

wayinwhichparticipantsviewedtheiragency,orlackthereof,withinthese

symptoms.Allthreegirlspresentedthesethoughtsandfeelingsassomethingthat

operatedindependentlyofthemandsowerebeyondcontrol.Thislackofcontrol

wasmanifestedthroughthewaythatparticipantsexperiencethethoughtorfeeling

inthefirstinstance,aswellasinthewaysthattheymanagethemandtheactions

theytaketoresolvethem.

ForAmeliaandJennifer,therewasastrongsensethattheysawthemselves

aspassivewithintheactualoccurrenceoftheinitialthoughtorfeelings.Bothgirls

repeatedthephrase“Idon’tknowwhy”throughoutdiscussionoftheirsymptoms.

Jennifer’suseofthisphrasewasacentralfeaturewithinherinterview,occurringin

heraccountalmostfiftytimes;forexample,“Idon’tknow.IjustthinkthatI’ma

failure,Idon’tknowwhy.”Forbothgirls,this“Idon’tknow”rhetoricwasthreaded

throughouttheirgeneraltalkintheinterviews,ratherthansolelyoccurringwhen

strugglingtoansweragivenquestionfromtheinterviewer.Thissuggeststhat“not

knowing”isanaturalcomponentofexperiencingthesesymptoms,ratherthan

simplybeingamethodologicalartefact,althoughcertainlyexpressingthese

complexinternalprocessesaloudcouldbeacontributor.Therewerealsoanumber


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ofmorenuancedindicationsthatthetwogirlsdidnotseethemselvesashavingan

activerolewithinthesesymptoms.Insomeinstances,forexample,Ameliahad

difficultyarticulatingthesourceofherworriesinthefirstpersonandinstead

expressedthisthroughthevoiceofothers.Forinstance,whilerecallingtheworries

sheexperiencedwhileatathemepark,shehesitatedandswitchedtohermum’s

assessmentofthesituationratherthanherown:“Iwasworried‘causeIdon’tlike…

mymumsaidIdon’tlikethe,d’yaknowtheunknownanddarkrides.”InJennifer’s

account,therewereanumberofoccasionswhereshepausedandwasquietfora

timeasshetriedtoexplainafeelingoranactiontotheinterviewer;oftenwhen

thishappenedshewasnotabletocomeupwiththisexplanation.Onseveral

occasions,sheidentifiedsomedisagreementbetweenherviewofherselfandher

actualexperiences,andintheseinstancessheappearedtoengageinan

uncomfortableattemptatassimilation:

I’mneverreallyhappyeventhoughIgot…high,‘causelike,IgotanAin

Scienceand,stufflikethat[…]Idon’tknow,I’mneverhappy,withmyself.I

meanIambutlike,sometime…I’mneverhappywithlike,thegradethatI

get,Idon’tknow.ButIamhappywithmyself,Iguess.

Jennifer’sdifficultyhereatmatchinguphermismatchedinternalandexternal

worldsindicatesthatshecannotfullycomprehendwhythesethoughtsaretaking

place,giventhattheydonotseemtomakelogicalsensetoher.Asaresult,sheis

leftfeelingunabletoconfidentlyassessherownthoughtsandemotionalstate,

leavingherto“guess”atwhatshethinksandfeels.Theseexperiencessuggestthat

alackofabilitytounderstandwherethesesymptomsarecomingfromorwhythey

donotmatchreality(apointexploredfurtherinthenexttheme)maybeadifficult

andconfusingexperiencewithlittleresolution.

Grace’spassivitywasslightlydifferent.UnlikeAmeliaandJennifer,shehad

lessdifficultyinidentifyingwhereherfeelingscamefrom,drawingdirectlinks

betweenherinternaldistressandthethreatandinstabilitythatshesawinthe

worldaroundher.ToGrace,herfeelingswereanentirelyrationalresponsetothe

behaviourofothers,suchasbulliestargetingherorhermumnotbehavinglikea

parent.Inthisway,herpassivitywasnotinrelationtoanabsenceofunderstanding


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ofwherethesefeelingscamefrom,butwasborneoutofalackofcontrolover

thosecauses;sheherselfwasnotchoosingtofeelthisway,itwassimplyan

inevitabilitygiventhevariouschallengesshefaced.

Gracethenalsoseemedtofeelalackofagencyinhowsherespondedto

thesefeelingsoncetheyhadarisen;thisseemedtobethecaseforallthree

participants,astheydidnotconsiderthemselvesabletoactivelyandeffectively

regulateandrespondtothesesymptoms.ForAmeliaandGrace,thisextendedto

makinguseofthosearoundthemtohelpthemmanageandresolvethese

symptoms,astheyseemedtofeelunabletodosoindependently.InAmelia’scase,

thiswasevidencedthroughastrongrelianceonthosearoundhertomanageher

worriesonherbehalf;herdog,familymembers,andfriendswould“make”herfeel

better,or“take”herworryaway:“[mydog]justlike,takemyworryaw-,ermworry

away[…]mydog’sreallyhelpingmenowandjustmakingmelike,notthinkabout

likethenegativethingssoshehelpsalot.”Inthesecomments,Ameliacastsherself

asapassivemediumthroughwhichothersinteractwithandmanageheremotional

landscape,whilesheremainsremovedfromthisprocess.Indeed,whensheis

providedwithstrategiestomanagehersymptomsindependently,shefindsherself

unabletoenactthemanddescribesherthoughtsandfeelingsspirallingoutof

controlandoverwhelmingher:“Iforgottolikeflick[theworry]offthat’swhymore

worrieskeptoncomingandcoming”.Similarly,Gracetalkedaboutkeepinga

feelingwithinheruntilshecouldtalktoatrustedother,usuallyherdad.It

appearedinthiswaythatGracesawherselfasonlyabletocontainandholdthe

feeling,ratherthanactuallydoanythingwithitorresolveit,whichwouldrequire

anotherperson:“Ikeepitintomyselfallday,andthenI’llgohomeandtalktomy

dad.”

Wheretheparticipantsdidtalkaboutthetimestheyhadattemptedtotake

stepstoresolvetheirsymptoms,theydidnotpresentthemselvesasactiveinthese

actions.Theyfounditdifficulttounderstandexactlywhytheydidthesethings,or

feltlikeitwastheonlyoptionavailableratherthanbeinganactualdecisionthey

made.Jennifertalkedabouteatingcomfortfood“forsomereason”,whileGrace

talkedaboutself-harmingbecauseshe“didn’tknowwhattodoanymore”.Inthese


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instances,thegirlsdonotseethemselvesasactivelymakingdecisions,asthough

theythemselveshadnottrulychosentodothesethings,theyjusthappened.

Indeed,theyfoundthatthesestrategiesoftendidnotwork,addingtotheirgeneral

senseofhelplessnessinrelationtotheirsymptoms.Whentheinterviewerasked

Jenniferhoweatingcomfortfoodhelped,sheresponded:“N-,itdoesn’thelp,atall,

but,youjustthinkthatitwill,but,itwon’t.Like,eatingcomfortfood,itwon’thelp

you,atall.”Inthisinstance,asinmanyotherpointsinherinterview,Jennifer

switchesfromthefirsttothesecondperson,asthoughtoremoveherselffromany

discussionaroundthispoint.Sheemphaticallymakesthepointherethatthisdoes

nothelp“atall”,indicatingwhatappearstobeatotalrenouncementofthisasa

strategy;yet,itisoneshecontinuestouseinspiteofthisknowledge.Thus,it

seemstherearetimesthatparticipantsmakeuseofstrategiesthatdonotwork,

simplytodosomething,eveniftheydonotbelieveitwillhaveanyeffect.

Therewereseveralways,then,inwhichparticipantssawthemselvesas

passivewithintheoccurrenceandresolutionofthesesymptoms,withthemfeeling

unabletounderstandormanagetheseprocesses.Asaresulttherewasageneral

senseofhelplessnessacrossallthreecases,withparticipantsconsidering

themselvesremovedfromtheseprocessesandonlyabletowatchasthesethings

simplyhappenedwithinthem.

MismatchbetweenSymptomsandReality

Someparticipantsidentifiedamismatchbetweenthenegativeexpectations

thatcomewiththeirsymptomsandtherealityoftheworldaroundthem.Both

AmeliaandJenniferclearlyarticulatedthattheybelievedthattheconcerns

presentedintheirworriesandnegativethoughtswerenotreflectiveofreality.

Ameliatalkedfrequentlyaboutlookingfor“evidence”toprovetoherselfthat

somethingshefearedwouldhappenwasinfactimpossible.Thatis,ifthereisno

evidencethatthiscouldhappen,thentheworryisunfounded:

IfsomethingdoesworrymeI’lljustsaylike,where’stheevidenceaboutit?

Like,andifsomethingdoesh-,like,erm,worrymeI’lljustsaylike,where’s

theevidenceaboutit?LikeIknowit’snotgonnahappen.


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Jenniferalsodescribedlookingforevidencetodisproveherparticularconcerns.

Shereflectedthatshehadnegativethoughtsthatnoonelikesher,“but,Iknow

that’snottrue,‘cause,Ihavesomanyfriendshere”,andtalkedabouthowshewas

neverhappywithheracademicachievementeventhoughshecouldseethatshe

alwaysgotthehighestpossiblegrades.Thisactoflookingforexternal

“evidence”todisprovetheirconcernsindicatedthatthegirlsperceivedtheexternal

worldasobjective,whiletheirinnerprocesseswereseenasirrationalandtheir

fearsunfounded.Inthisway,theyappearedtobelievethattheworldaroundthem

providedabarometerofsortsagainstwhichtheycouldcheckandperhapseven

underminetheirfearsandexpectations.

Thisideaofevidencewascoupledwithtalkabout“knowing”thattheirfears

werenottrueordidnotmeasureuptowhattheysawhappeningaroundthem,as

intheexamplesabove.Bothparticipantstalkedconsistentlyabout“knowing”these

things,addingtothesensethattheexternalworldprovidedwhatwasperceivedto

beobjectiveinformationor“evidence”thatcouldfeedintoconcrete“knowledge”.

However,thisalsogaveanimpressionthattheparticipantsveryfirmlybelieved

thattheirinnerconcernsandexpectationsdidnotalignwiththerealitytheysaw.

Thatis,theydidnotsimplythinkorsuspectthatthiswasthecase,theyknewit.

Nevertheless,recognitionofamismatchbetweenexpectationsandreality

didnotseemtobeconsideredparticularlyuseful.Bothgirlsdescribedhowtheir

concernspersistedeveninthefaceofthisunderstandingandevenextendedto

doubtingit.Ameliaseemedtobeabletosayobjectivelythatsheshouldlookfor

evidenceandthatagivenoutcomewouldnothappen,butshewasstillleftwitha

nigglingbeliefthat,inaveryrealway,itcouldhappen.Sheexplainedthatthis

techniquewashelpfulbutthatshewasstillleftwithquestions,“sayingbutwhatif

thereisn’tanyevidenceorwhatifthishappens”.Jennifershowedconsiderable

difficultyandfrustrationaroundthewaythathernegativethoughtsandher

knowledgedidnotmatchup.Shedirectlyexplainedthatanawarenessofthis

mismatchdidnothelp:

IthinkthatI’mnotgoodenough,andlike…that…mmm…yeah,I’mjustnot

goodenough.ButIknowthateveryone’snotperfect.[Interviewer:Doesit


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makeadifferenceknowingthat?]NonotreallyI’vealwaysknownthat,but,

yeah.

Thus,abeliefthatone’sconcernsdonotmatchrealitydoesnotnecessarilylessen

thoseconcerns.Anemphasison“knowing”,combinedwithcommentsthatthis

informationdoesnotmakeadifference,suggeststhatthismismatchcanbe

understoodatanobjective,abstractlevel,butdoesnotextendtodeeperthinking

processes.Asaresult,participantswereexperiencinganadditionallayerof

discomfort;firstly,theyweretryingtomakesenseofamismatchbetweentheir

expectationsandreality,withfurtherdifficultyarisingwhenthisknowledgedoes

notchangethewaytheyfeel.Thatis,beingawarethatone’sthoughtsandfeelings

areirrationaldoesnotnecessarilymakethemgoawayandcaninsteadbeafurther

sourceoffrustration.Inattemptingtoexplainthisdisparitybetweenherinnerand

outerworlds,Jenniferexclaimed:“Idon’tknow.It’sabitconfusing.”Thus,notonly

isthisperceivedknowledgefutile,itcanbedirectlydifficulttoincorporateintoan

alreadyconfusinglandscapeofwhatisknownversuswhatisfeltandbelieved.

6.3.3DemandsandControl

Thissuperordinatethemecapturesthewayinwhichparticipantsviewedthe

variousdemandswithintheirworlds.Itexploresthedominanceoftheseperceived

demandswithintheirlifeworldsandtheresponsibilitythatparticipantsfeltto

adapttomeetthem,evenwhenthisadaptationmightbetotheirowndetriment.It

alsocapturesthespeculativefearsthatparticipantshaddevelopedaroundthese

demandsandtheirperceptionofhowmuchcontrolandvoicetheyhaveinfacing

theseissuesintheirexternalworlds.

DemandsandResponsibility

Allthreeparticipantsfeltthattherewerearangeofdemandsonthemin

theirdailyliveswithwhichtheywerestrugglingtocope.Thespecificnatureof

thesedemandswasdifferentforeachparticipant;oftentheywerelocatedwithin

theexternalworld,thoughsomewereinternal.Ameliawasstrugglingwithher

schoolworkandhomeworkandwasdeeplyafraidoftheconsequencesofgetting


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thingswrong,whilebattlingherowncompulsivebehavioursand,indeed,worry

aboutherownworry.Jenniferwasalsocopingwithacademicdemandsbut

seeminglyfromtheotherendofthespectrum;shetalkedaboutbeingahigh

achieverwhilealsoexperiencinganunderlyingfearthatshewassomehow“not

goodenough”andanurgetobeconstantly“productive”.Grace’schallengesmostly

relatedtothebehaviourofotherpeople,asshedescribedhavingadifficultandat

timesvolatilerelationshipwithhermumandhermum’sboyfriend,whilealsobeing

persistentlybulliedatschool.

Whilethenatureofthesedemandsdiffersconsiderablyacrossthecorpus,

ineachcasetheyseemedtotakeonanincrediblydominantrolewithinthegirls’

lifeworlds,posingapersistentandoverwhelmingsourceofpressure.Participants

loopedbacktothesamedemandsthroughouttheirinterviewsandpresentedthem

asacentralandconsistentfeatureofday-to-daylife.Thiswasparticularlywell-

illustratedinGrace’suseofabsolutetermsinrelationtothesedemands,which

gavetheimpressionofthemasconstantandunrelenting:“Ialwayssaytohim,

you’renotmydad”;“Igeteverythingblamedonme”;“itneverstopped”[emphasis

added].Indeed,Gracecommented“I’vehaditallmylife”onseveraloccasions,

suggestingthatthesedemandshavebeensuchaconsistentfeatureofherworld

thattheyhavecometobeacceptedasanunavoidable,andindeed

insurmountable,partoflife.Overall,then,thesedemandswerepresentedas

centralwithintheparticipants’livesandindeedappearedtohavebecomethe

subjectofsomefixationwithintheirthinkingprocesses.

Allthreeparticipantsconsistentlydrewdirectlinksbetweenthedemands

placedonthemandthesymptomstheywereexperiencing;forinstance,intalking

aboutthetimeswhenshewasstrugglingtokeepupwithwhatwashappening

duringlessons,Ameliaexplained,“Idon’tlikegettingsomethingwronglikethat’s

whatIworryaboutlike,gettingsomethingwrong[…]ifhegetsmadatmeorgave

meadetentionorsomethinglikethatthat’swhatIworryabout.”Thisjoint

presentationanddiscussionofspecificdemandsandparticipants’symptomsgave

theimpressionthattheseareseenasdeeplyintertwinedcomponentsoftheirlife

worlds.Ashasbeendiscussedearlierinthischapter(inthetheme“Symptomsarea


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PluralMassthatcanGrow”),thereweresuggestionsfromsomeparticipantsthatit

wasnotnecessarilyasingledemandthatwasproblematic,butitwaswhenthey

builtupthatthisbecameoverwhelming.Aspreviouslydescribed,Gracetalked

aboutmultipleincidentsbuildinguntiltheeffectsbecamedrastic,likeself-harmor

a“breakdown”.ThiswasalsoaparticularlystrongpatternwithinJennifer’s

account,whodescribedhow“itallpilesup”andbecomes“toomuch”,surpassing

herabilitytomanagethedemandsonher:“It’ssometimesabittoomuch,like,I

can’thandleit‘cause,ImeanI’vegothomeworkfromschoolandthenI’vegota

tutor,andthen…Idon’tknowwhatdosometimes.”

Participantsviewedthemselvesashavingaresponsibilitytokeepupwith

thesedemandsandweretakingeffortstodoso.Jennifer,forinstance,talkedabout

gettingupatfiveo’clockinthemorninginordertokeepupwiththevolumeof

academicworksheneededtocompleteforschoolandhertutoringprogramme.

Sheconsistentlyassertedaresponsibilitytobe“productive”andfeltguiltywhen

shesawherselfasfallingshortofthis:

IjustkindofwasteallthattimethatIhave,like,eveninthemorningsIstill,

goandwatchTVand…yeah,I’llbethereforlike,anhourorso,eventhough

Iwakeuplike,erm...five,halfpastfive…yeah,and,Iwasteallthattime.

Todifferentextents,bothJenniferandGracequestionedwhetherornotthey

shouldinfacthavetokeepupinthisway;thatis,theyappearedtothinkthatthe

demandsbeingplacedonthemwerenotnecessarilyfair.Thiswasparticularly

pronouncedforGrace,whofeltveryintenselythatthewayotherpeoplewere

behavingwasinappropriateandexpressedconsiderablefrustrationaboutthefact

thatthisthenimpactedonher.However,bothgirlsfeltlimitedcontroloveractually

resolvingtheseissues,abeliefthatisexploredindetailinalatertheme;asaresult,

theyfeltthattheyneededtoadapttomeetthesedemands.Forallthree

participants,regardlessofwhethertheyfeltthecircumstancestheyfacedwere

unfair,therewasaclearbeliefthatitwastheirresponsibilitytoadaptandmeet

thesedemands.Eachofthethreegirlsdescribedtakingcleareffortstokeepupand

bendthemselvestoaccommodatethechallengestheywerefacing,asinJennifer’s

excerptabove,evenwhenthisbelievedtobedisruptiveorevenharmfultothem.


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Forinstance,Gracewasstrugglingwithadecisionofwhetherornottostop

spendingtimeinhermum’shome,asthiswasseenasavolatileenvironmentand

sheexpressedconcernthatshewasnotsafewhenshewasthere.However,she

wasconflictedinthisdecisionasshewasconcernedaboutupsettinghermum:“I

don’twannahurtmymum,butIdon’twanttobewith…h-,herpartner,‘causehe’s

justdrivingmecrazy.”Thus,theseparticipantsweremakingconsciousdecisions,

sometimesperceivedtobedetrimental,inordertomeetapotentially

overwhelmingsetofperceiveddemandsinfluencingtheirday-to-daylives.

FearthatSomethingBadWillHappen

Eachofthethreeparticipantsdescribedintenseandpervasivefearsthat

somethingbadwasgoingtohappenintheirlives.Aswiththedemandsthey

perceived,thenatureofthisfearwasdifferentforeachparticipant.Jenniferfeared

thatshewouldnotbegoodenoughandthatotherswouldfindoutandjudgeher,

whileGracewasafraidthatsomeonewouldtrytophysicallyhurther.Ameliahada

strongfearthatshewouldgetintroublefornotkeepingupinschool,buttherewas

alsoamoregeneralfearappliedtovariousexperiencesthatshewentthrough,with

anyexperiencesheengagedinseenashavingthepossibilityfornegativeoutcomes.

Ascanbeseen,thespecificfearsthateachgirldescribedwerestronglylinkedto

thenatureofthedemandstheyperceivedaroundthem;forinstance,Grace’sfear

forherphysicalsafetyreflectsherobservationsthatotherpeopleinherhomeand

schoolliferegularlybehaveaggressivelytowardsher.Onseveraloccasions,the

participantstalkedaboutthesefearsdirectlyinrelationtotheirsymptoms.Asin

Amelia’searlierquote,itseemsitisnotalwaysthedemanditself,butthepotential

futureconsequencesthataredistressing;so,forAmelia,itisnotstrugglingwith

schoolworkthatisproblematic,itisthefearthatshewillgetintotroubleforthis.

Althoughthesefearsarerelatedtoparticipants’perceiveddemands,italso

appearedthatthenegativeconsequencestheyfearedhadnotyetcometofruition.

InGrace’saccount,thethreatandverbalaggressioninherschoolandhomelife

hadnotatthispointappearedtohavebecomephysical.Jenniferwasmaintaining

anoutwardimageofbeing“goodenough”andahighachieverandfeltnoonehad

yetrealisedotherwise,whiletheconsequencesAmeliahadactuallyexperiencedin


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heracademicdifficultieswererelativelylow-levelcomparedtotheextreme

punishmentsheexpected.Despitethis,thesefearsstillposedaveryrealpossibility

fortheparticipantsandtheywereoftenpresentedasinevitable.Forexample,

Gracefrequentlyused“yet”inhertalkofpossiblephysicalattacks,suchas“she

hasn’tdoneit…yet”,andweighedupduringtheinterviewwhatproofshewouldbe

abletouse“ifanythinghappened”withhermum’sboyfriend.Thefactthatthe

eventstheyfearedwerenotactuallyhappening,atleastnotasofyet,gavethe

impressionthatthegirlsheldanalternativeandhypotheticalworldintheirminds,

filledwithendlessnegativepossibilities.Sometimestheyplayedouthypothetical

scenariostoexplainapointwithoutappearingtohavegiventhisagreatdealof

thought,suggestingthatthesescenariosweresimplyanacceptedpossibilitythat

alreadyexistedintheirmind.Whentryingtoexplainhowshefeltathome,Grace

talkedquitecasuallyaboutwhatwouldhappenifsomeonecameintoherhome

andattackedher.Althoughshebeganthissentencewith“if”toshowits

hypotheticalnature,thelanguageshethenusedexpressesacertaintyratherthana

possibility,presentingthisasafutureeventthat“will”happen,ratherthanas

somethingthatcouldhappen:

IfeelreallysafewhenI’maroundwithmydadandstepmum.‘Causeit’slike,

theywon’ttakeanything.Like…ifsomeonewantstolike,comein,tohurt

me,mydadwillstepinstraightawayorcomeintohurtmystepmum,my

dadwillbeonit.

ThisparticularscenariofromGraceseemedsuchanextremeexample,andwas

presentedassucharealisticpossibility,thatitimmediatelypromptedthe

interviewertoaskwhetherornotGracethoughtthismighthappen.

Indeed,thereweretimesacrossallthreeparticipantswherethepotential

repercussionstheytalkaboutaredramaticandpotentiallycatastrophic.InAmelia’s

account,andtoalesserdegreeforJenniferandGracealso,therewassome

difficultyinconceptualisingwhatthebadthingthatcouldhappenactuallywas.

Ameliatalkedaboutthesefearsthroughoutherinterviewanditwasnotalways

clearwhatshethoughtwouldhappen,simplythatsomethingverywellcouldgo

horriblywrong.Shereferredto“somethinglikethat”andexplainedatonepoint


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whenaskedwhatmighthappen:“somethingbadwillhappen.Orsomethinglike

that.”Asaresult,itseemedthatthesepossibleoutcomesthatthegirlsfearedwere

drivenbyanunderlyingfearthattheydidnothavetotalaccessto,giventhatthey

didnotalwaysknowwhatitwastheywereafraidof.Thisabstractnessgavethe

impressionthatperhapstoinspectthesefearstoocloselywassomehow

dangerous,andsoitwasbestnottodoso,orperhapsthatitwasnotevenpossible

toaccessandinspectthem.

VoiceandControlovertheWorld

Asdescribedinanearliertheme,participantsfeltaresponsibilitytoadaptto

meetthedemandsplacedonthem,includingtakingstepsperceivedasdetrimental

tothem.Theimpressionacrossallthreecaseswasthatthiswasunderpinnedbya

beliefthattheyhadeithernorightorabilitytodoanythingaboutthedemand

itself.Notably,thismirrorstheirviewofthemselvesaspassiveinrelationtotheir

symptomsandspeakstoabroadersensethattheparticipantsfeltagenerallackof

controlthroughouttheirlives.

BothAmeliaandJenniferwereexperiencingchallengesinschool,with

AmeliastrugglingtokeepupandJenniferworryingaboutslippinginherstatusasa

highachiever.Ateachturn,itwasclearthattheyperceivedtheonustobeonthem

tomanagethis,withoutquestioningwhetherthesystemtheyweretryingto

navigatehadflawedexpectationsorshouldchange.Instead,theyweretheones

thatwerewrongandnotkeepingup,andtheyweretheonesthatneededtobend

themselvestofit.ThisisillustratedbyJennifer’sperceivedinabilitytotellher

parentsthatshedidnotreallyneedtutors,despitefindingthattheworkshehadto

completefortutoringwasoverwhelmingalongsideherhomework.Shedidnot

believethatshecoulddoanythingtoaddressthisissue,soinsteadshejusttriedto

fiteverythingin:

Wegetsomuchhomeworkand,Ialsohavetutorsso,itgetsabittoomuch,

sometimes[…]Imean,Ialreadyknowthisstuffandlike,I’mjustdoingit

again[…][Interviewer:Wouldyoueverspeaktoyourmumanddadabout

it,doyouthink?]No‘cause,theymightgetmadatme‘causeI,theydidsign

thecontractandIdidagreetoit.


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Giventhattheydidnotseeanyrealreasonfortheseexternalfactorstoadaptto

meettheirneeds,thenanychallengesthattheseparticipantsexperienced

constitutedafailureontheirpart.

Gracealsoperceivedalackofcontrolovertheexternalworld,butunlike

AmeliaandJennifersheveryfirmlybelievedthatthethingshappeninginherlife

werewrongandwasfrustratedthattheyaffectedher.Shegenerallyviewedother

peopleasirrationalandconsideredherselfthevoiceofreason.Atseveralpointsin

heraccount,Gracerecountedtimeswhenshehadattemptedtotellotherpeople

thatsomethingwasunfairandhadtriedtocommunicatewhatsheneededinstead.

Forinstance,whentalkingaboutanincidentofwhatsheperceivedtobe

inappropriatebehaviorfromhermum’sboyfriend,Graceexplained,“Iturned

aroundtomymumandsaid,‘allyoudoisbelievehim,youneverbelieveme’.But

heneedstostopdoingthis,butshedon’tlistentome.”Hence,notonlydidGrace

believethechallengesshefacedwereunfair,butshealsobelievedsheshouldbe

abletodosomethingaboutthat.However,herexperiencewasthatthismadelittle

difference,asothersdidnotlistentoherandcontinuedtoignoreherneeds.As

such,althoughGracebelievedthatshehadtherighttovoiceherneeds,thisvoice

hasnotbeenheard;“IsaywhatIwant,tosay,butitjustendsupgoingwrong.”Her

perceivedlackofotheroptionsappearedtohaveleftGraceinasituationof

enforcedhelplessness,whereallshecoulddowastrytoprotectherself.

6.3.4DrawingonOthers

Thisfinalsuperordinatethemeexploresthewaysinwhichtheparticipants

weredrawingonothersastheynavigatedtheirsymptomsandparticulardemands.

Itcapturesthewaysinwhichtheydeterminedwhototurntoforemotional

supportandtheperceivedbenefitsoftalkingtoothersabouttheirthoughtsand

feelings.ThefinalthemefocusesonGrace’sviewofoneparentasherprotector,

boththroughphysicalprotectionandbycompensatingforthehurtcausedby

others.


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MappingtheEmotionalSupportNetwork

Thethreeparticipantsappearedtohaveactivelyassessedwhattheywanted

inemotionalsupportandhadidentifiedparticularpeopleintheirworldswhothey

believedcouldfulfiltheseneeds.Thisevaluationandselectivenessgavethe

impressionthattheparticipantswere“mappingout”aneffectiveemotional

supportnetwork.Ameliahadawidersupportnetworkthantheothertwo

participants,thoughtherewasstillevidencethatshewasselectiveinwhoshe

turnedto;thiswaspredominantlyherfamilymembers(includingherdog)anda

smallnumberoffriends,ratherthansimplyanybody.Indeed,ononeoccasionshe

describedhowshetalkedtohersupportworkeraboutthings“inprivate[…]ifI

don’twannatellmyparents”,indicatingthattheremightbetimeswhenitis

necessarytobeselectivewithinthesupportnetwork.GraceandJennifer,onthe

otherhand,hadidentifiedamuchnarrowernetwork,andwerefirmthatthere

werepeopletheywouldnotconsideranappropriatesourceofsupport.Grace

typicallyonlywenttoherdadforhelpwithherfeelingsandrarelyreachedoutto

others.Whenshedid,thiswastypicallyheroldersisterandherstepmum,buteven

intheseinstancesthiswasbecauseherdadwasphysicallyunavailableatthattime,

suchaswhenhewasatwork.Theseindividualsthusservedasatemporarysolution

untilhebecameavailable,orevenasanintermediarywhowouldpassonthe

informationtoherdad,asinthefollowingextract:

Yesterday,itwasjustmeandmystepmum,andthedog.Mydadweren’t[…]

homefromworkyet.And,er…so,ifthathap-,ifthathappensandI’mreally

upsetI’lltalktomystepmum,andthenshe’llliketalktomydadandthen

mydadwilltalktome.

Similarly,Jennifergenerallyfeltitwasmostappropriatetotalktohermumorher

nanabouthernegativethoughts;thoughearlyinherinterviewsheexplainedshe

could“alwaysgoto[her]friends”,shelaterchangedhermindandsaidshewould

onlytalkabouttheseissueswithhermumornan.Indeed,Jenniferseemed

uncomfortablewiththeideaoftalkingtosomeoneelseabouthernegative

thoughts,asexploredinthenextsection,whichmaybewhyshewasinconsistent

inidentifyingwhoshewouldturntoforthistypeofsupport.


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Indescribingwhomtheywouldturntoforemotionalsupport,participants

oftenfocusedonparticularqualitiesoftherelationshipstheyhadwiththese

individuals,includingcloseness,trust,andcare.Forinstance,whenaskedwhat

adviceshewouldgivetosomebodystrugglingwiththeirfeelings,Ameliasaidshe

wouldgivethemthesameadvicethat“myfriendsormyparentsoranyonethatI

knowarecloseto[me]willgiveme”.Suchcommentssuggestthattheemotional

supportnetworkcomprisesthosethatcanbeconsideredtohavea“close”

relationship.Jenniferwasconcernedwithwhetherornotsomeonecouldbe

consideredto“genuinely”careforherand,aspartofthis,whetherornotthey

weretrustworthy.Whenaskedhowsheknewshecouldtrustsomeonewiththese

negativethoughts,sheexplained“cause…theywould,really,careforyou,like

genuinelycareforyouandnot,youknow,justfakeit.”Jenniferhighlightedthat

somepeoplewouldofferapoorsourceofsupport,particularlyteachersand

sometimesfriends,astheywouldsaythingstheydidnotmeanortellotherpeople.

Itseems,then,thatforsomeonetobeconsideredaqualitysourceofsupport,

thereneedstobeameaningfulandpersonalrelationshipwiththatindividual.

Anotherconsiderationthatwasmadeinidentifyingwhototurntowasthe

perceivedavailabilityandreliabilityofsupport.BothAmeliaandGracegavethe

impressionthattherewerepeopletheycouldconsistentlyrelyonforemotional

support.Theyemphasisedanobjectiveknowledgethattherewassomeonethey

couldturntowiththesedifficulties,andtrustedthatthiswouldbeanoption;as

Graceemphasisedoften,“IknowIcanrelyonmydad.Iknowthathe’salways

there.”Aspreviouslyexplored,bothoftheseparticipantsreliedstronglyonthose

aroundthemtohelpthemmanagetheirfeelings.Theyviewedthisasaconstant

optionanddrewonitwithouthesitation.Jennifer,ontheotherhand,generallysaw

othersasunavailableforanykindofsupport,particularlyinrelationtohernegative

thoughts,andwasreluctanttoreachouttoothersforhelpwiththis.Mostoften,

thiswasseenasbeingaphysicalabsence;shefrequentlycommentedthather

parents“alwayshavework”andexplainedthatshemightsometimesspeaktoher

mumabouthernegativethoughts,“ifshehastimeoff”.


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ReleasingSymptomsthroughTalk

Participantsbelievedthattheirsymptomscouldbereleasedthroughtalking

tothesecarefullyselectedothersintheirlives;thatis,aftersharingagivenfeeling

withanotherperson,itwasnolongerconsidered“inside”them.Forinstance,when

askedwhatpeopleshoulddoiftheywereexperiencingproblemswithworries,

Ameliaexplained,“don’tlike,makeyoufeelshyorhideyourworriesjustlet‘em

outandletpeopleknow.”Thealternative,itseems,istokeepitinside,asin

Jennifer’saccount:

Italktothemalotandlike,sometimesItalktothemaboutthingsthat,erm,

yeahthat…Ikeepinsideanddon’twannatellanyoneelse,but,Italkto

themaboutthataswellanditreallyhelpsme.

Afocusontheinsideand“lettingitout”carriesanimplicitbeliefthattalking

providesaveryliteralrelease.Theemphasishereisongettingthefeelingoutside

ofoneself.Itdoesnotseemtobethatthefeelingisdiminishedorsplitsomehow,

asintheadage“aproblemsharedisaproblemhalved”;rather,thewholefeelingin

itsentiretyisnolongerinsideandhasbeensingularlyreleasedfromtheself.This

addstothesensethatparticipantsviewedthesesymptomsasbothconnectedto

themand,yet,separatefromtheself.

Participantstypicallytalkedaboutreleasingasinglefeelinginthese

interactions;thatis,aparticularworryforAmelia,aspecificnegativethoughtfor

Jennifer,orthestateofupsetthatGracewasinonthatparticularday.Ineachcase,

theirtalkwithothersabouttheirsymptomswashighlyspecifictotheparticular

concernorpointofdistressthattheywereexperiencinginthatmoment,rather

thanbeingaconversationaboutmoregeneraldifficultieswiththesetypesof

thoughtsandfeelings.Forinstance,Gracetalkedabouthowifshebecameupsetat

schoolshewould“keepitinto[herself]allday,andthenI’llgohomeandtalktomy

dad”.Thissuggeststhattheseconversationsaredrivenbywhatisofimmediate

concern,andareusedreactivelytoaddressthespecificthoughtsandfeelingsthat

participantsareexperiencingintheirlivesastheyarise.


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Mostly,whatparticipantsappearedtofindmeaningfulaboutsharingtheir

symptomswassimplybeingheard,and“havingsomeonethere”(Jennifer).These

interactionsmadethemfeelcaredforandunderstood;Jennifercommented,“I

trustthem,andliketheyunderstandaswell”,whileAmeliaexplained,“Idotellmy

parentsthoughaboutit…andtheycantellthatIgetworried”.Thereisanemphasis

hereontheinsightthatotherscanhaveintotheseemotionalexperiences,wherein

theycanrecogniseandrelatetothethoughtsandfeelingsexpressed.Theimpetus

wasnotongainingasolutiontoanyproblemthathadfedintothefeeling,with

participantsrarelygivinganyindicationthattheysoughtemotionalsupportasa

meansto“fix”anythingintheirlives.Thiswaspresentoccasionally,butofteninthe

formofadviceorreassurance,ratherthanconcreteaction.Instead,thefocuswas

onthetalkitself:

Interviewer:What’sthefirstthingyoudo[whenyouhaveaworry]?What

doyoudo?

ErmwellboutmyworriesI’dnormallygoandtellmyparentsaboutitand

thenIjustlikechilloutwithmydog(Amelia)

Thismirrorsthewayinwhichparticipantsselectedothersbasedonperceived

qualitiessuchastrustworthinessorrelationshipcharacteristicslikeclosenessand

care,asopposedtochoosingsupportthathasanykindofpowerorabilitytofix

theirperceiveddemands.Inthisway,otherpeopleareabletohelpthemrelease

theiremotionssimplybyprovidingalisteningearand,crucially,showingcareand

understanding.

WhileAmeliaandGraceweregenerallycomfortableaboutsharingtheir

emotionswithothers,Jenniferexperiencedsomediscomfort.Sheviewedher

negativethoughtsasprivateandsensitive,andexplainedthatshewouldpreferto

“keepitinside”.Inspiteofthis,shetoobelievedthattalkingcouldprovidea

releaseforthesethoughts,andshediddescribetalkingtoothersaboutthem“to

justgetitoutofyourhead”.However,itappearedthatshedidsooutofnecessity

ratherthanbecausesheactuallywantedto.Sheseemstohavebeenforcedto

weighupherurgetokeephernegativethoughtsinsideagainstthepotential

benefitsoftalkingtoothers,andhasatleastonsomeoccasionsfoundthatthe


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releasetalkingcanofferhaswonout.Hence,itmaybethatevenwhentheactof

talkingaboutthesesymptomsisfelttobeunpleasant,thereleasethatcanbe

achievedmaybesubstantialormeaningfulenoughtooverrideanydiscomfort.

OthersasProtectors

ThisfinalthemeexploresGrace’sbeliefthatherrelationshipwithherdad

couldprotecther,bothinaveryliteral,physicalsenseandbycompensatingforthe

limitsshesawinwhatotherswereofferingher.Thisthemeissolelyunderpinned

byGrace’saccount,asitwasaparticularlysalientandcentralelementofherlife

world.

ItwasevidentthroughoutGrace’saccountthatherrelationshipwithher

dadwasdeeplymeaningfultoher.Shesawhimasaconsistentsourceofsupport

notonlyinrelationtoheremotionsbutalsoinnavigatingherday-to-daylife.In

manyways,thishadtakenonaformofprotection,ofteninaveryliteralphysical

sense.Shetalkedabouthowherdadwas“sostrong”andrelayedincidentsin

whichhehadphysicallykepthersafe,suchaswhenshefellwhilewalking:“causeit

wasrightnexttoaroad,sohejustlikegrabbedholdofme”.Asexploredinan

earliertheme,Graceexpressedconcernsaboutthepossibilityofphysicalharm

fromthepeoplearoundher.However,eveninthesehypotheticalscenariosherdad

washersaviour:

IfeelreallysafewhenI’maroundwithmydadandstepmum.‘Causeit’s,

like,theywon’ttakeanything.Like…ifsomeonewantstolike,comein,to

hurtme,mydadwillstepinstraightawayorcomeintohurtmystepmum,

mydadwillbeonit.

Thus,althoughsheexperiencedongoingfearofphysicalharmfromothers,Grace’s

dad’sstatusastheprotectorprovidedsomecomfort.

Gracewasalsousingherdad’swideractionsasaformofinternal

protection,shieldingherselffromthepaincausedbyherrelationshipwithher

mum.Shesawhermumasfailingtofulfilmotherlybehavioursanddutiesand

appearedhurtbythewaythathershedidnotprioritiseherneeds:


211

Iturnedtoherandsaid,allyoudoisthinkaboutyourself,‘causethatisall

shedoes.Sh-,allshethinksaboutis,her,allshethinksaboutisher

boyfriend,allshethinksaboutis…money,andbooze,that’sallmymum

thinksabout.

Commentsonhermum’sapparentselfishnesscameupfrequently,carryingan

implicitangerthatGraceherselfisnotfeaturedinhermum’spriorities.However,

shesawloveandcareinherdad’sactions,andthroughoutheraccountshedirectly

drewuponthesewhentalkingabouthermum.Itwasasthoughthethingsthather

daddidforhercouldcompensateforwhathermumdidnot,bothemotionallyand

physically.Inthisway,Gracecouldshieldherselffromthehurtshefeltather

mum’sbehaviourbyremindingherselfthatherdadlovedherandwouldbehave

appropriately.

Gracewouldoftennoteaperceivedfailureonhermum’spartandfollow

thiswith“butmydad”toexplainhowhehaddonesomethingmorehelpful.In

someinstances,theseactsalsoextendedtoaformofphysicalpreservation;Grace

recalledhowasababyherhipshadbeenunformed,andshehadneededtobeina

harnessforseveralhoursadaytoallowthemtodevelop:

Mymum,I(sighs)don’tknowhowtosaythis,but…mymumneverusedto

putmeinit,atalloranything,sheneverusedto…sheneverusedtoreally,I

don’thowtoputitlike,not,likesheneverusedtocareaboutmeor

anything,‘causeIknowsheprobablydid,butsheneverwantedto,like,put

meinit,oranything[…]he[dad]usedtoalwayscomehomeafterareally

longdayandputmeinitallthetime.

Firstly,thisquoteclearlydemonstratestheinnerturmoilthatGracegoesthroughin

tryingtounderstandwhetherornothermum“cares”abouther.Theexcerptalso

illustrateswellthedualrolethatGrace’sdadplayedasherprotector;ontheone

hand,hepreservesherphysically,andontheotherhand,hisloveandcaredirectly

compensatesforthephysicalandemotionaleffectsofhermum’sneglect.This

compensationnotonlyresolvestheissue,butitallowsGracetorecogniseasource

ofcareandloveinherworldthatcanmakeupfortheperceivedlackofit

elsewhere.


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6.4ReflexiveAppraisalDiscussion

AsdescribedinChapterFour,stepsweretakenforreflexivitythroughout

thedesign,analysis,andwritingstagesofthequalitativestrand,includinguseofa

researchdiaryanddiscussionwithsupervisorsandpeers.Inthefinalsectionofthis

chapter,keythemesthatarosethroughthisprocessarebrieflyexplored.This

includestheauthor’sownidentificationwithparticipants’experiences,maintaining

abalancebetweenuniqueandsharedexperiences,widerknowledgeof

participantsbeyondtheiraccounts,andtheuseofaconcurrentmixedmethods

design.Thisisnotanexhaustivelistofthereflexivejourney,butisintendedto

provideinsightintocentralaspectsofthisexperienceandeffortstakentomaintain

qualityandrigour.Thissectioniswritteninthefirstpersongivenitsfocuson

understandingthewaysinwhichtheresearcherisimplicatedinthefindings.

6.4.1IdentificationwithParticipants’Experiences

AshighlightedinChapterFour,IPArecognisesthattheinfluenceofthe

researcher’svalues,experiences,andpreconceptionsisconsideredtobenotonly

unavoidablebutalsopotentiallyvaluable,astheresearchermaybeableto

generatefurtherinsight(Larkin&Thompson,2006;Mayoh&Onwuegbuzie,2015;

Pietkiewicz&Smith,2014;Smithetal.,2009).Itcanbeargued,then,thata

researcher’sownpersonalexperiencesofthephenomenonofinterestcanaida

deeperandricherunderstandingofparticipants’sense-makingandexperiences

(Smithetal.,2009).However,itisimportanttoacknowledgesuchinfluencesandto

takeeffortstoensurethatinterpretationsremaingroundedinparticipants’own

accounts,ratherthanbecomingcloudedbytheresearcher’slens.Assuch,carewas

giventhroughouttoexaminingthewaysinwhichImyselfidentifiedwith

participants’experiences.

Primarily,thestudy’sinterestin“whatitislike”tobeanearlyadolescent

girlexperiencingemotionalsymptomsandriskstemsinpartfrommyown

experiencesduringadolescence.Priortobeginninganalysisofdata,Ispenttime

exploringhowmyownvaluesandexperiences,bothpersonalandprofessional,


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relatetothefocusofthestudyandthequalitativeresearchquestion,andexplored

howthiscouldinfluencethewayImightinteractwithdata.Idocumentedthese

reflectionsanddiscussedthemwithmysupervisorsandsupportivepeers.During

eachstageofanalysisIsoughttoinspectmyinterpretationsofdatatoexplorethe

extenttowhichtheseweregroundedinthewordsoftheparticipantsthemselves,

asoutlinedinSectionXXtoavoidover-reachingbasedonmyownpreconceptions.

Havingdocumentedmyearlypreconceptionsbeforebeginninganalysis,Iwasable

tolookbacktomyinitialnotesinthisareatohelpmemorerigorouslyexamine

whetherIwasimposingmyownthoughtstoostronglyontheinterpretation.

Furthertothis,therewereanumberofnarrowerareasofparticipant’s

experiencesthatresonatedwithmeinmoreunexpectedways.Jennifer’s

difficultieswithperfectionistictendenciesandproductivityandGrace’sfrustrations

offeelingunheardasanadolescentstronglyresonatedwithme.Whiletheseareas

ofpersonalidentificationmayhavefacilitatedamoremeaningfulinteractionwith

theseaccounts,reflexivebracketingtechniqueswereusedtoensure

interpretationsremainedgroundedinthedataasmuchaspossible.Ikeptongoing

reflexivenotesthroughoutthisprocesswhereverareasofrecognitionarose,

engagedindiscussionwithsupervisorstofacilitatecriticaldiscussionofhowthese

areasdevelopedasthemes,andutiliseddecontextualisationstrategiessuchas

readingfragmentedlines(asdescribedinSection4.9.2).

Tofurthersupportreflexivityinensuringinterpretationsweregroundedin

thecases,afteranalysisofeachindividualcase,Isharedthekeyquotes

underpinningeachthemewithmymainsupervisor.Ithenoutlinedtheprocessof

analysisforthatcase,includingdiscussionofanyparticularpointsthatresonated

withmeorwhereIfeltIhadexperienceddifficultywithbracketing.Mysupervisor

andIreviewedeachthemeinturnwithattentiontothequotesunderpinningitto

explorewhetherthedatapresentedsupportedtheinterpretationsbeingdrawn.I

repeatedthisexerciseafterdevelopingthemesacrossthecorpustoexplore

whetherthecollateddatasupportedeachofthethemesthathadbeencreated.


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6.4.2BalancingUniqueandSharedExperiences

AsdescribedinChapterFour,IPAisgroundedinanidiographiccommitment

totheparticular,ratherthantocreatinggeneralisations,andaimstoexploreand

representbothindividualandsharedfindingsacrossthecorpus(Reidetal.,2005;

Smithetal.,2009).Furthermore,theuseofarelativelysmallsampleinthecurrent

studyofferedtheabilitytoexplorecasesingreaterdepth,aswellasformore

nuancedexplorationofexperienceswithinthewrittenaccountsofthemes.Assuch,

ongoingattentionwasgiventoachievinganappropriatebalancebetweenthat

whichisuniqueandthatwhichissharedacrossparticipants’accounts,duringboth

theanalysisandwritingprocesses.

AsnotedinSection4.9.2,breaksweretakenbetweenanalysingindividual

casestocreatedistancefromthepreviousaccountandassociatedthemes.Where

connectionsordifferenceswereidentifiedatthisstage,Inotedthesedownand

inspectedthemtoexaminewhethertheyweregenuinelylocatedwithinthe

separatecasesorwhetherIwascarryingmeaningbetweentheaccounts.I

discussedthisprocesswithsupervisorsandpeersanddocumentedthisclosely.For

instance,JenniferandAmelia’saccountssharedmanycommonfeatures,including

afocusonacademicissues(albeitfromdifferentperspectives),asenseof

powerlessnessandpassivity,andissuesaroundirrationalityintheirthoughtsand

feelings,andsothesenaturallybecameevidentduringanalysisoftheirindividual

cases.TheseappearedquitedifferentfromtheexperiencesofGrace,whowas

facinglargelydifferentchallengesinherlifeandwasmakingsenseofthesein

differentwaysattimes.Forinstance,whileallparticipantsdescribedfeeling

powerlessandadaptingtodemands,AmeliaandJenniferappearedtofeelthat

adaptationwasthemostappropriateaction,whereasGraceviewedthisastheonly

availableresponsegiventhatattemptstoresolvethesechallengeswerenot

successful.

Insuchinstances,Ipausedanalysistospendsometimedocumentingand

appraisingtheseconnectionsandexaminingtheextenttowhichthismighthave

beeninfluencedbymyowninterpretations,orwhetherthisconstitutedthe

emergenceofasharedtheme.Thistypeoffore-structuringofthefinalmaster


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themesis,ofcourse,inevitabletosomeextent,butshouldbeinterrogatedclosely

(Smithetal.,2009).Indeed,ithasbeenarguedthatattentiontothewayinwhich

wordsandsense-makingechoacrosscasesallowsbothreflexiveappraisalwhile

alsofacilitatingadeeperinterpretationacrosscases(Goldspink&Engward,2018;

Smithetal.,2009).

Indevelopingmasterthemes,Iexperiencedsomeinitialdiscomfortwherea

themedidnotcaptureexperiencesfromallthreeparticipants,andrealisedthatI

wasattemptingtoreconfigurethesetocaptureexperiencesacrosstheentire

corpus.Indoingso,IfoundthatIwasbeginningto“zoomout”sofarthatitrisked

losingspecificpointsofmeaningandnuance.Inordertochallengethisinstinct,I

spentsometimeexaminingthisdiscomfortandengaginginpeerdiscussion.I

movedbacktoanearlierthematicstructure,whichhadencapsulatedgreater

variabilityacrossparticipants,andlistenedtoeachoftheaudiorecordingsagain

whilereviewingthetrackingofeachcase’sanalysis,inordertorealignmyselfwith

participants’lifeworldsandregainmyfocusontheindividual.Thisallowedmeto

revisitthethemeswitharenewedfocusontheidiographic,andrefinethem

withoutlosingindividualexperienceormeaning.Indeed,inthefinalsetofmaster

themes,therearesomethemeswithonlytwoparticipantsrepresentedandone

themethatcapturedonlyGrace’sexperiences.

Finally,itshouldbenotedthatthethemesandthewayinwhichparticipants

wererepresentedwithinthemchangedthroughthewritingprocess.Themes

sometimescameintosharperfocusthroughdevelopingawrittennarrativeof

them,atwhichpointIrevisitedthedataandearlierstagesofanalysistoassess

thesechangesinjudgement.Insomecases,thismeantrevisitinganalysisofacase;

forexample,throughexplaininghowGracedidnotconceptualisehersymptomsas

objectsbutinsteadasastate,Irealisedthatthishadbeenoverlookedinherinitial

individualthemesandwentbacktoherdatatoreviewthis.Atthisstage,theinitial

theme“symptomsasobjects”became“thenatureofsymptoms(objectorstate)”.


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6.4.3WiderKnowledgeofParticipants

AsoutlinedinChapterFour,participantsweredrawnfromthequalitative

baselinesampleintheHeadStartevaluation,whereinparticipantsareinterviewed

annuallyforfiveyearsbymembersoftheresearchteam(includingmyself).As

such,althoughthecurrentstudyfocusedonparticipants’baselineinterviewsin

2017,eachoftheseparticipantstookpartintwofurtherinterviewswhilethis

researchwasbeingconducted,in2018and2019.Specifically,IinterviewedAmelia

atallthreetimepoints(thoughonlyherfirstinterviewfeatureshere),andJennifer

andGracewereinterviewedbyothermembersoftheHeadStartteamandsoIhad

limitedengagementwiththeirlaterinterviews.Thus,myownroleinterviewing

HeadStartparticipantsmeantIsometimeshadaccesstoparticipants’later

experiencesbeyondthedatafocusedonhere.

Firstly,IhaveinterviewedAmeliaatallthreetimepointswithinthe

longitudinalHeadStartprogrammeevaluation,thoughonlyherbaselineinterviewis

utilisedinthecurrentstudy.Toreducetheimpactofthisfurtherengagement,I

analysedthiscasepriortoconductinghersecondinterviewandimmediatelyafter

thisinterviewreflectedondifferencesandsimilaritieswithherpreviousaccount.

Thismeantthatwhileitispossibletoreturntoapreviouslyanalysedcaseandfind

newinterpretationsinIPA,Iwasabletoconsultmynotesfromhersecond

interviewtocross-checkwhetheranynewinsightpossiblyreflectedlater

interactions.IrepeatedthisatthethirdinterviewinApril2019,althoughbythis

stagethequalitativefindingswerefullydevelopedandwrittenup,offeringless

scopeforintrusion.

AlthoughotherresearchersinterviewedJenniferandGrace,Iwasmade

awareofparticularelementsofJenifer’ssecondinterviewthatrelatedtoher

discomfortintalkingtoothers.ThisoccurredduringanalysisofJennifer’scaseand

soitwasimportanttoensurethatthisinformationdidnotimposeitselfonmy

interpretations.Fortunately,thistookplaceafterthesecondstageofanalysingher

accountwascomplete,meaningIhadalreadyrecordedsystematicline-by-line

codingreflectinginterpretationsofthisdata.Thus,indevelopingthemesforthis

caseIutilisedthissystematiccodingtocross-checkmyongoingthinkingtoavoid


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introducingnewideasbasedonthiswiderawareness.Beyondthis,IensuredIhad

nofurtherinteractionwiththedataproducedthroughthesecondandthird

interviewswitheitherJenniferorGrace.

Finally,becauseparticipantswereinterviewedbymultipleresearchers,my

knowledgeandinsightintoAmeliaasapersonwasgreaterthanthatofJennifer

andGrace,giventhatIhadmetherandconductedtheinterview.When

participantswerefirstselectedasstudyparticipantsIspokewithJenniferand

Grace’sinterviewerstoexploretheirperspectivesoftheseparticipantsandtheir

interviews.IalsolistenedtoJenniferandGrace’sinterviewaudiorecordingsseveral

timesduringanalysistoretainafocusonthemasindividuals,inordertohelpme

connectmorecloselywiththeirlifeworldsratherthanthroughsimplyinteracting

withwordsonapage.

6.4.4ContextoftheBroaderStudy

Considerationwasgivenheretothecontextoftheanalysiswithinthe

broaderstudy,includingcompletionofotherchaptersandaconcurrent

quantitativestrand.

Duringtheanalyticalprocess,Iwasalsoengaginginwiderreadingand

completingcomponentsofChaptersOne,Two,andThree,exploringandpresenting

thecurrentliteratureintheseareas.Itisofcoursedifficultforresearchersto

separateouttheirwiderknowledgeinagivenareawhencompletinganalysis,and

inthecontextofathesisitisnotalwayspossibletopostponewritingofother

chaptersgiventhevolumeofworktobecompleted.AsaresultIsoughttotake

carethatmyengagementwithdatawasgroundedinthedataitself,ratherthan

drivenbyanyareaoftheliterature.Nevertheless,itshouldbenotedthatSmithet

al.(2009)haveacknowledgedthatexistingconstructswithintheliteraturemaywell

offervalueintheinterpretivecomponentofcodingandmakingsenseofdata,

wherehandledwithcaution.Thereisperhapsadistinctiontobemadebetween

recognisingwiderpsychologicalconstructs(e.g.,“identity”),andlinkingwhatis

observedwithindatatomorenarrowedexistingpiecesoftheoryorliterature(e.g.,

aparticulartheoryofidentityoraspecificfindingpublishedinastudyaround


218

identity).WhereIobservedthesemorenarrowedparallels,Isoughttopauseand

inspectmythinkingwhyImighthavemadethislink,whichIoftenfoundusefulin

returningtowhatwasofinitialinterestinthedataandmovingoninwithamore

inductivefocus.

Asthetwomixedmethodsstrandsofthecurrentstudywerecarriedout

concurrently,considerationwasgiventhroughouttothewayinwhichelementsof

thequantitativestrandmayinfluencequalitativeprocessesandfindings.This

includesemergingquantitativeresultsaswellasthequantitativestrand’sheavier

focusonnarrowlydefinedconstructsandvariables,suchasriskfactorsand

cumulativerisktheory,thatareinconsistentwiththeinductiveand

phenomenologicalnatureofIPA.AsdescribedinSection4.9.2,theanalyticalsteps

inIPArequiretheresearchertoenterparticipants’lifeworldsandengageinaclose

andsystematicanalysisoftheiraccount.Thisapproachencouragestheresearcher

toconnecttheirthinkingwiththedatainaparticularlyfocusedwayandIfound

thatthiswasusefulinbracketingwiderpreconceptionsbasedonquantitative

hypotheses.Indeed,IfoundthatIcouldsomewhatreadilyidentifysituationswhere

mythinkingwasinfluencedbyelementsofthequantitativestrand,giventhatIwas

activelyanddeliberatelyengagingwiththeseconstructs.Ifeltthiswaslesstruefor

identifyingtheinfluenceofmyownvaluesandpreconceptions,whichareless

easilydefinedandreadilyapparent.

Ialsotookfurtherstepstomanageandwherepossiblelimitthepotential

effectsofcarryingoutquantitativeandqualitativeanalysisconcurrently,including

considerationsoftiming.Thisincludedspacingoutmyengagementwitheither

datasetthroughoutaworkingweek,sothatIalwaystooksometimebetween

completinganygivenanalysis.Forinstance,mostofthetimeItriedtoworkwith

qualitativedataonMondaysandthentoengageinwiderwritingandbroader

departmentalresponsibilitiesonTuesdaysandWednesdays,beforeengagingwith

quantitativeanalysislaterintheweek.Ifeltthisapproachworkedquitewellontwo

counts.Firstly,thismeantIhadsomedistancefromquantitativeanalysisovera

weekendbeforeengagingwithqualitativeanalysisandsodidnothavequantitative

constructsandmodelsattheforefrontofmymindduringanalysis.Secondly,this


219

approachmeantIhadthespacetoprocessmyreactionsandthoughtsfrom

qualitativeanalysisbeforeengagingwiththequantitativestrandsoasnotto

inadvertently“solve”anylingeringthoughtsaboutacasethroughmyengagement

withstatisticalinformation.ItshouldalsobenotedthatIwaitedtocompletemore

mechanisticcomponentsofanalysis(i.e.,indirecteffectsofperceivedstress

componentsandprotectivefactors)untilIhadidentifiedqualitativethemesacross

thecorpus,insteadfocusingonearlierstagesofanalysis.Ifeltthatthiswas

beneficialasthesemechanismslinkmoreexplicitlywiththeemphasisoninner

processescapturedinthequalitativestrand,whereasidentificationofriskfactors

couldperhapsbelessinfluentialonmythinkingininterpretinggirls’experiences.

Parallelsbetweenthetwosetsoffindingswerecertainlyofinterestgiven

theuseofmixedmethodsandareunavoidablegiventhatbothstrandsfocusonthe

samephenomena.However,Itriedtoensurethatanysimilaritiesorparallelswere

trulylocatedwithinthefindings,ratherthanshapingfindingsinthefirstinstanceby

myownidentificationofsimilarities.WhereIobservedsuchparallels,Inotedthese

separatelytorevisitatalaterstageandmovedoninmyanalysis.Thisapproach

allowedmetodirectlyacknowledgetheseareasinmythinkingandbracketthemas

somethingthatcouldbereturnedtoafterformingamorecompleteimageofthe

qualitativefindings.Thereweresomeinstanceswhenmyinterpretationsofthe

datamoredirectlyreflectedthequantitativestrand,suchasAmelia’sindividualised

theme“cumulativesupportnetwork”mirroring(tosomeextent)cumulativerisk

theory,orGrace’sperceptionofherdadasaprotectorreflectingdiscoursewithin

resilience.Whenthisoccurred,Inotedthesetobracketthemoffduringanalysis,

andreturnedtothematalatertimewhenIcouldinspecttheseinterpretations

closely,discussingthemwithsupervisorsandpeerstoestablishwhethermy

conclusionstrulyreflectedthedataoranimpositionofdiscreteconstructs.

6.5ChapterSummary

IndividualthemesweredevelopedforAmelia,Jennifer,andGraceandfour

superordinatethemesweredevelopedacrossthecorpus:(1)Theexperienceof


220

symptoms,capturingthewaysparticipantsconceptualisedandexperiencedthe

thoughtsandfeelingsthatcomprisedtheirsymptoms;(2)internalgrappling,

encapsulatingparticipants’conflictinunderstandingthesefeelingsinrelationto

themselvesandtheouterworld;(3)demandsandcontrol,exploringthepersistent

demandsparticipantsexperiencedthattheybelievedtobebeyondtheircontrol;

and(4)drawingonothers,exploringthewaysparticipantsmappedoutanddrew

onanemotionalsupportnetwork.Strategiesforreflexivitywereutilised

throughoutanalysisandkeyareasofthisprocesshavebeenoutlined.

CHAPTERSEVEN:DISCUSSION

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Chapter7:Discussion

7.1ChapterOverview

Thischapterpresentsadiscussionofthestudy’sfindings.Itbeginsby

summarisingfindingsforeachresearchquestionbeforeexploringtheseingreater

depth,consideringhowexistingtheoryandliteraturemayofferanexplanationand

examininguniquecontributionstoknowledge.Next,findingsacrossthe

quantitativeandqualitativestrandsareintegratedintometa-inferences,whichare

discussedwithconsiderationofimplicationsanddirectionsforfutureresearch.The

chapterthenreflectsonthestudy’sstrengthsandlimitationsand,finally,offers

concludingremarks.

7.2SummaryofFindings

7.2.1ResearchQuestion1:RiskFactorsandProcesses



Thisfirstquestionaimedtoidentifytheriskfactorsassociatedwith

emotionalsymptomsamongearlyadolescentgirls,andtoinvestigatemultiplerisk

effectsandunderlyingprocesses.Analysisidentifiedfourriskfactorssignificantly

associatedwithhigherlevelsofemotionalsymptomswithinthesample,namely

lowacademicattainment,SEN,lowfamilyincome,andcaregivingresponsibilities.

Thefirstthreeoftheseriskfactorsweresmallinmagnitude,whiletheassociation

betweencaregivingresponsibilitiesandemotionalsymptomswasmoderateinsize.

Acumulativeriskscorecomprisingthesefourriskfactorswasfoundtobea

significantpredictorofemotionalsymptoms,providingevidenceforcumulativerisk

effects;thatis,asthenumberofriskfactorsoneisexposedtoincreases,sotoo

doesthereportedlevelofsymptomatology.Assessmentofmeasurementmodels

torepresentmultipleriskexposureindicatedthatalatentriskconstructwasthe

strongestpredictorofemotionalsymptoms,explainingagreaterproportionof


222

variancerelativetocumulativeriskscoreandmultipleregressionapproaches.This

latentvariableoffersarepresentationofmultipleriskexposurethatunitesrisk

factorsasasingularconstruct,inlinewithindicationsthatriskstendtocluster

aroundanindividual,whilepreservingthespecificnatureofeachriskfactor,

offeringamorecomplexrepresentationthanisofferedintraditionalcumulative

riskindexing.

Finally,itwasfoundthatmultipleriskexposurewasassociatedwith

emotionalsymptomswithinthesampleentirelythroughindirectpathways,via

perceiveddistressandperceivedcoping.Thatis,greaterlevelsofmultiplerisk

exposurewereassociatedwithgreaterperceiveddistressandloweredperceived

coping,bothofwhichwereassociatedwithgreatersymptoms.Afteraccountingfor

indirecteffects,therewasnoevidenceofastatisticallysignificantdirecteffect

betweenmultipleriskexposureandemotionalsymptoms,indicatingsupportfor

“fullmediation”.Thetotalindirecteffectswerefoundtobesmalltomoderatein

magnitudeandthismodelexplainedasubstantiallylargerproportionofvariance

(60.5%)comparedtothemodelwithonlythelatentconstructasasingular

predictor(8.8%).

7.2.2ResearchQuestion2:FactorsandProcessesforPositiveOutcomes



Thisresearchquestionsetouttoidentifythefactorsassociatedwithlower

levelsofemotionalsymptomsamongearlyadolescentgirls(promotiveeffects)and

toinvestigatewhetherexternalfactorsmoderatetheprocessesunderlyingmultiple

riskeffectsamongthispopulation(protectiveeffects).

Analysesfirstidentifiedthreepromotivefactorssignificantlyassociatedwith

lowerlevelsofemotionalsymptomswithinthesample,specificallyfamilyadult

connection,schoolpeerconnection,andactiveengagementinhomeandschool

life.Theseassociationswereallobservedtobesmallinsize,withschoolpeer

connectiondemonstratingthestrongestassociationwithloweredsymptomatology.


223

Thefinalmodelexaminedwasaconditionalindirecteffectsmodel,wherein

hypothesisedprotectivefactorsweremodelledasmoderatorsoftheunderlying

distressandcopingmechanismswithintherelationshipbetweenmultiplerisk

exposureandemotionalsymptomsinthesample(Figure5.11,shownagain

overleaf).Inspectionofthismodelindicatedthatpathwaysbetweenriskexposure

andperceiveddistressandcoping,respectively,wereeachmitigatedbygreater

perceivedfamilyadultconnectionandschoolpeerconnection,withfamily

connectiondemonstratingthestrongesteffect.Conditionaleffectswereobserved

onlyforthefirststageofindirecteffects,withthepathwaysfromriskexposureto

bothperceiveddistressandcopingmitigatedbyperceivedconnectiontofamily

adultsandschoolpeers.Thiswasnottrueforthesecondstageoftheindirect

pathways;thatis,parametersfromdistressandcopingtoemotionalsymptoms

unaffectedbyanyoftheprotectivevariablesassessed.Alsoofnotewastheextent

ofthechangeobservedhere.Greaterperceivedconnectiontofamilyadultsand

schoolpeersdidnotsimplylesseneffects,butchangedtheirdirection,sothat

thoseexposedtogreaterlevelsofriskwerelesslikelytoappraisetheirlivesas

stressful(withalargeeffectsize)andmorelikelytoreportagreaterabilitytocope

(withasmalleffectsize).


224

Figure5.11.Specificconditionalindirecteffects.Familyadultconnection(FAMILY)andschoolpeer

connection(PEER)areshownmoderatingtheeffectsofmultipleriskexposureuponperceived

distressandperceivedcoping.Positiveparametersareshowninblocklinesandinverseparameters

areshownindashedlines.

7.2.3ResearchQuestion3:LivedExperience

3.Whatisitliketobeanearlyadolescentgirlwhoisexperiencingemotional


Thisresearchquestionexploredtheemotionandlivedexperienceof

participants,withafocusonthewayinwhichtheyexperiencedandmadesenseof

theseareasoftheirlives.Findingsweregroundedinfoursuperordinatethemes:

Theexperienceofsymptoms;internalgrappling;demandsandcontrol;anddrawing

onothers.

Ascapturedin“theexperienceofsymptoms”,participantsconceptualised

theirsymptomseitherasobjectifiedcognitiveentitiesthatcouldbehad,or

affectivestatesthatonebecame.Participantsviewedthemasamassthatcould

growandbuild,attimestotheextentthattheywerebeyondtheirowncontrol,

andinsomecasespresentedthesesymptomsasdominantwithintheirbroader

emotionallandscape.Asencapsulatedin“internalgrappling”,participants


225

experiencedanumberofinternaltensionsandconflictsinmakingsenseofthese

symptoms,whichtheyappearedtoviewasoccurringwithinthem,butoperating

independentlyofthem.Theyconsideredthesethoughtsandfeelingstobe

connectedtothembutalsoseparatefromtheircoreidentityandpositioned

themselvesaspassivewithinboththeoccurrenceandresolutionofthese

symptoms.Furthermore,insomecasesthesetypesofthoughtsandfeelingswere

seenasirrational,althoughthisbeliefdidnotappeartobehelpfulinchallenging

them.

“Demandsandcontrol”capturedthewaysthatparticipantsmadesenseof

thedifferentdemandsintheirworlds.Theperceiveddemandsthatparticipants

facedwereseenasdominatingtheirlifeworldsandtheyfeltastrongresponsibility

toadapttomeetthesedemands,evenwhenthiswasperceivedtobedetrimental

tothem.Theydescribedintenseandpervasivefearsthatsomethingbadwasgoing

tohappenandbelievedthattheyhadnorightorabilitytodoanythingaboutthe

demandsthattheywerefacing.Finally,“drawingonothers”exploredthewaysthat

participantsdrewonthepeoplearoundthemastheynavigatedtheirsymptoms

andthedemandstheyfaced.Theydescribedaprocessofmappingouttheir

emotionalsupportnetwork,assessingandselectingindividualswhotheyviewedas

abletofulfiltheirsupportneeds,andbelievedthattalkingtoothersabouttheir

symptomscouldbebeneficial.Inthecaseofoneparticipant,otherpeoplecould

alsoactasaprotector,shieldingherfromphysicalharmandcompensatingforthe

hurtcausedbyotherpeopleinherworld.

7.3ResearchQuestion1:RiskFactorsandProcesses



7.3.1RiskFactors

a.Oftherisksidentified,whatisthemagnitudeoftheirassociationwithearly



226

ConfirmedRiskFactors

LowAcademicAttainment

Findingssuggestthatearlyadolescentgirlswithlowacademicattainment

aremorelikelytoreporthigherlevelsofemotionalsymptoms.Thissupportsa

consistenttrendpresentacrosstheliterature,withawealthofstudiesreporting

evidenceofsucharelationship(Bondetal.,2005;Deightonetal.,2018;Panayiotou

&Humphrey,2018).Similarlytopreviousstudies(Bondetal.,2005;Moilanenet

al.,2010;Panayiotou&Humphrey,2018;Weeksetal.,2016),thisassociationwas

observedtobesmallinmagnitudewhenconsideredinlinewithCohen's(1988)

thresholds.

Itshouldbenotedthatpriorevidenceindicatesthattheremaybea

bidirectionalassociationbetweenlowacademicattainmentandemotional

symptoms,withdifficultieswithsuchsymptomspotentiallyinfluencingone’s

achievementlevels(Deighton,Humphrey,etal.,2018;Verboometal.,2014).The

datadrawnuponinthecurrentstudycapturedparticipants’attainment

approximatelyoneyearpriortothecompletionoftheWMF(seeSection4.7.1),

whichprovidesanindicationofalongitudinalassociation;however,asitwasnot

possibletocontrolforprioremotionalsymptoms,bidirectionaleffectscannotbe

ruledout.

SEN

ParticipantswithSENweremorelikelytoreportgreaterlevelsofemotional

symptoms,reflectingpreviousindicationsofincreasedratesamongchildrenand

adolescentswhohaveanSENcondition(e.g.,Emerson,2003;Nelson&Harwood,

2011)aswellasgreaterlevelsofdiagnosablepsychiatricconditions(e.g.,Brereton

etal.,2006;Simonoffetal.,2008).Studieshaveoftenreportedevidenceofa

moderateassociationinrelationtovariousSENconditions(e.g.,Nelson&Harwood,

2011),thoughherethisrelationshipwasfoundtobesmallinsize.However,itis

notablethatthecurrentstudyassessesSENasanoverarchingriskfactorrather

thanfocusingonindividualSENconditionsasinpreviousresearch.AsSENcaptures

considerableheterogeneitybothacrossandwithinconditions(DfE&Department


227

ofHealth,2015),suchfindingscannotreasonablybegeneralisedtootherswiththe

sameorotherconditions.Giventhatindividualsaretypicallyidentifiedashaving

SENbecausetheyarerecognisedashavingneedsnoteasilymetwithinusualschool

practices,thecurrentstudyindicatesthatoperatinginaschoolsystemnot

necessarilydesignedtomatchone’sneedsmaybedetrimentalinrelationto

emotionalsymptoms.

LowFamilyIncome

Evidenceofarelationshipbetweenlowfamilyincomeandemotional

symptomsinthecurrentstudywasunsurprising,asthisisoneofthemostwell

establishedriskfactorsacrosspreviousliterature(e.g.,Morrisonetal.,2014;

Santiagoetal.,2011).Thisrelationshipwassmallinsizeandindeedwasthe

weakestcontributoracrosstheconfirmedriskfactors.Mixedfindingsaroundeffect

sizesacrossexistingliterature,rangingfromsmalltomoderate,havebeen

attributedtofluctuationinsamplecharacteristicsincludingageandgender,aswell

asmethodologicalfeaturessuchasmeasurementofincome(Mendelsonetal.,

2008;Reiss,2013).Thecurrentstudyaddstocurrentknowledgeandunderstanding

ofthemagnitudeofthisrelationshipspecificallywithinearlyadolescentgirlsacross

disadvantagedareasofEngland.UseofbothpastandpresentFSMeligibilityto

indicatelowfamilyincomeallowedincorporationofpreviousexposure,inlinewith

evidenceindicatinglong-termeffects(e.g.,Najmanetal.,2010;Santiagoetal.,

2011).However,thestudycouldnotexploreshiftsinthetiming,duration,and

intensityoffamilialpovertyandlowincome,whichcaninfluencetheextentof

effectsuponmentalhealthoutcomes(Reiss,2013).

CaregivingResponsibilities

Participantswhoidentifiedthemselvesashavingsomelevelofcaregiving

responsibilitiesreportedhigherlevelsofemotionalsymptoms.Thereissome

previousevidenceofsuchanassociationamongchildrenandadolescentswith

caregivingresponsibilities(Banksetal.,2001;Kavanaughetal.,2015;Shifren&

Kachorek,2003).However,investigationhasbeenrareandthesestudiesoften

focusonspecificgroupsofcaregivers,suchasthosecaringforadultswitha


228

disability,offeringhighlycontextualfindings.Thus,examinationofbroader

caregivingresponsibilitieshereprovidesinsightintopatternsacrossarangeof

circumstances,facilitatinganunderstandingoftheeffectsofdeliveringcareto

othersmoregenerally,ratherthaninthecontextofaspecificneedordisorder,

thusofferinggreatergeneralisability.

AsexploredinChapterFour,thisvariablewasre-definedbasedon

prevalenceestimatesandsoitisimportanttonotethatthisrelatestocaregiving

responsibilitiesatagenerallevelratherthandescribing“youngcarers”.

Nevertheless,thisvariableshowedamoderateassociationwithemotional

symptoms,substantiallylargerthanthatofotherriskfactors.Indeed,thisfinding

suggeststhatgeneralcaregivingresponsibilities,beyondthatreflectedinthe

narrowedcategoryofyoungcarerstatus,maybeparticularlyproblematicfor

emotionalsymptomsduringthisdevelopmentalphase.Qualitativeresearch

exploringyoungcarers’experienceshasindicatedthatcaregivingexperiencesare

markedbypersistentstressinday-to-daylifeandchallengingshiftsinone’sidentity

(Bolasetal.,2007;Earleyetal.,2007;Rose&Cohen,2010).Givenlimited

knowledgeinrelationtohowcaregivingresponsibilitiesmaybeassociatedwith

emotionalsymptoms,findingsindicateaneedtoreplicatethisstudyacrossdiverse

populationsandcontextsandtoundertakefurtherqualitativeexploration.Factors

suchastheextentandtypeofcarethatyoungpeopleareprovidingmayinfluence

themagnitudeofthisassociation,ascouldtherelationshiptothepersonneeding

careorthespecificdifficultynecessitatingcare(Ireland&Pakenham,2010;

Kavanaughetal.,2015).Indeed,givenindicationsthatthecurrentstudyis

capturingawidergroupofindividualsthanthosemoretypicallyidentifiedasyoung

carers,itmaybeimportanttomorefullyunderstandthepointatwhichtheextent

andregularityofcaregivingbecomesproblematicformentalhealthoutcomes.

Asthecurrentstudyfocusesonunderlyingmechanismsandprotective

factorsinthecontextofmultipleriskexposure,suchprocessesarenotdirectly

examinedinrelationtocaregivingresponsibilitiesasanisolatedvariable.Given

currentlimitationsinknowledgeandunderstandingregardingmechanismsand

adaptiveprocessesamongyoungcarers(Kavanaughetal.,2015),alongside


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qualitativeevidencethatyoungcarersreporthighlevelsofstressindailylife(Bolas

etal.,2007;Earleyetal.,2007;Rose&Cohen,2010),futureresearchshouldseekto

directlyexplorethisinrelationtoemotionalsymptoms.Furthermore,the

measurementandprevalenceissuesencounteredhereindicateaneedfor

considerationinthewayinwhichyoungcarerstatusand/orcaregiving

responsibilitiesismeasuredinresearch.Whileapreviousstudyfoundthata

definitionalapproachasadoptedhereyieldedsimilarestimatestomoredetailed

measures(Banksetal.,2001),findingsheresuggestthatthisapproachcouldlead

toinflatedestimates.Itisimportantforresearcherstocarefullyconsiderthe

implicationsoftheirmeasurementapproachandhowopenthismaybeto

interpretationfromparticipants.Furthermore,researchersshouldclarifyfor

readershowmeasurementmayaffectthenatureoftheirdataand,inturn,their

inferences.

ExcludedRiskVariables

Youngrelativeage,highacademicattainment,ACEs,andneighbourhood

socioeconomicdeprivationwerenotfoundtobeassociatedwithincreasedlevelsof

emotionalsymptomshere.Giventhateachofthesevariableswasincludedbased

ontheoreticaland/orempiricalsupportacrosstheliterature,findingsmayoffer

furtherindicationsofthecontextualnatureofrisk.Forinstance,muchofthe

previousevidencearoundACEsandneighbourhoodsocioeconomicdeprivationis

focusedonadults,withlimitedinvestigationofadolescentoutcomes;thus,itmay

bethatthereislittleoveralleffectforearlyadolescentgirls.Similarly,itmaybe

thatthefocusonearlyadolescenceinparticularisrelevant.Forinstance,itmaybe

thatnegativeeffectsinrelationtohighacademicattainmentoccurinlaterstagesof

adolescenceintimesofparticularacademicpressure,suchasGCSEpreparation,

ratherthaninearliereducationalstages.Thefocusongirlscouldalsoberelevant

fortheseriskvariables,asthesefactorscouldperhapsbeproblematicforboysand

thusproduceanassociationifbothgirlsandboyswereanalysedtogether.

Findingsmayalsorelatetothemethodologyused.Asnoted,riskfactorsare

oftenexaminedinisolationratherthaninunison,meaningthatconfoundingeffects

ofotherco-occurringvariablesarenotaccountedfor;thus,itmaybethatthestudy


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offersamorepreciseestimateoftheserelationships.However,itmayalsobethat

themeasurementusedfortheseriskfactorshasinfluencedresults.Forinstance,

useofCINstatusasaproxyforACEsdiffersfromthemoretypicaluseofaself-

reportinventoryspanningnumerousadverseexperiences.Thoughthisovercomes

issuesofrelianceonrecall,itprovidesbinaryinformationratherthanascaled

response(e.g.,cumulativeexposuretoACEs)andmayonlycapturemoreextreme

circumstancesalbeitwithsupportinplace,giventhatdesignationofCINstatus

denotesaneedforprofessionalintervention.

Futureworkisneededtoexplorethesevariablesacrossdifferent

circumstancesandpopulations.Ofcourse,itisalsoimportanttonotethatjust

becauseafactorisnotfoundtofunctionasriskyforagroupasawholedoesnot

meanitisnotproblematicforsomeindividualsorevengroupsofindividualswithin

thatlargergroup.Thisisillustratedwellinthecaseofhighacademicattainment

throughthequalitativeexperiencesofJennifer,whodescribedintensedifficulties

andpressureinrelationtohighattainment.Suchdisparitiesdemonstratetheneed

toretainafocusonindividualexperiencesratherthangeneralpatternsalone,both

inresearchandinpractice.

7.3.2CumulativeRiskEffects

Thecurrentstudyoffersevidenceofsmallcumulativeriskeffectsinrelation

toearlyadolescentgirls’emotionalsymptoms.Specifically,thisfindingprovides

supportfortheaccumulationprinciple,thefirstcoreassumptionofcumulativerisk

theory,whereinincreasedlevelsofriskexposureareassociatedwithworsening

outcomes.Itisalsoconsistentwithageneraltrendacrosspreviouscumulativerisk

investigations,withaccumulationeffectsfoundacrossawiderangeofpopulations

andoutcomes(Evansetal.,2013).Paststudieshaveidentifiedanassociation

betweencumulativeriskexposureandinternalisingdifficulties,includingemotional

symptoms,bothconcurrentlyasinthecurrentstudy(Flouri&Kallis,2007;Jones,

Forehand,Brody,&Armistead,2002;Panayiotou&Humphrey,2018)and

longitudinally(Appleyardetal.,2005;Gerard&Buehler,2004;Horan&Widom,

2015;Panayiotou&Humphrey,2018).Assuch,thisfindingprovidesfurther


231

confirmationthatincreasedlevelsofriskexposureappeartonegativelyinfluence

adolescentinternalisingdifficulties.However,thereareindicationsthatcumulative

riskeffectsaremoderatedbyfactorssuchaspopulationcharacteristics,including

gender,andtheoutcomeofinterest(Evansetal.,2013).Giventhatearly

adolescenceappearstobeapivotalmomentingenderedmentalhealthtrajectories

andtheemergenceofgreaterlevelsofdepressiveandanxioussymptomsand

disorderamonggirlsandwomen,itisparticularlyimportanttounderstandthe

contributoryfactorsatthisdevelopmentalstage.Previousstudieshaverarely

focusedexplicitlyonearlyadolescence,insteadspanningwiderdevelopmental

periods,andhaveoftennotfocusedexplicitlyongirlsand/orgenderedpatterns.As

such,thecurrentstudyprovidesfurtherknowledgeandunderstandingspecifically

relatingtocumulativeriskeffectsforemotionalsymptomsatacritical

developmentaljunctureforgirls.

Thesmallrelationshipobservedhereisconsistentwiththemagnitudeof

cumulativeeffectsinpreviousstudiesfocusedoninternalisingdifficultiesincluding

emotionalsymptoms(Gerard&Buehler,2004;M.Panayiotou&Humphrey,2018).

Notably,thereareindicationsthatcumulativeriskeffectsforinternalising

difficultiescouldbeweakerthanthoseobservedforexternalisingdifficultiesand

otheroutcomes.Forinstance,PanayiotouandHumphrey(2018)foundthat

cumulativeriskexposureexertedgreatereffectsforexternalisingdifficultiesthan

internalisingsymptoms(asreportedbyteachers).Thus,itmaybethatcumulative

riskeffectsarenotasprofoundforinternalisingdifficulties,includingemotional

symptoms,relativetoothermentalhealthoutcomes,thoughitremainsunclear

whythismightbethecase.Whiledirectcomparisonofsucheffectsacross

outcomesamongearlyadolescentswasbeyondthescopeofthecurrentstudy,

futureresearchcouldexamineandcomparesuchassociationsfurther.Indeedgiven

indicationsthattheextentandnatureofcumulativeriskeffectscanbeoutcome-

specific(Horan&Widom,2015),futurestudiesshouldexplorewhythismaybethe

case,boththroughqualitativeinquiryandthroughanalyticalmodelsthatcan

examineunderlyingpathwaysforspecificoutcomes.However,giventhatuseofa

latentconstructofferedgreaterpredictivevalidity,asexploredinthefollowing


232

section,itcouldbethatafocusonlyontheextentofriskexposureinacumulative

riskindexdoesnotcapturethecomplexityofadversity,whichcouldcontribute

differentiallytodifferentoutcomes.Itcouldalsobethatsuchdisparitiesare

attributabletomeasurementofoutcomes.AlthoughtheSDQsubscaleusedinthe

currentstudyhasshowngoodvalidityandreliability,asoutlinedinChapterFour,it

maybethattheuseofonlyfiveitems,togetherwithathree-pointLikertscale,is

notabletocomprehensivelycapturethecomplexandmultidimensionalconstruct

ofemotionalsymptoms(seeSection7.7.1forareflectiononthemeasuresutilised).

Thereisalsoscopeforfurtheranalysisexamininggenderedcumulativerisk

effectsamonggirlsandwomen.AsexploredinChapterTwo,previousauthorshave

suggestedthatincreasedratesofdepressiveandanxioussymptomatologyand

disorderamonggirlsandwomenarelikelynotattributabletoanysinglefactor,but

rathertoaninteractionofnumerouscontributors(Hydeetal.,2008;Nolen-

Hoeksema&Girgus,1994).Whilesomestudieshaveexaminedinteractions

betweenvaryingstressors,includingbiologicalcomponentsandwiderindividual

andinterpersonalfactors,furtherempiricalexaminationofgender-specifictrends

andpathwaysrelatingtocumulativeriskexposurecouldgenerategreaterinsights.

Thecurrentstudy’suseofsecondarydataanalysismeantthattheriskvariables

assessedwereincludedbasedontheirexistingavailability,ratherthanbeing

selectedbasedonevidencerelatingtothosefactorsconsideredmostproblematic

forgirlsandwomen.Thatis,althoughsomeoftheriskvariablesassessedare

understoodtoexertgreatereffectsforgirlsandwomen(e.g.,lowacademic

attainment,neighbourhoodsocioeconomicdeprivation),thiswasincidental.

Futureresearchshouldseektocollectdatarelatingtoriskfactorsthoughttobe

specificallyproblematicforgirlsandwomeninordertoexplorethewaythat

multipleriskexposuremayfunctionbasedongenderedexperiences.Forinstance,

itcouldbeusefultoassesseffectsinthecontextofacumulativeriskscore

comprisingfactorsunderstoodtodisproportionatelyaffectgirlsandwomen,such

asadrenalandovarianhormones(Albert,2015;Nolen-Hoeksema,2001;Steineret

al.,2003),ruminativecoping(e.g.,Johnson&Whisman,2013;Nolen-Hoeksema&


233

Girgus,1994)andgender-relatedviolence(e.g.,Fredrickson&Roberts,1997;

McLean&Anderson,2009).

Itshouldbenotedthattherelativelysmallnumberofhypothesisedrisk

variablestestedinthecurrentstudy,alongwiththeconfirmationofonlyfourrisk

factorsinthissample,precludedinvestigationofsomeofthemorenuanced

aspectsoftheobservedcumulativeriskeffects.Firstly,itwasnotfeasibleto

examinethefunctionalformofthisrelationshiptoassesswhetheralinearor

curvilinearrelationshipwaspresent,ashasbeenexploredinpaststudies(Horan&

Widom,2015;Oldfieldetal.,2015).Pastresearchexaminingthefunctionalformof

cumulativeriskeffectshaveproducedmixedevidence,warrantingongoing

investigation.Multiplestudieshavereportedalinearassociationbetween

cumulativeriskexposureandoutcomes,withincrementalincreasesinnegative

outcomeswitheachadditionalriskfactor,includinginrelationtoemotionaland

internalisingsymptoms(Appleyardetal.,2005;Gerard&Buehler,2004;Horan&

Widom,2015;Ravivetal.,2010).Othershavefoundevidenceofcurvilineareffects,

includingmassaccumulationwithnegativeeffectsbecomingdisproportionateto

thenumberofrisks(Biedermanetal.,1995;Forehandetal.,1998;Jonesetal.,

2002;Oldfieldetal.,2015)andasaturationmodelwherebyeffectsplateauaftera

certainlevelofexposure(Morales&Guerra,2006).However,becausethefinal

cumulativeriskscoreusedinthecurrentstudyconsistedof3+risks,itwasnot

feasibletoassessthefunctionalformofeffectsbecausepaststudieshaveindicated

thatcurvilinearshiftstendtooccurwhenparticipantsareexposedtothreeormore

risks(Biedermanetal.,1995;Forehandetal.,1998;Jonesetal.,2002;Morales&

Guerra,2006).Inparticular,itwouldnothavebeenfeasibletoassesswithcertainty

whetheranycurvilineareffectsobservedatthislevelofriskexposurewouldreflect

agenuineacceleratoryaffect,ortoassessthefunctionalformbeyondthispoint.

Givenmixedfindingsacrosstheliteratureregardingthefunctionalformofrisk

effects,whichmaybeattributabletopopulation-andoutcome-specificity(Horan&

Widom,2015),futurestudiesshouldseektomakeuseofalargerinventoryofrisk

variablestofacilitatesuchanalysisforearlyadolescentgirls’emotionalsymptoms.


234

Secondly,itshouldbenotedthatsomestudieshavemadeuseofmultiple

cumulativeriskscoresbygroupingtogetherdomainsoftheoreticallyrelatedrisk

factors.Forinstance,inanexaminationofriskeffectsforpsychopathology,Flouri,

Tzavidis,andKallis(2010)clusteredvariablestogethertocreateadistalfamilyrisk

score(capturingadverseexperiencesinthechild’sfirstyear),aproximalfamilyrisk

score(thoseinthechild’ssecondandthirdyear),andanareariskscore

(encapsulatingneighbourhoodriskfactors).Indeed,Evansetal.(2013)observed

thatstudiesexaminingexposureacrossanumberofdiscretedomainsgenerally

reportlargereffectsizes.Inthecurrentstudy,suchgroupingwasnotpossiblegiven

thesmallnumberofvariablesassessedinthefirstinstance;forexample,hereonly

oneneighbourhood-levelvariablewasavailable.Futurestudiescouldexaminethe

extenttowhichdifferentlevelsofriskexposureacrosstheecologycontributeto

emotionalsymptomsamongearlyadolescentgirls.Nevertheless,thecurrentstudy

alsooffersanumberoffurtheranalysesthatseektoovercomebothconceptual

andmethodologicallimitationswithincumulativerisktheory,inordertodevelop

knowledgeandunderstandingofthisphenomenon,asisexploredinthefollowing

sections.

7.3.3RiskMeasurementModels

Findingssuggestedthatalatentriskvariable,capturingexposureasa

singularconstructwhilepreservinginformationabouteachindividualriskfactor,

showedthegreatestpredictiveutilityforemotionalsymptoms(8.8%).Thus,

unifyingriskexposurewithinasingularpredictorvariablewhilestillretaining

statisticalinformationwassuperiortoapproachesprioritisingoneofthese

features;namely,multipleregression,whichfocusesonthenatureofeachrisk

factor,andacumulativeriskindex,whichcapturesthenumberofriskfactors,with

thesetwoapproachesshowingsimilarlevelsofpredictivepower.Notably,

predictiveutilityacrossallofthesemodelsislowrelativetopreviousstudies

exploringmultipleriskeffectsforinternalisingdifficulties(Bayeretal.,2012;Gerard

&Buehler,2004;Patalay&Fitzimons,2018),howeverthesestudiesdiffer

methodologically,examininglargernumbersofriskfactorsand/orlongitudinal


235

associations.Thus,anincreasefrom2.8%to8.8%isnoteworthy.Itisalsoimportant

tohighlightthatevidenceinthecurrentstudyishighlycontext-specificanddoes

notnecessarilyindicatethatalatentriskconstructisthemostappropriate

representationofmultipleriskexposureinallcircumstances.Rather,itsuggests

thatamongthissampleofearlyadolescentgirls,thisparticularsetofriskfactors

reflectedacoherentunderlyingconstructabletopredictthisspecificoutcome.

Firstly,thisisbecausetheviabilityofalatentfactoriscontextuallydetermined

basedontheindicatorsitdrawsuponandinriskresearchstudiesoftendiffer

substantiallyintheamount,type,andmeasurementofriskvariablestheyassess.

Assuch,anygivenstudywouldhaveadifferentcombinationandamountof

indicatorsavailableforlatentfactorformationandexploration.Secondly,existing

researchexamininglatentfactorsforriskeffectsremainslimitedandmostly

constrainedtoevaluationofriskeffectsforcognitiveoutcomes(Belskyetal.,2012;

Burchinaletal.,2000;Halletal.,2010).Itmaybethatthemostappropriate

predictorforagivenoutcomeisdependentuponthenatureoftheavailablerisk

factorsand/orthenatureoftheoutcomeitself.Assuch,thestudydoesnot

concludethatalatentfactormaybethemostsuitableapproachinall

circumstancesandinsteadadvisesthatthisshouldbetestedineachindividualcase

priortoinferentialanalysis.However,thisfindingdoesholdanumberof

methodologicalandconceptualimplications,whichareexploredhere.

Firstly,findingsindicatethatinthemeasurementandmodellingofmultiple

riskexposure,bothunificationandnatureofriskexposuremaybeimportant.This

mirrorsfindingsfrompreviousinvestigationscomparinglatentmodellingwitha

cumulativeriskindexinrelationtocognitiveandlanguagedevelopment(Burchinal

etal.,2000;Halletal.,2010).Thisdifferenceislikelyattributabletothestatistical

advantagesoflatentmodelling,aslatentfactorsaccountformeasurementerror,

offeringmorerobustestimatesofrelationships(Gefenetal.,2011).Ithasalsobeen

highlightedthatcollapsingtogetherriskvariablestocreateacumulativeriskindex

maybestatisticallyproblematicastheresultinglossofinformationmayreduce

sensitivityandpredictivepower(Belskyetal.,2012;Evansetal.,2013;Halletal.,

2010;Kraemeretal.,2001),assupportedbycurrentfindings.Indeed,thoughvery


236

fewstudieshaveexploredlatentmodellinginthiscontext,Evansetal.(2013)

reportedintheirsystematicreviewthatof95instanceswherestudieshad

comparedmultipleregressionwithacumulativeriskindex,overhalffoundmultiple

regressiontobesuperiorandonlysevenreportedsupportforacumulativerisk

index(therestofthetime,thesewererelativelyequalinpredictivepower).Thus,

findingsinthecurrentstudyandacrossthewiderliteratureindicatethata

cumulativeriskindexmaynotbethemostusefulwaytomeasuremultiplerisk

exposure,withalatentfactorperhapsofferingamorerobustalternativewith

greaterpredictivepower.

Supportforalatentapproachsuggeststhatitisusefultodrawon

interactionsacrossriskfactors,giventhatwithsomeadjustmenttheseriskfactors

reflectedacoherentunderlyingconstruct.Notably,thisassumptioncannotbe

formallyassessedoraccountedforwithinacumulativeriskindex(Belskyetal.,

2012;Halletal.,2010;Kraemeretal.,2001).Thisprovidessupportforuseof

traditionallatentmodellinginordertodrawupontheseinteractions,ratherthan

thereflectiveapproachundertakenbyHalletal.(2010),whichdoesnotoffer

greaterpredictiveutility.Indeed,thegreaterpredictivepoweraffordedbydrawing

ontheseinteractionsindicatesthatthetransactionsacrossriskfactorsappear

meaningfulforoutcomes,consistentwithRutter's(1979)proposalthattransactions

acrossrisksresultindisproportionateeffects.Nevertheless,thisalsolends

credencetotheargumentthatfocusingonmagnitudeonlymaybeareductionist

waytounderstandacomplexphenomenon,giventhatitdoesnotdirectlydraw

uponthesetransactions(Belskyetal.,2012;Burchinaletal.,2000;Halletal.,2010).

Furthermore,theapproachtakenhereperhapsallowsamorenuanced

representationofriskexposurebyutilisingtheseinteractionstoestimatethe

individualcontributionofeachriskindicator,ratherthanassumingthateachrisk

factorisequallyrepresentativeoftheunderlyingdisadvantageparticipantsface

(Halletal.,2010).

However,itmaybethatthemostappropriatemeasurementmodelfor

multipleriskexposureiscontext-dependent.Hooper,Burchinal,Roberts,Zeisel,

andNeebe(1998)foundthatacumulativeriskindexwassuperiorfor


237

communicationbehaviour,butmultipleregressionshowedgreaterpredictiveutility

formentaldevelopmentandreceptivecommunication.Astheseprevious

comparisonshavefocusedoncognitiveandlanguagedomains(Burchinaletal.,

2000;Halletal.,2010),thecurrentstudyprovidesfurthercorroborationanda

uniquecontributionbyexploringthiswithinmentalhealth.Giventhatriskis

context-specificandcanfluctuatebasedontheparticularriskfactors,outcomes,

andpopulationsunderinvestigation,thecurrentstudydoesnotseektoadvocate

forthisasthemostappropriatemethodinallcircumstances.Indeed,Burchinalet

al.(2000)advisethatthespecificmeasurementmodelutilisedmaydependupon

theparticularcontextofeachstudy.Thus,thecurrentstudyprovidesfurther

contextualsupportforBurchinaletal.'s(2000)argumentthatalatentriskconstruct

isparticularlyusefulincasesofarelativelylownumberofriskfactorsandalarge

sample.Thus,researchersexaminingtheeffectsofmultipleriskexposureshould

comparedifferentrepresentationsbeforeundertakingmorecomplexanalyses.

Latentmodellingmayalsobeproblematicwithsmallernumbersofriskfactors,asit

maynotallowforthepost-hocmodificationsnecessarytomakethefactorviable

foranalysis,asfoundherewhencontrollingforresidualcorrelationswasnot

possibleinthefinal,morecomplex,model.Thus,researchersshouldinspect

whethersuchissuesmaybelikelytooccurindeterminingthemostappropriate

analysiswiththeparticularvariablesavailable.

Finally,findingscouldbeconsideredtochallengethenumber-over-nature

principleofcumulativerisktheory,suggestingthatneithertheextentnorthe

natureofriskexposureinisolationyieldsgreaterpredictivepoweroverearly

adolescentgirls’emotionalsymptoms.Directexaminationofthisprinciplehasbeen

modestoverall,withmostpublishedstudiesfocusingonwhetheracumulativerisk

indexispredictiveofoutcomes,andthisassumptionhasnotbeentestedinrelation

toemotionalsymptomsinadolescence.Itisimportanttonote,however,thatthe

currentstudycannotofferadirectconclusionrelatingtothisprinciplegiventhe

focusoncomparingmeasurementmodels.Thatis,itisnotpossibletoascertain

whethertheincreasedpredictivepowerofferedbythelatentriskconstructissolely

theresultofthestatisticaladvantagesitaffords,orwhetherthisisinpartduetoa


238

genuineeffect.Onewaytoexplorethisprinciplemoredirectlyisthroughlatent

classanalysis,whichallowsresearcherstoidentifysubgroupsofparticipants

exposedtodifferentcombinationsofriskandthencomparetheeffectsofthese

profilesuponoutcomes(Lanza&Cooper,2016).Severalstudiesadoptingthis

approachhavefoundthattheparticularcombinationsofrisksthatchildrenand

adolescentsexperienceareheterogeneousanddifferinrelationtoimpactupon

outcomes,withsomeriskprofilesassociatedwithgreaternegativeconsequences

acrossparticularareasofhealthanddevelopment(Lanieretal.,2018;Lanzaetal.,

2010;Lanza&Cooper,2016;Rhoadesetal.,2011;A.L.Roy&Raver,2014).This

approachhasindicatedthatriskfactorsdonotappeartocontributeequallyto

outcomesforchildrenandyoungpeopleexperiencinghighlevelsofadversity,

contrarytothenumber-over-natureprinciple.Futurestudiesshouldseektoutilise

thisapproachinrelationtoearlyadolescentgirls’emotionalsymptoms,tomore

directlyidentifytheextenttowhichextentandnatureofexposurecontributesto

outcomes.Thiswouldalsoallowidentificationwhetherthereareparticular

combinationsoffactorsthatcontributetogreatermultipleriskeffectsamongthis

group.

7.3.4IndirectEffectsofStress

Findingssuggestthatindividualsexposedtogreaterlevelsofmultiplerisk

arelikelytoappraisetheirlivesasmorestressfulandtobeexceedingtheircoping

resources,whichinturnareassociatedwithgreaterlevelsofemotionalsymptoms.

Indicationsof“fullmediation”,withtheinclusionofindirectpathwaysnullifyingany

directeffects,indicatethatcomponentsofstressappraisalmayplayasubstantial

roleintheextenttowhichmultipleriskexposureimpactsuponemotional

symptomsinearlyadolescentgirls.Althoughthisconceptofstressasamechanism

forriskeffectsisacentraltenetofcumulativerisktheory,todatenostudieshave

empiricallyexaminedthis.Thus,whilefindingsarecontextuallyspecificto

emotionalsymptomsandearlyadolescentgirls,thestudyoffersnovelempirical

insightintotherolethatstressmayplayinmultipleriskeffects.Futureresearch

shouldexplorethereplicabilityofthisfindingacrossdifferentcontexts,including


239

variedpopulationsandoutcomes.Furthermore,althoughthereisevidencethat

multipleriskexposureisalsoassociatedwithheightenedengagementof

physiological,ratherthanpsychological,stress(Brodyetal.,2013;Evans,2003;

Evansetal.,2007;Evans&Kim,2012),thesestudieshavenotfocusedonsuch

associationsasmechanismsformentalhealthoutcomes.Thus,futurestudies

shouldseektoexplorebothpsychologicalandphysiologicalstressresponsesand

theroletheyeachplayintheemergenceofemotionalsymptomsandotherforms

ofmentalhealthsymptomatology,particularlyamongat-riskgroups.

Notably,underlyingindirectpathwaysforbothperceiveddistressand

coping(thatis,effectsspanningbothstagesofthemediationmechanism)were

foundtobemeaningfulandsimilarinmagnitude.Thatis,higherlevelsofrisk

exposurecorrespondtogreaterperceiveddistressandinturnemotional

symptoms;conversely,increasedriskexposureisassociatedwithalower

perceptionofone’sabilitytocopewithstressors,whichalsorelatestoheightened

emotionalsymptoms.Thisindicatesaneedtolookbeyondsimply“stress”in

understandingmechanismsfortheemergenceofmentalhealthsymptomsand

insteadconsidertheextenttowhichadversityisviewedasexceedingone’scoping

capacities.Thisconceptualdistinctionreflectsthetransactionaltheoryofstress

appraisalinitiallypositedbyLazarusandcolleagues,whichincludesboththe

appraisalofstress(distress)andone’sperceivedabilitytomanageorreducethis

potentialharm(coping;Lazarus,1966;Lazarus&Folkman,1984).Whilethisinitial

theoryindicatedasequentialprocessinwhichoneappraisesthreatandthen

assessescopingresourcesandpossibleresponses,thecurrentstudyfocuseson

distressandcopingasinter-relatedphenomena(Cohenetal.,1983).Indeed,ithas

beennotedthattheimmediacyofinteractionsbetweenappraiseddistressand

copingmeansitisdifficulttoempiricallyassesstheseinasequentialfashion,

particularlywhenexploringgeneralappraisalsofliferatherthanparticularstimuli

(Ben-Zur,2019).Nevertheless,researchhasindicatedthatbothdistressandcoping

appraisalsarerelevantforoutcomes,includingmentalhealthsymptoms(Bovieret

al.,2004;Demkowiczetal.,2019;Eppelmannetal.,2016;Suldoetal.,2008).The

distinctrolesthatperceiveddistressandcopingeachplayasunderlying


240

mechanismsshouldbeexploredindifferentcontexts.Forinstance,theremaybe

distinctpatternsforinternalisingsymptomatologyanddisordergiventheemphasis

oninternalappraisalofthesecomponents,necessitatinginvestigationofeffectsfor

diversementalhealthoutcomes.Thisfindingalsosuggeststhatitmaybeimportant

toaccountforperceivedcopingcapacitieswithinexplorationsofstressasa

mechanism,regardlessofwhethertheemphasisisonpsychologicalorphysiological

stress.

Indicationsthatperceivedcopingcouldfunctionasadistinctmechanismfor

riskeffectsmayfacilitatepreventionandpromotioneffortstolessenthenegative

impactofadversity.At-riskyoungpeoplefacearangeofpotentiallystressful

experiencesintheirday-to-daylivesanditisgenerallyunlikelythatpractitioners

areabletosubstantiallylessentheextenttowhichthesestressorsoccur.Thus,it

maybemorepragmatictofocusonbolsteringyoungpeople’scopingcapacitiesand

strategies.Indeed,thereisevidencethatpsychoeducationalinterventionsfocused

ondevelopingeffectivecopingbehaviourscanpositivelyimpactperceivedcoping

resourcesamongadolescentexperiencingvariousmentalhealthsymptomsand

difficulties(BevanJonesetal.,2018;Brentetal.,1993;Demasoetal.,2006;M.A.

Lopezetal.,2005).However,itisalsoimportanttoconsiderthatnotallcoping

strategiesaregenerallyconsideredeffectiveorevenpositive(seeSkinneretal.

(2003)foracomprehensivereviewofcopingtaxonomies).Forinstance,reaching

outtoothersforsupportmaybeconsideredanadaptivecopingbehaviour(Skinner

etal.,2003)whileruminationisconsideredmaladaptivegivenassociationswith

depressivesymptoms(Nolen-Hoeksema,2000).Thus,althoughthecurrentstudy

providesinsightintotheextenttowhichparticipantsconsiderthemselvesableto

copewiththeirdailylives,theparticularcopingbehavioursindividualsadoptmay

affecttheextenttowhichthisoffersprotectionagainstnegativeoutcomes.Thus,it

maybehelpfulinfutureresearchtofocusonspecificcopingstrategiesand

behavioursaswellasindividuals’overarchingappraisaloftheirresources,inorder

tomorefullyunderstandhowdifferentapproachesinfluencetherelationship

betweenriskexposureandoutcomes.Inpractice,itmaybehelpfultounderstand


241

anindividual’sidiosyncraticcopingstrategiesandtoidentifywherethesemaybe

ineffectiveorharmfulandjointlyexplorealternatives.

Evidenceinthecurrentstudythatmodellingriskexposureinawaythat

unitesriskfactorswhileretainingtheirinformationismeaningfulforoutcomesmay

indicateaneedtoconsiderhowbothmultiplicityandtypeofriskexposuremay

contributetounderlyingstressmechanisms.Discussionoftheallostaticload

hypothesisispredominantlycentredaroundtheoverwhelmingofthebiophysical

stressresponsesystem;however,stressisbothaphysiologicalandapsychological

phenomenon(e.g.,Oldehinkeletal.,2011;Sladeketal.,2016;Zimmaroetal.,

2016).Itmaybethatthenatureofthestressorsbeingfacedisrelevantforthe

appraisalofstress,orthatspecificfactorsmaycontributedifferentiallyto

physiologicalandpsychologicalresponsesystems,warrantingfurtherresearch.This

contributesfurthertocriticismsofcumulativeriskindexingusingaweighted

approachtoriskfactorsasthisassumesallrisksequallycontributetooutcomes,

whichislikelynotthecase(Halletal.,2010).Treatingeachriskfactorasequal

overlooksthefactthatindividualsaremanagingmultiplestressorsthatmaybe

challengingtocopewithindifferentwaysandmayofferdifferentlevelsofmeaning

andrelevancewithinone’slife.Widerfindingsacrossboththequantitativeand

qualitativestrandsofthecurrentstudymayofferfurtherinsightintothese

underlyingprocessesandarediscussedinSection7.6.

Finally,thisfindingisparticularlynotablegiventhestudy’sfocusonearly

adolescentgirls.Chronicstresshasbeenproposedasakeycontributortothehigh

ratesofemotionalsymptomsanddisordersamonggirlsandwomenanditis

thoughtthatthisisparticularlyrelevantduringearlyadolescence,whensuch

symptomsoftenemerge(e.g.,deLijsteretal.,2016;Girgus&Yang,2015;Meadows

etal.,2006;Nolen-Hoeksema,2001).Foranumberofreasons,thecurrentstudy

cannotofferclarityonthistheory;theparticularriskfactorsexaminedarenot

inherentlygendered(comparedto,forinstance,gender-basedviolence),gender

differenceshavenotbeenexploredtoidentifywhetherthisisadistinctpatternfor

girls,andthestudyhasnotinvestigatedtrajectoriestoinferwhetherthisis

particularlymeaningfulfromearlyadolescenceonwards.Nevertheless,indications


242

thatstresscomponentsplayakeyroleinthewaythatmultipleriskeffectsrelateto

emotionalsymptomsduringakeyperiodinearlyadolescentgirls’mentalhealth

trajectoriesarenotableandwarrantfurtherattention.

Thereareofcoursesomelimitationstobeawareofwhenconsideringthis

finding.Firstly,thereisaneedtoreflectontheuseofofficiallyrecordedriskdata

viatheNPD(withtheexceptionofcaregivingresponsibilities)asapredictorofself-

reportedperceiveddistressandcoping.Inparticular,theindirecteffectsmodel

assumesthatparticipants’appraisalsoftheirdistressandcopingcapacitiesis,to

someextent,directlyrelatedtotheirlevelofriskexposureasdesignatedviathese

officialrecords.Thoughfindingsdosupportsuchanassociation,thisinherent

assumptionperhapsoverlookswhetherparticipantsactuallyconsiderthese

particularfactors(orcombinationoffactors)ascontributingtotheirstresslevels.

Althoughpastresearchindicatesthatofficiallyrecordedriskdataistypicallymore

reliableandrobustasapredictorofvariousoutcomescomparedtoself-report

methods(e.g.,Brownetal.,1998;Wallace,Stuart,&Smith,2014),wherestudies

focusonstressorotherinternalisedmechanismsself-reportofriskexposuremay

haveaddedvalue.Thatis,itmaybebeneficialtomoredirectlydrawon

participants’self-perceivedexposuretopossiblestressors(e.g.,throughthe

AdolescentStressQuestionnaire)inordertomoredirectlyassesshowday-to-day

challengesinfluenceanindividual’sstressappraisalsand,inturn,theirlevelof

emotionalsymptoms.Thecurrentstudy’suseofofficialdatamayfailto

comprehensivelycapturehowvariousfactorsrelatetostressappraisal

mechanisms,andfutureresearchcouldexplorewhetherdifferentapproachesto

measurementcontributetodifferentialpathwaysinunderlyingstressmechanisms.

Thereisalsoaneedtoconsidertherelationshipbetweenemotional

symptomsandperceivedstresscomponents,bothconceptuallyand

methodologically.Emotionalsymptoms,whichasoutlinedinChapterTwocaptures

bothdepressiveandanxiousfeelings,hassomeconceptualsimilaritywithstress

appraisalprocesses,thoughtheydorepresentconceptuallydistinctconstructs.

Thatis,emotionalsymptomsareessentiallyfeelingsofdistress,worry,and

perceivedlackofcontroloverone’sexternalworld,whichisnotunlikethefeelings


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onewouldexpecttoexperienceifreportinghighlevelsofglobalperceivedstress

(asmeasuredusingthePSS-4).Inthecurrentstudy,althoughdatashowsa

correlationbetweensymptomsandperceiveddistress(r=.52,asshowninFigure

5.12inSection5.3.4)andperceivedcoping(r=.36),respectively,thesecorrelations

arenotsohighastosuggestthattheyareoverlappingconstructs(inlinewiththe

.70thresholdadoptedformulticollinearity;Tabachnick&Fidell,2013).However,it

shouldbeconsideredthatboththeSDQandthePSS-4eachofferalimitednumber

ofitems,withemotionalsymptomscomprisingfiveitems,andperceiveddistress

andcopingeachcomprisingjusttwoitems.AlthoughtheSDQsymptomssubscale

wasdesignedwithattentiontodiagnosticcriteriaandexistingmeasuresatthetime

ofdevelopment(Goodmanetal.,1998),itisnotconsideredadiagnostictooland

reliesuponjustfiveitemstojointlycaptureaverysmallnumberofdepressiveand

anxioussymptomatology.Thus,inferenceofeachconstructisgroundedinlimited

information,whichisperhapsnotidealwhenexploringtherelationshipsbetween

suchinter-relatedconstructs,asthisrelationshipmaybeinflatedifevenasmall

amountofitemsareconceptuallysimilar.Itisimportantthatfutureresearchseeks

toexplorestressasamechanismforemotionalsymptomatologyanddisorderusing

morecomprehensivemeasuresofeachconstructinfutureresearchtofacilitate

morerobustassessmentoftheseunderlyingprocesses.

Indeed,collectionofbothstressandsymptomsdatafromasinglesource

(i.e.,self-report)warrantscautioninthisparticularregard,aswellasforanalysisof

furthermodelsexploringsymptomsandstressinrelationtoprotective/promotive

variables,respectively.Relianceondatafromasinglesourcecaninflate

relationshipsbetweenvariablesgiventhatthisapproachcanincreasetheshared

varianceacrossvariables(Conway&Lance,2010;Doty&Glick,1998).Itisalso

importanttonotethattheuseoflargelycross-sectionaldata,withnoabilityto

controlforpriorlevelsofstress,emotionalsymptoms,orlevelsofconnectionor

engagement,meansthatcausalitycannotbeinferred.Itwillbekeythatthis

mechanismisinvestigatedfurtherusingdatacollectedfrommultipleinformants

(e.g.,self-reportandparent-report)withinalongitudinaldesign,particularlygiven


244

theconceptualoverlapbetweenemotionalsymptomsandstress(seeSection7.7

forfurtherreflectiononthestrengthsandlimitationsoftheseapproaches).

7.4ResearchQuestion2:FactorsandProcessesforPositiveOutcomes



7.4.1PromotiveFactors

a.Ofthepromotivefactorsidentified,whatisthemagnitudeoftheirassociation

withearlyadolescentgirls’emotionalsymptoms?

ConfirmedPromotiveFactors

FamilyAdultConnection

Greaterperceivedlevelofconnectiontoafamilyadultcorrespondedhere

toloweredlevelsofemotionalsymptoms.Thisreflectslargelyconsistentfindings

acrosspreviousliterature,whereinstrongerconnectionwithfamilymembersis

frequentlyreportedtobeassociatedwithreducedlevelsofinternalisingand

emotionalsymptoms(e.g.,Costelloetal.,2008;Roweetal.,2016;Willeetal.,

2008).Itshouldbenotedthatthescaleusedtomeasurefamilyconnectioninthe

currentstudyfocuseson“anadult”withinthehome.Whilethisdoesnot

necessarilylimitresponsestoparents/carers,itislikelythatthisisthecase,though

forsomethismayencompassextendedfamilymemberswhoalsoresidewithinthe

home.Thus,whilethereisevidencethatconnectiontosiblingscanactasavaluable

resourceforchildrenandadolescents(e.g.,Buist,Deković,&Prinzie,2013;Gasset

al.,2007),suchrelationshipsareunlikelytobecapturedhereunlesssiblingsare

consideredadults.

Giventhatpreviousresearchsuggeststhatone’sparentalconnection

becomeslesssalientduringadolescence,withagreateremphasisonfriends(B.B.

Brown&Larson,2009;Umbersonetal.,2010),itisnotableherethatfamily

connectiondiddemonstrateasmall,thoughmeaningful,association.However,as


245

exploredlaterinthefollowingsubsection,connectionwithschoolpeerswasshown

tohaveasmalltomoderaterelationshipwithreducedsymptomatology,thus

providingfurthersupportforapatterninwhichparentsarelessinfluentialfor

healthbehavioursandoutcomesthanarepeers(Brown&Larson,2009;Umberson

etal.,2010).Notably,however,ithasbeenarguedthatfamilyrelationshipsmay

playaparticularlycomplexroleinfunctioningandoutcomesduringadolescence,

operatingthroughindirecteffectsovertimethatcannotbecapturedinexamininga

directrelationship(Roweetal.,2016;Williams&Merten,2014).Furtherfindingsin

thecurrentstudyrelatingtoprotectivefactorsandqualitativeexperiencesmay

offerfurtherinsightintothemeaningfulnessandnatureofsocialconnectionsfor

girlsduringthistime,includingwithfamilymembers,asexploredlaterinthis

chapter.

SchoolPeerConnection

Findingsindicatethatearlyadolescentgirlswhoperceivegreater

connectiontotheirschoolpeersarelikelytoreportlowerlevelsofemotional

symptoms.Previousstudieshaveconsistentlyfoundevidencethatelementsof

peerconnectionandrelationshipsduringadolescenceareassociatedwithlowered

levelsofinternalisingdifficulties,includingemotionalsymptoms(e.g.,Bosackietal.,

2007;Lereyaetal.,2016;McGrawetal.,2008;Millingsetal.,2012;VanVoorhees

etal.,2008).Assuch,thisfindingprovidesfurtherconfirmationthatconnectionto

one’speerscanservetopositivelyinfluencethisaspectofmentalhealthforgirls

duringearlyadolescence.Furthermore,asnotedabove,thisrelationshipwas

showntobemoderateinsizeandindeedwaslargerthantheothervariables

identifiedasservingapromotivefunction,includingfamilyconnection.Thecurrent

studyprovidesfurtherinsightintoearlyadolescenceinparticular,demonstrating

thateveninthisearlystageofadolescence,peersappeartoconstitutean

importantpredictorofmentalhealthoutcomes.Inaddition,itshouldbenotedthat

themeasureusedinthisstudycapturespeers,ratherthanthenarrowercategory

offriends,andalsorelatesparticularlytopeersinaschoolcontextratherthan

capturingwiderpeerrelationships,suchasthoseinone’sneighbourhood.Assuch,

findingsindicatethatconnectiontopeersspecificallywithintheschoolcontextcan


246

bemeaningful,whichissomewhatunsurprisinggiventhatschoolservesasa

centralsocialcontextforchildrenandyoungpeople.

ActiveEngagementinHomeandSchoolLife

Participantswithgreaterperceivedactiveengagementintheirhomeand

schoolliveswerelesslikelytoreportexperiencingemotionalsymptoms.This

relationshipwassmall,butstatisticallysignificant.Previousresearchhasnot

directlyexaminedthisrelationshipineitherahomeorschoolcontext,thoughthere

hasbeensomeresearchexaminingrelatedoutcomessuchaspsychological

wellbeing(Fuligni&Pedersen,2002;Fuligni&Telzer,2013;Kavanaughetal.,2015).

Anumberofstudieshaveidentifiedarelationshipbetweeninstitutionalschool

connectionatanoverarchinglevelandemotionalsymptoms(Bondetal.,2007;

Costelloetal.,2008;EwellFosteretal.,2017;Loukasetal.,2016;Pateetal.,2017),

buthavenotgenerallyfocusedonthissub-componentofschoolconnectedness.

Thus,thisfindingoffersanovelcontributiontotheliteratureasitisthefirstto

examinethespecificconstructofactiveengagementacrossthesecontextsin

relationtoemotionalsymptoms.

Thisfindingsuggeststhattheextenttowhichearlyadolescentgirlsperceive

themselvestobeactivedecision-makersandcontributorsintheirday-to-daylifeis

relatedtopositiveoutcomesforemotionalsymptoms.Evidenceofsucha

relationshipwithinearlyadolescenceisnotable,asthisdevelopmentalphaseis

oftenaccompaniedbygreaterautonomyanddecision-makinginthehome,

particularlyamonggirls(Gutman&Eccles,2007;Wray-Lakeetal.,2010).Atthe

sametime,earlyadolescentsarenavigatingthepotentiallychallengingtransitionto

anewandunfamiliarsecondaryschool.Researchhasindicatedthatthereisoften

littleemphasisonthevoiceofyoungpeopleduringthetransitiontosecondary

schoolandindeedthisprocesscanleadtofeelingsofdisengagementforsome(van

Rensetal.,2018).Ithasalsobeenarguedthatinadolescencethereisanincreasing

emphasisonadultcontrolandorderinbothschoolandthehome,whichis

arguablyatoddswiththedevelopmentalneedforgreaterautonomy(Ecclesetal.,

1993;Hargreaves,2017;Smetana,Campione-Barr,&Daddis,2004).Thecurrent

finding,then,providesfurthersupportfortheargumentthatbothschoolsand


247

familiesshouldensurethatearlyadolescentsareprovidedwithappropriate

opportunitiestobeactivedecision-makersandcontributors.

ExcludedPromotiveVariables

Perceivedschooladultconnection,communityadultconnection,and

engagementinextracurricularactivitieswerenotfoundtobepromotivefor

emotionalsymptoms.Althoughthepossibilityforthesevariablestobepromotive

wastheoreticallyorempiricallysupportedacrossthewiderliterature,allthreehad

modestevidencebasescomparedtoconnectiontoone’speersandfamilies,which

aremoreestablishedpromotivefactorsforhealthanddevelopment.Thus,the

studyoffersgreaterinsightintothestatusofthesevariablesinrelationtoearly

adolescentgirls’emotionalsymptoms.Itisplausiblethatcontextualfactorssuchas

timingarerelevanthere;forinstance,studiesreportingschooladultconnectionto

bepromotivehavegenerallynotdirectlyfocusedonearlyadolescence(e.g.,Lereya

etal.,2016;O’Connoretal.,2012;Wangetal.,2013),asisthecasehere.Thefirst

yearofsecondaryschoolisatimeoffluctuationinschool-basedrelationshipsand

teacher-pupildynamics(Loukasetal.,2016)anditmaybethatanyperceived

connectiontoschooladultsmaynotyetbemeaningfulinrelationtointernalising

difficultiesatthisearlystage.

Itmaybethatmeasurementofthesevariablesplaysaroleinthesefindings.

Forinstance,themeasureforcommunityadultconnectionfocusesonanadult

“awayfromhomeorschool”,whichcouldreasonablycapturerelationshipswitha

widerangeofindividualsincludinggrandparentsandextendedfamily,community

orreligiousleaders,orfamilyfriends,amongstotherpossibilities.Thenatureof

suchrelationships,andindeedtheirquality,regardlessoftheadult’sroleorrelation

totheparticipant,coulddiffersubstantially,whichmaybemeaningfulformental

healthoutcomes.Similarly,theremaybeparticulartypesofextracurricular

activitiesthataremoremeaningfulforoutcomesthanothers,whichwouldnot

havebeencapturedhere.Notably,thestudy’scross-sectionaldesignwouldnot

offerinsightintolong-termeffects;giventhatthesefactorsaretheorisedtooffer

wideradvantages(e.g.,engagementinextracurricularactivitiesisbelievedto

supportsocialskills;Alvord&Grados,2005;Nicholsonetal.,2004;Schaeferetal.,


248

2011),longitudinalanalysisofindirecteffectsmayoffermoreinsight.Finally,itis

notablethatallthreeofthesefactorsmaybemoremeaningfulforthosewith

negativeorlimitedrelationshipsinthefamilyandpeergroup(Hamre&Pianta,

2001);directexaminationofsuchcompensatoryinteractionswasbeyondthescope

ofthecurrentstudybutshouldbeprioritisedinfutureresearch.

7.4.2ProtectiveFactors



protectivefactors?

ProtectiveFactorsandStressAppraisal

Therewereseveralfeaturesofparticularnoteinthewaythatprotective

factorsfunctionedinrelationtoindirecteffects.Firstly,resultsindicatedthatthese

factorsfunctionedonlyonthefirststage,ratherthanthesecondstage,of

underlyingstressmechanisms.Thatis,findingssuggestthatinformalrelationships

withfamilyadultsandschoolpeerscanaffectthewaythatat-riskearlyadolescent

girlsappraisetheirlivesasstressfuloroverwhelminginrelationtotheircoping

resources.Thisofferssupportforthestressbufferinghypothesisasoutlinedin

ChapterThree,whereinsocialrelationshipslessentheextenttowhichnegativelife

eventsareperceivedtobestressful.Thishasbecomeacentralcomponentof

resiliencetheoryandresearch(Barnes,2016;Masten,2014b,2018)andseveral

studieshavefoundthatsocialconnectionmoderatestheeffectsofnegativelife

eventsuponmentalhealthsymptomsanddisorders(e.g.,Anderson,Salk,&Hyde,

2015;Ditzen&Heinrichs,2014;Hazeletal.,2015;Landermanetal.,1989).

However,asnoted,studieshavetypicallyfocuseduponmoderationofthedirect

effectsofexposuretoadversity,ratherthanexamininghowprotectivefactors

operatewithinunderlyingstressmechanisms.Thus,thecurrentstudyprovides

directempiricalevidencetosupportstressbufferinginrelationtomultiplerisk

exposure,inthecontextofearlyadolescentgirls’emotionalsymptoms.


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Resultsalsoindicatethattheseconnectionsappearnottobemeaningfulin

relationtohowappraiseddistressorcopingcapacitiesinfluencesymptoms.Thatis,

onceanearlyadolescentgirlhasappraisedtheirlifetobestressfulorexceeding

theircopingresources,externalfactorsincludingsocialconnectionandactive

engagementindailylifeappearunlikelytolimittheextenttowhichthisevokes

depressiveandanxioussymptoms.Thisoffersclarityontheparticularfunctionof

stressbufferingatthepsychologicallevel,whichisofparticularinterestgiven

growingemphasisonthewaythatprotectivefactorsrelatetostressprocessesin

thecurrent“fourthwave”ofresilienceresearch(Masten,2014b,2016,2018).This

insightemphasisestheneedforsystemsandpractitionerstotakeproactivesteps

toboosttheresourcesofat-riskadolescentgirls,ratherthanprimarilyresponding

reactivelywhereindividualsappeartobe,orreportfeeling,overwhelmed.This

couldbeachievedthroughfacilitatingqualityinformalrelationships;forinstance,

interventionsfocusedonimprovingparentingskillsandqualitycanbebeneficialfor

arangeofchildandadolescentoutcomes,particularlyforthosefromhigh-risk

backgrounds(e.g.,Horwitzetal.,2010;Pattersonetal.,2002;Sanders,2008;Scott,

2012).However,futureresearchcouldalsoseektoidentifywhetherthereare

factorsthatmoderatetheimpactofstressuponoutcomes.Thismaybeparticularly

importantforunderstandingtheapparentphenomenonofskin-deepresilience

observedinstudieswithAfricanAmericanadolescents,whereinupwardlymobile

individualsexposedtomultipleriskfactorswerefoundtohavehighlevelsof

allostaticloadmarkers,buttobemaintaininggenerallypositiveoutcomes(Brodyet

al.,2013;Miller,Cohen,Janicki-Deverts,Brody,&Chen,2016).

Thedegreeoftheconditionaleffectsobservedhereisnotable,withthe

relationshipsbetweenriskexposureandperceiveddistressandcopingentirely

reversedafteraccountingforinteractionswithwiderfactors.Thisfindingappears

toillustratethecontextualambiguityofwhatismeantbyriskandresilience,a

distinctionarguedbyUngar(2011,2012)tobeoverlysimplisticandfailingto

accountforthecomplexsystemswithinwhichindividualsoperate.Theextentto

whichthesefactorschangedthenatureofeffectsthereforedemonstratesthe

valueofcomplexanalysesthatcanincorporatethewiderprocessesand


250

transactionsinfluencingoutcomes,ratherthanfocusingonsingularpredictorsas

positiveornegative(Belskyetal.,2012;Ungar,2011,2012).Here,itappearsthat

whereanat-riskgirlconsidersherselftobeembeddedwithinastrongsocial

networkoffamilyadultsandschoolpeers,circumstancesotherwiseconsidered

riskymayservetohelponethrive.Whileitisoftenarguedthatindividualrisk

factorscanhavebenefitswithappropriatesupportinplace,suchascaregiving

responsibilities(Banksetal.,2001;Fraser&Pakenham,2009;Ireland&Pakenham,

2010;KennethIanPakenhametal.,2006,2007),thecurrentstudygoesbeyond

singularpredictorsandindicatespossiblebenefitsevenforthoseexperiencing

greaterlevelsofadversity.

Thisperhapshighlightsthesociallydeterminednatureofadversity,wherein

itisnotaparticularfactorthatleadstoanegativeoutcomebutthewiderstructural

systemsinwhichsuchcircumstancesareembedded(CommissiononSocial

DeterminantsofHealth,2008;Graham&Kelly,2004;Marmot,2005;Vineretal.,

2012).Forinstance,beingafamilyinalowerincomebracketdoesnotinandof

itselfcausestress,butdifficultiesareincurredwhenoneliveswithinasocietythat

doesnotprioritiseequalopportunitiesforhousing,employment,education,

healthcare,andsafety.Thatis,here,thefactorsconsidered“risky”forearly

adolescentgirls’emotionalsymptomsmaynotbeautomaticallyadverseforall

individuals,butmayevenbebeneficialwherethereisappropriatesocialsupportin

place.Conversely,however,itmaybethatyoungpeoplebattlingthemostcomplex

systemsofriskexposurebecome,overtimeand/orwithsocialsupport,more

accustomedtoandpracticedinadaptingtochallengethantheirpeerswithlower

levelsofexposureorlesssupport(orboth).Suchadjustmentscouldleadto“trade-

offs”,ornegativeimpactinotherareas,assuggestedbyMasten(2018)and

indicatedinthecasesofskin-deepresilienceoutlinedabove.Findingshighlightthe

needforresearcherstoinvestigatethecomplexprocessesandinteractionsthat

influenceyoungpeople’soutcomesinthecontextof“adversity”tobetter

understandcontextualnuancesandcomplexities.

Itisimportanttonotethatthesefindingsareconceptuallyspecific.Firstly,

inferencesrelatetoperceivedstressandmaynothavebeenthesamehadthe


251

focusbeenonallostaticbiomarkers;futurestudiesshouldexaminetheseprocesses

withattentiontobothpsychologicalandphysiologicalstressresponses.Thestudy

wasalsonotabletoexaminewhethertheseprotectivefactorsaffectedthe

overarchingstresspathwaystoemotionalsymptoms,insteadfocusingondiscrete

pathwayswithinunderlyingmechanisms,asitisnotpossibletodosowhere

continuousmoderatorsaremodelledonbothstages(Hayes,2015).Thatis,the

studyhasfoundthataccesstoparticularfactorsinfluencestheeffectsofrisk

exposureuponperceiveddistressandcoping,buthasnotinvestigatedwhetherthis

lessenstheextenttowhichriskexposureinfluencesemotionalsymptomsviastress

appraisal.Thisisanimportantfeaturethatneedstobeexaminedinfuture

research.Furthermore,onlyexternalfactorswereinvestigated;theremaybe

internalfactors,suchasfacetsofemotionregulationorlocusofcontrol,thatcould

bemeaningfulinmitigatingtheeffectsthatgreaterperceivedstresshasupon

emotionalsymptoms.Futureresearchcouldexplorebothexternalandinternal

factorsinrelationtostressmechanismsformentalhealth.Studiescouldalso

explorethedevelopmentaltimingofsuchinfluences,asadolescentsaremorelikely

thanyoungerchildrentomanagetheirstressmoreinternallythroughregulating

theirresponsesandattemptingtochallengethestressfulsituation(Barnes,2016;

Compasetal.,2001).

Ofcourse,itshouldalsobeconsideredthatthesefindingsmayhavebeen

affectedbytheparticularmethodsemployedhere,includingthetemporalnature

ofthedata.Theriskfactorsutilisedtocreateacompositeriskvariablewere

predominantlymeasuredusinginformationgatheredpriortoparticipants’

completionofmeasures,withtheexceptionofcaregivingresponsibilities.Allother

variablesexaminedinthismodelwerecross-sectional(stressappraisal

components,protectivevariables,andemotionalsymptoms).Thus,itmightbethat

indicationsofconditionaleffectsforthefirststageofthismodelaremorerobust,

whileresultsrelatingtothesecondstageofthemodelmaybeaffectedbytheir

relianceondatacollectedatasingletimepoint.Forinstance,itmightbethat

participants’responsestotheSRSsubscaleitemswereaffectedbytheirlevelsof

distress,coping,andemotionalsymptomsatthatspecifictimepoint,orviceversa.


252

Itisimportantthatfutureresearchexaminestheseeffectslongitudinally,firstlyto

overcomeanymeasurementeffectsbutalsobecauseitisunderstoodthat

protectivefactorsaremostpowerfulwhenembeddedinone’slifeovertime

(Barnes,2016;Masten,2014b).

ConfirmedProtectiveFactors:FamilyAdultandSchoolPeerConnection

Findingssuggestthatgreaterperceivedconnectiontofamilyadultsand

schoolpeersbothaffectedtheextenttowhichmultipleriskexposureinfluenced

perceiveddistressandperceivedcoping.Thissectionexplorestheseprotective

factorsjointly,giventhattheyaregenerallyconsideredthemostimportant

informalsocialconnectionsinyoungpeople’sworlds(Brown&Larson,2009;

Umbersonetal.,2010;Umberson&Montez,2010)andinordertofacilitate

discussionoftheirrelativecontributions.

Intermsoffamilyadults,findingsmirrorresultsfrompreviousstudies

indicatingthatparentsandcarerscanplayanimportantroleinbufferingtheeffects

ofnegativeeventsuponstressduringthisdevelopmentalperiod(Andersonetal.,

2015;Gunnaretal.,2015;Hazeletal.,2015;Hostinaretal.,2015,2014).Though

severalstudieshaveidentifiedthatpeerrelationshipspredictlowerlevelsof

internalisingdifficulties(e.g.,Bosackietal.,2007;Lereyaetal.,2016;McGrawetal.,

2008;Millingsetal.,2012;VanVoorheesetal.,2008),therehasbeenlimited

investigationoftheirroleinstressresponses.Wherethishasbeeninvestigated,

studieshavereportedthatpeerrelationshipsand/orfriendshipsdonotshowstress

bufferingqualitiesandmayinfactincreasestressresponsesamongadolescents

(Doometal.,2017;Printzetal.,1999).However,asnoted,theinteractionaleffect

ofbothfamilyandpeerrelationshipswithadversityhasnotpreviouslydirectly

beentestedforunderlyingstressmechanisms,withfindingsgenerallyfocusing

purelyonstressoutcomesoronmentalhealthoutcomes,ratherthanexploring

interactionswithinamorecomplexmodel.

Itisparticularlynotablethatfamilyconnectionwasfoundtoexerta

strongereffectuponriskpathwaysthanconnectiontoone’speers.Researchhas

consistentlyindicatedthatinadolescence,peersmorestronglypredicthealth

outcomesthandoparents,adistinctshiftfromearlierdevelopmentalstages


253

(Brown&Larson,2009;Umbersonetal.,2010).Indeed,previousanalysisforRQ2a,

examiningthepromotivefactorsforemotionalsymptoms,foundthatpeer

connectionwasmorestronglyassociatedwithloweredsymptomatology,relativeto

familyadultconnection.Thisshiftsuggeststhatalthoughpeersappearmore

importantforemotionalsymptomsatagenerallevel,familyadultsmayplaya

morevitalroleintheextenttowhichearlyadolescentgirlsexperiencingadversity

appraisetheirlivesasstressful.Priorevidencesuggeststhatthestressbuffering

roleofparentalrelationshipsisoftenweakerorevenabsentamongadolescents,

includingearlyadolescents,relativetochildren(Doometal.,2015;Gunnaretal.,

2015;Hostinaretal.,2014,2015).However,thesestudieshavegenerally

investigatedphysiologicalbiomarkersratherthanpsychologicalstressandhave

beenfocusedonthedirectpresenceofparentswithinexperimentallymanipulated

laboratorystressors.Thus,althoughthecurrentstudydoesnotexamine

trajectoriesorexploredifferentagegroups,findingsprovideimportantinsightinto

therolethatfamilyadultscanplayinthe“realworld”,indicatingthatearly

adolescentgirlsexperiencingmultiplepossiblestressorsonaday-to-daybasis

clearlybenefitfromperceivedrelationshipswithparentsand/orotherfamily

adults.

However,itmaybethatthesefindingsareattributabletotheageof

participants,asearlyadolescencerepresentsthetransitionalperiodbetween

childhoodandadolescence.Futurestudiesshouldseektoexaminethe

developmentaltimingintheextenttowhichfamilyandpeerscontributebothto

generaloutcomesaswellasforstressbuffering.Itshouldalsobeconsideredthat

thesedifferentialcontributionsdependuponthenatureoftheriskoneisexposed

to,asindividualsmayturntodifferentpeopleforsupportorcomfortdependingon

theneedcreatedbytheparticularstressorathand(Barrera,1986;Stapleyetal.,

2019).Althoughthecurrentstudy’semphasisonmultipleriskexposuremeanssuch

effectsrelatetoabroadersystemofadversityratherthansingularfactors,itmay

bethattheparticularfactorsmeasuredhereallhappentobecircumstancesfor

whichparentconnectionisconsideredmoremeaningfulthanpeerconnection.

Futurestudiesshouldseektoexplorestressbufferingeffectsfordifferentrisk


254

factorsandprofilesofriskexposuretodeterminewhetherdifferentsourcesof

supportareofgreaterimportanceindifferentcontexts.

ExcludedProtectiveVariables

Perceivedconnectiontoaschooladultandactiveengagementwerenot

observedtofunctionasprotectivefactorsatanystageofunderlyingstress

mechanisms.Thisisnotablegiventhatithaspreviouslybeensuggestedthatthese

factorsmayinfluencestresslevels;forinstance,ithasbeensuggestedthat

contributinginthehomedevelopsstressappraisalandcopingcapacities(Beckeret

al.,2010;Borellietal.,2015).Contextually,itisreasonabletoassumeforschool

connectionandindeedpartiallyforhomeandschoolengagementthatthismay

reflectthetimingofthestudyinrelationtoeducationaltransition.Futureresearch

shouldexploretherolethatdifferenttypesofsocialconnection,includingteacher-

pupilrelationships,mayplayforparticularriskgroupsandoutcomesacross

differentdevelopmentalstagesofchildhoodandadolescence.

Consideredagainstpreviousanalysisofpromotivevariables,itisnotable

thatengagementinhomeandschoollifewasfoundtobepromotiveforsymptoms.

Indeed,intheconditionalindirecteffectsmodelthisvariablewasshowntohavea

smallassociationwithbothloweredperceiveddistressandgreaterperceived

coping.However,thesedidnotoperatetoaffectunderlyingpathways(thatis,

interactionpathwayswerenotstatisticallysignificant).Thus,whileperceptionsof

activeengagementappeargenerallypositiveforearlyadolescentgirls,theyappear

nottofunctiontodisrupttheeffectsofmultipleriskexposureeitherforstress

componentsoremotionalsymptoms.Thesefindingssuggestthatforgirlsexposed

tohighlevelsofriskexposure,theabilitytomakedecisionsandcontributeacross

theirdailylivesmaynotbesufficientlymeaningfultooffsettheextentofthe

demandsbeingplacedonthem.Thus,thoughitmaybebeneficialatagenerallevel

toprovideopportunitiesforearlyadolescentgirlstocontributewithintheirhome

andschoollives,thismaybeunlikelytobebeneficialforreducingsymptomsamong

thoseexperiencingadversityacrossthesedomainsortospecificallycombatthe

extenttowhichtheyfeelstressedorunabletocopeintheirday-to-daylives.


255

Ofcourse,theremaybemethodologicalexplanationsforthesefindings.In

measuringhomeandschoolengagement,focusingonbothhomeandschoollife

simultaneouslycouldalsohavemaskedeffectsonlypresentinoneofthese

domains,thoughthisjointfocusdoesofferinsightintotheeffects(orlackthereof)

offeelinglikeanactivememberacrossday-to-daylife.Indeed,thiscorrespondsto

theriskfactorsidentifiedandincludedintheriskexposurevariable,asthesewere

allgenerallylocatedatthefamilyandschoollevels.However,Ifagreaterinventory

ofriskfactorshadbeenavailable,itmighthavebeenpossibletogroupfactors

basedondomain(e.g.,schoolversushome),whichcouldallowanalysisofcontext-

specificprotectiveeffectsforfactorslikeschoolconnection.Itmayalsobethatthe

focusonanadultatschoolatagenerallevelmaynotcapturerelationshipswith

schoolstaffmorededicatedtopastoralsupport,whichmaybemorevaluablefor

thosefacingadversity.

7.5ResearchQuestion3:LivedExperience

Thissectiondiscussesqualitativefindings,exploringhowexistingtheoryand

literaturemayhelptoexplainparticipants’experiencesalongsidetheinsight

generatedinthecurrentstudy.Organisationofthisdiscussionisinformedbythe

masterthemespresentedinChapterSixbutismoreconceptuallyguided;thatis,

overarchingsectionsgenerallycorrespondtosuperordinatethemes,andthe

discussionpointswithinthesemayfocusonasinglethemeorbringtogether

multiplethemes,asillustratedoverleafinFigure7.1.Thisapproachhasbeenused

tofacilitateamorein-depthdiscussionandreflectstheneedforselectivenessin

exploringfindingsachievedthroughIPA,ratherthanexhaustivediscussion,given

therichnessofinformationencapsulatedinthemes(Smithetal.,2009).This

explorationisnotconstrainedtoanyonetheoreticallens,inlinewiththestudy’s

pluralisticapproachandtheuseofIPAasaninductiveprocess,anddiscussionwill

drawontheoryandthewiderliteratureasrelevant.


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Figure7.1.Conceptualrepresentationofthemesfordiscussion.Masterthemesareshownonthe

lefthandside,groupedwithinsuperordinatethemes,andarrowsshowhowthesehavebeen

integratedtofacilitateaconceptualdiscussionofqualitativefindings,asshownontherighthand

side.


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7.5.1TheExperienceofFeelings

ConceptualisationsofSymptoms

Participantsconceptualisedthedifferentfeelingsandthoughtsassociated

withtheirsymptomsindifferentways.Gracetalkedaboutthesefeelingsasastate

ofbeing,recallingtimeswhenshewas“gettingupset”or“feelingstressed”.This

conceptualisationrepresentsamoreimmersiveaffectiveexperience,inwhichthe

emotionisconsideredafeelingstatethatencompassestheself.Ameliaand

Jennifer’stalkwasmorecognitivelyoriented,withafocuson“worries”and

“thoughts”ratherthanonsomethingthatisfelt.Thesedifferentconceptualisations

appeartoreflectboththeaffectiveandcognitiveimpairmentsgenerallyconsidered

centraltobothdepressiveandanxioussymptomatologyanddisorder.Thatis,

depressiveandanxioussymptomscanbeaffective(e.g.,feelingsofsadnessand

fear),cognitive(e.g.,negativethoughtpatternsandinformationprocessingbiases),

andsomatic(i.e.,bodilyalterationssuchasfatigue,headaches,andstiffness;Beck

&Clark,1988;Kapfhammer,2006;Kokanovic,2011;Kovacs&Beck,1979;Stein,

2006).Thus,itappearsthatparticipantsfocusedmoreonparticularcomponentsin

theiraccounts.Suchdistinctionsmayreflectdifferingmanifestationsofparticular

symptoms;thatis,AmeliaandJennifermaybemoregreatlyexperiencingcognitive

symptomsrelativetoGrace,whomaybepredominantlypresentingwithaffective

difficulties.However,itcouldalsobethatthisreflectsdifferentwaysofthinking

aboutandmakingsenseofone’ssymptoms,withafocusoneitherfeelingsor

thoughtssimplyrepresentingdifferentwaysofunderstandingoverarching

difficulties.

Indeed,itisparticularlynotablethatthewayAmeliaandJennifertalked

abouttheirworriesandnegativethoughts,respectively,gaveasensethattheysaw

themnotonlyasthoughtsbutasobjectsthatcanbehadandevengivenaway.

Thus,thisfocusoncognitionmaynotnecessarilybeareflectionofpredominantly

cognitivesymptomatology,butinsteadmayactasawaytorationaliseormaintain

controloverdifficultthoughtsandfeelings.Previousqualitativestudieshavefound

thatadolescentsexperiencingdepressiveandanxioussymptomscanfindthem

confusinganddifficulttocontrol(Dundon,2006;McCannetal.,2012;Midgleyet


258

al.,2017;Wisdom&Green,2004).Externalisationandobjectificationofone’s

feelingsastangibleobjectsseparatefromtheselfmayreflectalackofcontrolor,

conversely,couldrepresentpsychologicalattemptstoretaincontrol.Indeed,such

externalizationofone’sdifficultiesisakeycomponentofsometherapeutic

approaches,suchasthenarrativeapproach,asawaytoseparatetheseissuesfrom

theselfandallowthemtobeinterrogatedwithoutself-alienation(White&Epston,

1990).ItmaybethatAmeliaandJenniferhaveindependentlyundertakensuch

thinkingstrategiesasamethodofcontrol.However,theemphasisonindividualised

sense-makingheremeansitisnotpossibletosaywhetherthisexternalisation

processisprotectiveorharmful,orindeedboth,dependingonthecontextand

individual.Thatis,thesemethodsofthinkingcouldhavecontributedto

participants’lowsenseofcontrolovertheirsymptomsbut,conversely,couldbe

protectingthemfromworsenedlevelsofdifficultiesorwiderperceivednegative

consequencessuchasshiftsinidentity(asexploredlaterinthischapter).Itmaybe

importantforpractitionersworkingwithadolescentgirlsexperiencingthese

symptomstounderstandonanindividualbasisthewaythattheyconceptualise

theirsymptoms,andhowtheseconstructionsrelatetowiderbeliefsanddecisions.

EmotionIntensityandCentrality

Participantsdescribedtheirsymptomsandassociatedthoughtsandfeelings

asbeingintenseandbuildingupuntiltheyfeltunmanageable,andinsomecasesas

beingdominantwithintheirwideremotionallandscape.Suchunderstandingsand

experiencessuggestthatemotionalsymptomsactasacentralandpotentially

overwhelmingpartofone’sinnerlife.Themultiplicityandintensitythat

participantsdescribedoffersinsightintothemultifacetedwayinwhichsuch

symptomsmaymanifestandbeunderstoodbyearlyadolescentgirls.Thatis,they

appearedheretobemorethansimplyanoverarchinglowmoodoraheightened

stateofanxiety,andwereinsteadseenascomprisingmanydifferentindividual

pointsofconcernanddistressthatoperatetogethertooverwhelmtheself.Though

therehasbeenlittlequalitativeexplorationofhowadolescentsexperiencethese

difficulties,anotherphenomenologicalstudyreportedsimilarfindings,with

adolescentspresentingtheirdepressionasamultitudeofvariedbutintense“bad


259

feelings”(Woodgate,2006).Thisconceptualisationofdifficultthoughtsandfeelings

asbuildinguptosomethingmorethanthesumoftheirparts,andthusbecoming

unmanageable,showshowintenselysuchdifficultiescanbeexperiencedandthe

inherentlossofcontrolthataccompaniesthem.Thisinsightintothecomplex

realityofhowemotionalsymptomsarefeltdemonstratestheneedtosupportearly

adolescentgirlsinexploringandcopingwiththedifferentwaysinwhichsuch

difficultiesmanifestthemselvesacrossdailylife.

Thismanifestationofsymptomsasoverwhelminganddifficulttomanage

mayexplainwhyforsome,thesethoughtsandfeelingscametodominatetheir

wideremotionallandscape.Here,bothAmeliaandJenniferappearedtohave

dividedtheirinnerworldsintothepresenceandabsenceofsymptomatology,with

evenpositiveemotionscomingtobedefinedinthisway.Suchunderstandingsand

experiencesreflectarecognitionthatemotionalsymptomsanddisordersare

definednotonlybythepresenceofdepressiveand/oranxiousfeelingsand

thoughts,butalsobytheirabilitytointrudeuponandlimitwiderareasofemotion

andcognition(AmericanPsychiatricAssociation,2013).Ithasbeenarguedthat

positiveemotionsarecriticalforcopingandadaptationinrelationtomentalhealth,

offeringawayforindividualstomentallyoffsetnegativeexperiencesasaformof

emotionregulation(Gloria&Steinhardt,2016;Tugade,2011;Tugade&

Fredrickson,2004).Here,althoughparticipantsdidnotdescribeaprocessofusing

positiveemotionstomentallyoffsetmoredifficultfeelings,theyhadcordonedoff

thesepositiveemotionsasseparatefromtheirsymptoms.Thatis,happiness

becomesconceptualisedonlyasaspacewherethesedifficultfeelingsandthoughts

areabsent.Thisperhapsindicatestheextenttowhichsuchfeelingsdominate

participants’worlds,giventhattheyconceptualisetheirexperiencesentirely

throughthelensofthepresenceorabsenceofsymptomatology.

7.5.2InternalGrappling

DistancebetweenEmotionalSymptomsandtheSelf

Acrossallthreeaccounts,therewasastrongsensethatparticipantshad

establishedaseparationfromtheirsymptoms,whichtheysawasoperatingwithin


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thembutalsoindependentlyofthem.Theypresentedthemassomethingthat

aroseoftheirownaccordand,oncetheyoccurred,werenoteasilycontrolledand

managed.Indicationsthatparticipantsfeltlittlecontrolovertheactualoccurrence

ofthesesymptomsinthefirstinstanceareunsurprising.Currentperspectiveshold

thatemotionoccurswithinthebrainindependentlyofcognitiveprocesses,andcan

thenbeperceived,interpreted,andregulated(Ledoux,2000;Salzman&Fusi,

2010).Thatis,humanscannotcontrolthearrivalofanemotion,butmaybeableto

cognitivelymodifyandmanageit(Ledoux,2000;Salzman&Fusi,2010).However,it

maybethatperceivedlossofcontrolwhenobservingtheoccurrenceofthese

symptomsiscompoundedwhenonestrugglestomakecausalattributionsfor

them.Here,AmeliaandJenniferexpresseddifficultyinunderstandingwherethese

symptomscamefrom,oftenexpressingalackof“knowing”.Asnotedearlierinthis

chapter,anumberofqualitativestudieshavereportedsimilarfindings,withsome

adolescentsexperiencingsuchsymptomsvoicingasenseofbewildermentand

confusionaboutwheresymptomshavecomefrom(Dundon,2006;McCannetal.,

2012;Midgleyetal.,2017;Wisdom&Green,2004).Midgleyetal.(2017)reflected

thatconfusionregardingtheoccurrenceofsymptomsmayindeedrepresenta

featureorsymptomofdepressioninitsownright,andthatworkingtojointly

inspectone’ssymptomsandattempttounderstandcausaloriginsmaythusbea

usefultherapeuticprocess.Causalattributionsandresponsestoexternaldemands

areexploredingreaterdetaillaterinthischapter,butareworthnotingatthisstage

inregardstohowthismayinfluencesense-makingofsymptomsandassociated

thoughtsandfeelingsthemselves.

Furthertoparticipants’perceivedlossofinternalcontrolinobservingthe

occurrenceoftheseemotions,theyalsoexpressedalackofagencyinregulating

andcontrollingthesesymptomsoncetheyhadarisen.Participantsseemedtofeel

unabletoeffectivelyregulateandrespondtotheiremotionsindependently,

insteadconsistentlyrelyingonexpressingthemtoothers.Whilethereare

understoodtobebenefitsinarticulatingthoughtsandfeelingstoothers,as

exploredlaterinthischapter,thesetwoparticipantsseemedtobelievethiswasthe

onlywaytolessenthesesymptoms,withtheirownrolesimplybeingtoholdontoit


261

untilanotherpersonwasavailable.Whereparticipantsdidtalkaboutstepsthey

hadtakentoresolvetheirthoughtsandfeelings,theydidnotgenerallysee

themselvesashavingactivelydecidedtodothosethings;theysimplyhappenedor

wereconsideredtheonlyavailableoptions,suchasself-harmingoreatingjunk

food.

Conceptually,suchexperiencesappeartosuggestlowlevelsofemotional

self-efficacy,whichpertainstohowconfidentindividualsareinrelationtotheir

emotionalabilities,includingcopingwithandmanagingdifficultemotions(Bandura

etal.,1999;Capraraetal.,2008;Kirketal.,2008).Itisimportanttonotethatself-

efficacyrelatestoone’sperceivedratherthanactualability(Bandura,1997),which

herealignswiththefocusonparticipants’subjectiveaccountsratherthanany

assessmentofregulatoryability.Thereisgrowingempiricalevidencethatlowered

emotionalself-efficacyisassociatedwithdepressiveandanxioussymptomsamong

childrenandadolescents(e.g.,Capraraetal.,2008;DiGiuntaetal.,2018;Muriset

al.,2001;Muris,2002;Niditch&Varela,2012).Asnotedabove,qualitativestudies

haveindicatedaperceivedlossofemotionalcontrolamongadolescents

experiencingemotionalsymptomatology(Dundon,2006;McCannetal.,2012;

Midgleyetal.,2017;Wisdom&Green,2004)andsomehavenotedthat

perceptionsofhavingactivecopingstrategiestomanagethesefeelingscan

facilitategreaterperceivedcontrol(Dundon,2006;Wisdom&Green,2004).

Findingsinthecurrentstudyfurtheraugmentunderstandinginthisarea,

suggestingthatexperiencingemotionalsymptomscanbedisempoweringand

confusingforearlyadolescentgirlsandmaybeperceivedasexceedingone’s

emotionalcapacity.Suchfindingsservetoemphasisetheimportanceofclear

emotionalsupportavenues,asexploredlaterinthischapter,butalsohighlightthe

needtobolsterbothregulationskillsandbeliefinsuchabilitieswithinthe

individual.

Thispassivityandlackofcontrolwerealsopartofawidersenseacross

thesecasesthatparticipantshadnotreconciledthesesymptomswiththeirsenseof

whotheywere.Theytalked,forinstance,offeeling“moremyself”whenthese

symptomswereabsent,orrecountedtimeswhentheiractionsdidnotreflectthat


262

oftheir“self”(e.g.,“Icouldn’thelpmyself”).Suchreflectionsinvokeasenseof

distancebetweenthesesymptomsandone’strueself;thisselfisperhapsis

considerednottofeelthesetypesofthingsandisabletobehaveinawaythatis

rationalandcontrolled.Thesesymptomsandactions,then,maybeperceivedasa

deviationfromtheconstructedselfinawaythatisdifficulttomakesenseof.Given

thefocushereonearlyadolescence,thisintersectionbetweenidentityandmental

healthisofparticularnote.Identity,broadlydefinedasone’sinternalconstruction

oftheself(Erikson,1959;Marcia,1980,1993;McAdams,1988,2011),isgenerally

consideredtosubstantiallyshiftandchangeinadolescence,asyoungpeople

engageinpersonalandsocialexperimentationandengagemoredeeplywitha

widerrepertoireofvaluesandbeliefs(Bukowskietal.,2011;Marcia,1980).Given

thatmanymentalhealthdisordershavetheirage-of-onsetinadolescence(Kessler

etal.,2005),particularlydepressionandanxiety(e.g.,Costelloetal.,2011;de

Lijsteretal.,2016;Jones,2013),itseemsimportanttoexploreandunderstandhow

suchexperiencesmayinteractwithdevelopingconstructionsoftheself.

Identityandmentalhealthareoftenconsideredascloselyintertwined,with

manydominanttheoriesofmentalhealthanddisorderincorporatingelementsof

identityconstruction(Thoits,2013).Theoristshave,forinstance,attributed

disordertounconsciouspersonalityconflicts(Freud,1933),arrestedidentity

development(Erikson,1963;Freud,1933),threatstoorlossofone’sidentity

(Breakwell,1986;G.W.Brown&Harris,1978),andthreatstoself-esteem

(Abramsonetal.,1989).However,lessattentionhasbeengiventohowthe

experienceofmentalhealthsymptomatologyanddisordermayinfluenceone’s

identityconstruction,ratherthantheotherwayaround.Qualitativestudieshave

highlightedthatthiscanbeaproblematicexperienceinadolescence,withyoung

peopledescribingidentityconfusionorinterruptionastheyexperiencesymptoms

andbehavioursseenasincongruentwiththeirsenseofthemselves(Crossley,2000;

Inderetal.,2008;Kuwabaraetal.,2007;Wilmotsetal.,2019).Findingssuchas

thesemayreflectthepsychodynamicdefencemechanismofsplittingoftheego,a

stateofinnerconflictwhereinanindividualisunabletounifydifferentpartsof

themselvesintoacoherentwhole(Freud,1933,1940).Thisseparationofone’s


263

symptomsfromtheselfmayindeedgobeyondalossofcontrolandinsteadreflect

aprotectiveact,meanttopreserveaprimaryconstructionofoneselfashappyand

rational,ratherthandefinedbythesemorenegativethoughtsandfeelingsandthe

actionstheyleadto.Researchhasidentifiedinstancesofyoungpeoplewhoover

timehavecometoseesymptomsanddisordersasacentralcomponentoftheir

identity,perhapstoholdontoasenseofstabilityforthoseexperiencingturbulence

inadolescence(Breenetal.,2013;Shawetal.,2009).Thisintegrationofdisorder

intotheselfcanmeanthattreatmentorchallengescanbeperceivedasathreatto

one’sidentity,promptingreluctancetoengageintherapyorworktowards

recovery(Shawetal.,2009;Warner,2001).Suchfindingsdosuggestthata

separationbetweentheselfandemotionalsymptomscouldbeanimportantactof

self-preservationforsome.Fromatherapeuticperspective,Midgleyetal.(2017)

havesuggestedthatempoweringyoungpeopletoexplorethemeaningoftheir

experiencesandsymptomsmayoffergreaterfeelingsofcontrolandorderand,in

turn,helptheminre-establishingasenseofidentity.

CognitiveDistortions

Participants’beliefsthatsomeoftheirthoughtsdidnotreflectrealityrelate

totheconceptofcognitivedistortion,oranegativebiasederrorininformation

processing,akeytenetofthecognitivemodelofpsychopathology(Beck,1963,

1974;Beck,Rush,Shaw,&Emery,1979).Distortionsoccurautomaticallyand

generallyreflectanindividual’scorebeliefsaboutthemselvesandtheworld(Beck,

1963;Hollon&Kendall,1980).Itisbelievedthatthisisatypicalhumanbehaviour,

butthatmorefrequentorpronouncedcognitivedistortionsbothprecedeand

maintainpsychopathology(Beck,1963,1974;Becketal.,1979).Therehasbeena

particularemphasisontheroleofcognitivedistortioninnegativeaffectivity;such

thinkingpatternsareseentocontributetothedevelopmentofdepressionandare

understoodtoaffectone’sstressappraisalcapacities,thusprovokingheightened

anxiety(Beck,1963,1974;Beck&Clark,1988;Muris&Field,2008).

Researchhasdemonstratedthatchildrenandadolescentsreporting

depressionandanxietyarelikelytoexperienceheightenedand/orfrequent

cognitivedistortions(e.g.,Birhameretal.,1996;Maric,Heyne,VanWidenfelt,&


264

Westenberg,2011;Pereira,Barros,&Mendonça,2012;Rudolph&Clark,2001).

Indeed,thereissomeevidencethatincreasedcognitivedistortionmayactasa

mediatorintherelationshipbetweenearlyadversityandadolescentemotional

symptoms(Flouri&Panourgia,2011;Panourgia&Comoretto,2017).Itisperhaps

unsurprisingthatsuchthinkingpatternswerepresentedbythesetwoparticipants,

giventhattheywereeachexperiencingemotionalsymptomsandmultiplerisk

exposure.Cognitivedistortionscanmanifestthemselvesindifferentways;several

typesofdistortionwerereportedbyAmeliaandJennifer.Forinstance,both

describedatypeofdistortionreferredtoasemotionalreasoning,whereinone’s

feelingsandbeliefsareunconditionallyassumedtobecorrect,outweighingmore

rationalisedthinking(Burns,1980).Theyalsodescribedcatastrophizing,where

negativefuturepredictionsaremadebasedonlittletonoevidence,andmental

filtering,wherebynegativeinformationisfocuseduponandpositiveinformationis

devalued(Beck,1963;Burns,1980).

Notably,althoughbothAmeliaandJenniferexpressedexplicitbeliefsthat

thesethoughtsdidnotmatchreality,thisdidnotdiminishthethoughtsoraffect

widerthinkingpatterns.Thus,notonlywerethesethoughtsoccurring

automatically,buttheyweresustainedthroughamoreconsciousinspection.This

mayreflectthedominantviewofinformationprocessingasadualprocess,withan

automaticresponseaswellasamorecontrolled,reflectiveresponse(Gawronski&

Bodenhausen,2006;Shiffrin&Schneider,1977;Strack&Deutsch,2004,2011).

Whilediscussionofcognitivedistortionsgenerallyfocusesontheirstatusas

automatic,itappearsthatthismaybeinterspersedwithamoreconscious

inspectionandacceptanceofsuchthoughts.Thisinabilitytousearecognitionof

distortiontoactivelychallengehasalsobeendescribedbyolderadolescents

experiencingemotionalsymptomsinpreviousqualitativeresearch(Wisdom&

Green,2004),indicatingthatthisdifficultyisnotnecessarilyduetocognitive

capacitiesinearlyadolescence.Cognitive-focusedtreatmentapproachessuchas

cognitivebehaviouraltherapy(CBT)typicallyincludecognitiverestructuring,

whereinapatientistaughttomonitortheirautomaticthoughts,identifyany

possibledistortions,andchallengethesethoughtsthroughexaminingtheevidence


265

forandagainstthem(Heninetal.,2016).Notably,AmeliaandJennifer

demonstratedtheabilitytoidentifythesedisparities,buttheiridentification

contradictory“evidence”didnotofferthemanewperspective.Indeed,Amelia’s

frequentquestion“what’stheevidence?”reflectsthetypeofquestioning

encouragedinCBT,suggestingshemayhavepreviouslyengagedinthisapproachin

someway.

Itmaybethatsuchawarenessisnotsufficientlypowerfultocreatechange

unlessexploredactivelywithanotherperson(suchasatherapist)orundertaken

alongsideothermethodsofchallengingfeelingsandbehaviours,asisthecasein

CBT.Indeed,arecentmeta-analysisfoundthatcognitiverestructuringwith

depressedadolescentswaseffectiveonlywhencoupledwithothercomponents,

includingchallengingreactivebehaviours(Oudetal.,2019).However,itmayalso

bethatchallengingone’sautomaticthoughtsdoesnotnecessarilyalterunderlying

beliefsystems;corebeliefsareunderstoodtodevelopininfancyandtobeless

susceptibletochangethanmoreimmediatepatternsofthinkingandbehaviour

(Beck,1995;Fishbein&Ajzen,2005;Wellman,1992).CBTasofferedtochildren

andadolescentswithintheNHSistypicallybriefandsometimescomputerised,

whichmaynotprovidesufficienttimetofacilitatechangeincorebeliefs.Notably,

althoughresearchshowsbothimmediateandlong-termpositiveimpactfor

childrenandyoungpeopleexperiencinganxietyanddepression(e.g.,Marchetal.,

2007;Vigerlandetal.,2017;Wolk,Kendall,&Beidas,2015),suchfindingsfocuson

wholegroupchangeratherthanonindividualimprovementrates.Arecentstudy

foundthattherapeuticservicesforadolescentsexperiencingdepressionand

anxiety,includingbutnotlimitedtoCBT,didnotresultinimprovementforthe

majorityofindividuals(Edbrooke-Childsetal.,2018).Itmaybethatforsome

childrenandadolescents,facilitatinganawarenessofthesethoughtsasdistorted

maynoteffectivelychallengethinkingpatterns,warrantingfurtherattentionin

therapeuticevaluations.


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7.5.3DemandsandControl

PersistentStressors

Understandingtheparticularfeaturesandexperiencesthatparticipants

describeindiscussingstressorsmayprovideinsightintohowtheyareperceivedto

bestressful.Thiscanaidunderstandingofthestressappraisalprocessexplored

earlierinthischapter,whichacknowledgesthatthereareenvironmental

antecedentslikelytopromptstress,butemphasisesthatthisisultimately

dependentonthewayinwhichonemakessenseofandassessestheseexperiences

(Folkman&Moskowitz,2000;Lazarus,1966,1990;Lazarus&Folkman,1984;

Lazarus&Launier,1979;Park&Folkman,1997).Here,participantsdrewattention

toboththemultiplicityofstressorsintheirlivesaswellasthewayinwhichthey

wereembeddedasongoingissues.Thedemandstheyexperiencedwerenot

necessarilytalkedaboutasthoughtheywerestressfulinandofthemselves,but

insteadweredescribedasbuildinguporinteractingwithoneanothertobecome

overwhelming.Gracetalkedaboutmultipleincidentsanddemandsbuildinguntil

theycauseddrasticeffects,likeself-harmora“breakdown”,whileJennifertalked

abouthowdemands“pileup”andbecome“toomuch”tohandle.Furthermore,

althoughthestressorsdescribedtypicallyrelatedtoday-to-dayconcernssuchas

negativeinteractionsoracademicpressures,thesewerenotseenasisolated

incidentsbutwereperceivedasembeddedwithinongoingissues,constituting

chronicstressors(Epeletal.,2018).Forinstance,Grace’sinteractionswithhermum

werestressfultoherassingularincidents,butalsotookongreatermeaningwithin

aninternalnarrativeofhermumas“always”havingoverlookedherneedsand,

indeed,compoundedthisnarrative.

Previousqualitativestudieshavereportedsimilarattributionsamong

childrenandyoungpeopleexperiencingemotionalsymptomsanddisorders,

whereinstressorsaccumulateuntila“breakingpoint”isreached(Dundon,2006;

Midgleyetal.,2017).Suchexperiencesmirrortheconceptoftheallostaticload

hypothesisincumulativerisktheory,whereinstressresponsesystemsbecome

overwhelmedwhentaskedwithrespondingtotoomanydemands(Evans,2003;

McEwen,1998;Sterling&Eyer,1988).However,participants’accountsillustrate


267

thisprocessasaconsciouslivedexperienceoffeelingoverwhelmed,ratherthan

simplyhavinganunderlyingphysiologicalresponseinwhichsystemsare

overwhelmed.Seminalliteratureexploringallostaticloadhasgenerallyfocusedon

physiologicalstressprocessesanduseofbiomarkersasawaytoassessthe

phenomenon(e.g.,Evans,2003;McEwen,1998;Sterling&Eyer,1988),but

infrequentlyacknowledgescognitiveappraisalsorpsychologicalstress.Findings

hereandelsewherethatadolescentsfeelcognitivelyandemotionallyoverwhelmed

emphasisesthatone’sabilitytocopewithpsychologicalstresscanalsobecome

overloadedinthefaceofmultipledemands.Indeed,previousworkhasnotonly

demonstratedthatpsychologicalandphysiologicalstresssystemsareinter-related,

buthasalsosuggestedthatitisone’sappraisalofmultiplestressors,ratherthan

thestressorsthemselves,thatbestpredictsallostaticload(Burkeetal.,2005;Clark

etal.,2007;Logan&Barksdale,2008;Sladeketal.,2016).Thus,itmaybe

importanttoconsidertheroleplayedbybothpsychologicalandphysiologicalstress

infutureadolescentmentalhealthresearchinordertocomprehensivelyexplore

stressasamechanismformentalhealthoutcomes.

Indeed,suchfindingscouldbeconsideredtoillustratethecontextualnature

ofmentalhealth.Asarticulatedinthetransactionalmodelofstressandthe

allostaticloadtheory,beingfacedwithconsistentstressorsthatexceedone’s

perceivedabilitytocopeisnaturallygoingtocontributetofeelingsofdistress.It

couldwellbearguedthatallthreeparticipants’feelingsofdistressandanxietyare

anentirelynaturalresponsetothevariouschallengestheyexperienceintheirlives.

Throughthislens,thereisperhapsaneedtoquestionwhetherthecategorisation

ofanyformofemotionaldistressasamentalhealth“symptom”or“difficulty”is

sensitivetothisreality,whereinindividuals’responsesmaybeappropriateoreven

healthy.Forinstance,Grace’sfrustrationanddistressoveradults’failuretohear

herevenassheindicatesthreatstohersafetycouldwellbeconsideredanadaptive

responsetothefailureofotherstosupportherboundaries.Indeed,ithasbeen

arguedthatsuchresponsesmaybehealthybutmayalsobecomeheightenedover

timeinresponsetocontinuedthreateningexperiences,whichcouldovertime

amplifyemotionalresponses(McLaughlin,2016).Suchconsiderationscreate


268

questionsaroundthewiderresponsibilitiesofsystemstosupportyoungpeoplein

addressingthesewiderareasofstressratherthanlabellingdifficultiesas

symptoms;thisisexploredingreaterdepthlaterinthischapter.

Indeed,theideathatone’sappraisalofagivensituationcanbeinfluenced

byaninternalnarrativesupportspreviousargumentsthatcumulativestressover

timecanshapethewaythatindividualsperceiveandappraisepotentiallystressful

events(Epeletal.,2018).Thismayalsoprovideinsightintowhygreaterchronicity

anddurationinexposuretostressorsandriskfactorsisseentocontributeto

worsenedmentalhealthoutcomes(Brooks-Gunn&Duncan,1997;Hammen&

Brennan,2003;Najman,Clavarino,etal.,2010;Reiss,2013),particularlygiventhat

stressisconsideredinstrumentalinriskeffectsmoregenerally(Evansetal.,2013).

Takentogetherwithindicationsthatmultipleco-occurringstressorscanbe

particularlystressful,findingsindicatethatinterpretationofagiveneventisnotan

isolatedappraisal,butisinsteadinformedbyone’swidercontextandhistory.This

maybeparticularlypronouncedamongindividualsexperiencingemotional

symptoms,asinthecurrentstudy,giventhatcognitivedistortionsandtendencies

towardsnegativeinformationprocessingcommonlyoccuraspartofthese

difficulties(e.g.,Birhameretal.,1996;Maric,Heyne,VanWidenfelt,&Westenberg,

2011;Pereira,Barros,&Mendonça,2012;Rudolph&Clark,2001).

Findingssuggestthatforadultsofferingsupporttoadolescentsexperiencing

stress,itwouldbeusefultodevelopanunderstandingofthewidercontextand

internalnarrativesthatinformtheirresponses.Thismaybeparticularlyimportant

wherearesponsedoesnotappearproportionatetothesituation,giventhat

prevailingdiscoursesofadolescentsisthattheyareirrationalandpronetomood

swings,whichcanleadtodismissiveadultresponses(Blakemore,2018;Stapleyet

al.,2016).Thismayalsoprovideopportunitiestojointlyreviewandidentity

persistentstressorswithyoungpeopleanddevelopappropriatecopingstrategies

oractiveresponses.Indeedfromaclinicalperspective,ithasbeensuggestedthat

adolescentswhoholdcausalbeliefsaboutexternalfactorscontributingto

symptomsarelikelytobenefitfromexploratorytherapeuticapproaches,suchas


269

psychodynamictherapy,tofacilitatethemindirectlyexploringandunderstanding

thesechallenges(Midgleyetal.,2017).

SocialDemandandThreat

Therewereinstanceswherethestressorsthatparticipantsidentifiedwere

orientedaroundspecificpeopleandsocialinteractions.ForAmeliaandJennifer,

thisgenerallyappliedtoteachers,whileforGracehermumandbullieselicited

distress.Thisreflectsadualityinsocialties,whereininteractionscanbepositive

andharmful,dependingonthecircumstances(S.Cohen,2004;Umberson&

Montez,2010).Anevolutionarynecessityforsocialinclusionmeansthatperceived

exclusionorriskcanbeexperiencedprofoundly,promptingstrongemotions(Allen

&Badcock,2003;MacDonald&Leary,2005).Adolescenceisaperiodofhighsocial

stressgivenincreasedcomplexityinrelationshipsalongsidegreateremphasison

peerrelationshipsandautonomyfromparents(Daveyetal.,2008;vanRoekelet

al.,2015).

Ofthenegativeinteractionsdescribedbyparticipants,parentalconflict,

parentalneglect,andbullyingvictimizationarewelldocumentedasproblematicfor

mentalhealth,whichisunsurprisinggiventheimportanceofparentsandpeersin

adolescence(Umbersonetal.,2010).Difficultieswithinparentalrelationshipsare

oftenassociatedwithemotionalsymptomatologyanddisorder,includingpoor

maternalcare(Branjeetal.,2010;Kim&Cicchetti,2004;Rey,1995;Schmidetal.,

2011;vanderVoortetal.,2014)andparent-childconflict(Brock&Kochanska,

2015;HiuYapetal.,2014),whileresearchhasconsistentlyindicatedarelationship

betweenbullyingvictimizationandemotionaldifficulties(e.g.,Bondetal.,2001;

Menesinietal.,2016;Stapinskietal.,2015).Thereislessresearchdirectlyfocused

onteachers.Researchhasshownthatchildrenandadolescentsrecogniseacademic

pressurefromteachers(Akos&Galassi,2004;Gorard&See,2011;Klingeretal.,

2015)andcandistinguishdifferentialteacherbehaviourbasedonpupil

performanceandcharacteristics(e.g.,Babad,2009;Brattesani,Weinstein,&

Marshall,1984;Myhill&Jones,2006).Qualitatively,adultsvividlyrecallnegative

experiencesofteachersperceivedtobehavecruellyorunfairly(e.g.,Díez,2010;

Miller,2015;Miller&Shifflet,2016).Takentogetherwithcurrentfindings,this


270

suggeststhatnegativeencounterswithteacherscanbeexperientiallymeaningful

toadolescents.Todate,thereislittlequalitativeexplorationofhowadolescents

viewteachers;asnotedbyBakxetal.(2015),researchtypicallyexploresteachers’

perspectives,whilepupilperspectivesofteacherpracticesareoftenexamined

quantitatively.Thiswarrantsfurtherexploration,includingamongthose

experiencingemotionalsymptoms,asinthecurrentstudy,asitmaybeespecially

importanttolessenanxietiesintheclassroomforthisgroup.Thismaybe

particularlytrueforgirls,givenheightenedpressure(Jones&Myhill,2004;Klinger

etal.,2015;Renold&Allan,2006;Skeltonetal.,2010)andconceptualisationsof

girlsasacademicallynon-problematic(Jones&Myhill,2004;Renold&Allan,2006;

Ringrose,2007;Skeltonetal.,2010).

Negativeinteractionseliciteddistressandfrustrationamongparticipants,

aligningwithevidencethattheyareassociatedwithelevatedstress(Cohen,2004;

DeVries,Glasper,&Detillion,2003)andtheemergenceandmaintenanceof

adolescentemotionalsymptoms(Herres&Kobak,2014;LaGreca&Harrison,2010;

A.Leeetal.,2010;Willetal.,2016).However,symptomsthemselvesmay

contributetothemeaningfulnessofnegativeinteractions,asdepressedindividuals,

includingchildrenandadolescents,oftenseekexcessivereassuranceandgreater

negativefeedbackinsocialinteractions(Evraire&Dozois,2011;Hamesetal.,2013)

andshowattentionalbiastowardsnegativesocialevents(e.g.,Banerjee,2008;

Luebbeetal.,2010;Wrightetal.,2010).Indeed,someofthissocialdistresswas

centredonfuturepredictions.Gracefearedthatherbullieswouldactualisetheir

threatsofphysicalaggression,withsomeindicationsthatshegeneralisedthisto

otherdomains,suchastalkingaboutastrangerassaultingherathome.Indeed,

priorevidenceindicatesthatbullyingvictimizationisachronicstressor,heightening

bothday-to-dayandlong-termanxiety(Carlisle&Rofes,2007;Craig,1998;Zarate-

Garzaetal.,2017).Similarly,AmeliaandGraceexpressedworryaboutpossible

responsesfromteachersiftheywerenotacademicallykeepingup.Thecurrent

studycannotascertaintheextenttowhichsuchissuesaretheresultofnegative

socialinformationprocessingorareasonableextrapolationbasedonexperiences,


271

butregardlessofhowcloselythisreflectsreality,theseinteractionsandpredictions

weresufficientlyrealtoparticipantstowarrantdistress.

Finally,itwasnotablethatGraceusedhersupportiverelationshipwithher

dadtocompensateforperceivedshortcomingsfromhermum.Researchexamining

theinteractionbetweenpositiveandnegativesocialinteractionshas

predominantlyexploredthiswithinspecificrelationships(Rossetal.,2019),rather

thanacrossone’ssocialnetwork.Itmaybeusefultoexaminehowdifferenttypes

ofrelationshipsinteractacrossadolescents’socialnetworkstounderstandhow

largelynegativerelationshipscansitalongsidemorepositiveones.Furthermore,

Grace’smentalidentificationofapositiveresourcetooffsetanegativeexperience

mirrorstheconceptofactiveresilience,whereinindividualsactivelymakedecisions

toadapttoadversity(Lerner,Theokas,&Jelicic,2005;Murray,2010;Ungar,2012).

Previousresearchhaslargelyfocusedonspecificbehaviours,suchasavoiding

particularsituations,buthasalsoindicateduseofthinkingstrategies.Murray

(2010)foundthatyoungoffendersengagedintemporalleaps,focusingonfuture

lifetoavoidcriminalactivity,and“othered”offenderstolimittheviewofoneselfas

agroupmember.Suchbehavioursaresimilarto,thoughdistinctfrom,Grace’s

mentalcompensation,whichcloselyelicitstheideaof“protective”functionsin

adversity.Furtherqualitativeresearchcouldexplorehowyoungpeopleperceive

theirownrolewithintheresilienceprocesstogainfurtherinsightintosuch

decision-making.

ControllabilityandVoice

Althoughparticipantsdididentifydemandsacrosstheirday-to-daylives,

theydidnotallconsistentlyattributetheiremotionalsymptomsorassociated

feelingsdirectlytothesestressors.Graceheldafirmbeliefthatthedemands

placedonherwereunreasonableandcausedherfeelingsofupsetandfrustration;

however,AmeliaandJennifergenerallytalkedasthoughtheproblemwasnotthe

demanditself,butrathertheirinabilitytorisetomeetit.Regardless,allthree

participantsdescribedfeelingaresponsibilitytoadapttomeetdemands,even

wheresuchactionswereperceivedtobedetrimentaltothem.Forinstance,

Jenniferdescribedgettingoutofbedatfiveo’clockinthemorninginordertokeep


272

upwithacademicwork,whileGracetalkedaboutgoingtohermum’shomedespite

feelingunsafethereasshedidnotwanttohurtherfeelings.Thus,since

participantsbelievedtheycouldnotcontroltheirenvironment,theyinsteadhadto

controltheirownbehavioursandresponses.

Thisdistinctionbetweencontrollingtheworldandcontrollingtheselfis

articulatedinRothbaum,Weisz,andSynder's(1982)two-processmodelof

perceivedcontrol.Thismodelcomprisesprimarycontrol,whereanindividual

attemptstocontroltheirouterworldinlinewiththeirownneeds,andsecondary

control,whereanindividualchangesthemselvestofitwiththedemandsofthe

world.Here,participantslargelyengagedinsecondarycontrol,andthoughGrace

didundertakeeffortstowardsprimarycontrol,thesewerenotperceivedtobe

successful.Asaresult,failurestokeepupwithdemandsareattributedtotheself,

resultinginfurtheradaptationandself-blame.Thisapparentcontradictionbetween

perceiveduncontrollabilityandacontinuedsenseofresponsibilityandself-blame

illustratesthedepressiveparadox,whichhighlightstheillogicalnatureofblaming

oneselfforuncontrollableevents(Abramson&Sackeim,1977).Notably,thereis

evidencethatadolescentgirlsexperiencingemotionalsymptomsanddisordersmay

bemoreinclinedtowardsself-blamefollowingadverseevents,relativetoboys

(e.g.,Bennettetal.,2005;Zlomke&Hahn,2010).

Whileallparticipantsdescribedadaptingtheirownbehavioursand

responses,therewasvariationinbeliefsandactionsaroundeffortstowards

primarycontrol.ThoughAmeliaandJenniferdidnotconsideritappropriatefor

themtoaskotherstochangetheirbehaviour,Gracedescribedconsistentlytelling

othersthatasituationwasunfairandcommunicatingwhatsheneededinstead,but

shegenerallyfoundthatthismadelittledifference.Thus,whileAmeliaandJennifer

appearedtoviewsecondarycontrolattemptsasthemostappropriatecourseof

action,thisappearedtobemoreofanenforcedactforGrace,giventhatherefforts

tocontroltheexternalworldwereperceivedashavingfailed.Thisfeelingofbeing

unheardreflectsawiderissueofeverydaypowerimbalancesbetweenadultsand

youngpeople.Researchhasindicatedthatdespiterecognitionoftheirrighttobe

heardinmattersaffectingthem(UnitedNationsChildren’sFund,1989),children


273

andadolescentsoftenfeeltheyarenottrulygivenasayindecisionsandinstead

feel“bossedabout”(Blakemore,2018;Hargreaves,2017;Kilkellyetal.,2005;

Lundy,2007;Morrow,1999).

Anincreasedemphasisonpositiveyouthdevelopmentperspectivesand

approacheshasledtoagrowingbodyofliteratureexploringthebenefitsof

introducingsystemsandapproachesthatcanempoweryoungpeopleandenhance

theirvoice(e.g.,Hazel,2016;Sargeant&Gillett-Swan,2015;Wong,Zimmerman,&

Parker,2010).However,thesestudiesareoftenfocusedonengagementwith

youngpeopleinaneducationalsettingorcommunitysettingssuchasyouthclubs.

Whileeffortstodevelopsharedcontrolandshareddecision-makingwithinsuch

contextsisimportantandindeedmaybevaluableforyoungpeoplelikeAmeliaand

Jennifer,itremainsunclearhowyoungpeoplemanageissuesofvoiceand

empowermentinafamilycontext.Researchhasemphasisedthatitis

developmentallybeneficialforadolescentstobepartofdecisionswithinafamily

contextandindeedthatthismaypromotepositiveoutcomesintermsofemotional

symptoms(e.g.,Beckeretal.,2010;Borellietal.,2015;Radziszewskaetal.,1996).

Yet,thereislittleunderstandingofwhathappenswhentheseneedsareoverlooked

andofhowwidersystemsmightbeinvolvedinfacilitatingyouthvoiceinafamily

context.Thus,whereadolescentsareidentifiedashavingmentalhealthsymptoms,

includingemotionalsymptoms,itmaybeimportantnotonlytoaddresscopingand

emotionregulationskills,butalsotojointlyidentifyareasofdifficultyandstress

acrosstheirworlds,andtoexplorewaystodirectlyaddresstheseandempowerthe

youngperson.

Itisimportanttonotethatparticipants’judgementoftheseparticular

stressorsasbeyondtheirimmediatecontrolisnotunreasonable.Academic

pressure,poorparentalrelationships,andbullyingvictimizationareallissuesthat

arelikelynoteasilyresolvedbyyoungadolescents.Indeed,findingsindicateaneed

toconsiderwhenitisappropriatetoexpectyoungpeopleto“adapt”or“cope”

withadversity,andwhenthereisaneedtofacilitatechangetobettermeettheir

needs.Ithasbeensuggestedpreviouslythattheconceptsofresilienceand

adaptationmaybedangerousinthattheyplacetheonusonanindividualtofit


274

withthestatusquo,thuscircumventinganyneedforsystemicchangesthatcould

facilitategreaterequality(Burman,2018;DeVerteuil&Golubchikov,2016;Ungar,

2012).Findingsheresuggestthatadaptationmaybedetrimentalinsomecases,

necessitatingpotentiallyharmfulbehaviours.ItisnotablethatmuchofAmeliaand

Jennifer’sdifficultiesinday-to-dayliferelatedtoacademicpressures,echoing

reflectionsbyMidgleyetal.(2017)thatacademicdemandsareperceivedbyyoung

peopletobeacommonstressorbutarenotgenerallyemphasisedinadversity

literature.Suchdifficultiesarenotablegiventhatyoungpeopleoftendonotfeel

“heard”withineducationsettings(e.g.,Lundy,2007),whichmaybeparticularly

trueforstudentspresentingashavingmentalhealthsymptoms,including

emotionalsymptoms(e.g.,Baker,2016;Cefai&Cooper,2010;Lewis&Burman,

2008).Itmaybeimportantforpolicymakersandpractitionerstocriticallyreflecton

when“resilience”istrulyrequiredandwhenitmayinsteadbenecessarytoadapt

tomeettheneedsofyoungpeoplefromdiversebackgrounds.

7.5.4DrawingonOthers

Help-SeekingBeliefsandBehaviours

Participants’mappingoftheemotionalsupportnetworkalignswith

literaturearoundmentalhealthhelp-seeking,definedbyRickwoodandThomas

(2012)asanadaptivecopingprocesstogainexternalhelpwithmentalhealth.This

includesbothinformalsocialnetworks(e.g.,family,friends)andformalavenues

(e.g.,teachers,psychologists).Participants’relianceonfamilyandfriendsfollows

consistentevidencethatadolescentsoverwhelminglyseekhelpforpersonaland

emotionalissuesfrominformalconnections,ratherthanprofessionals(e.g.,

D’Avanzoetal.,2012;deAnstiss,2009;JacksonWilliams,2012;Rickwoodetal.,

2005;Wilson,Bushnell,&Caputi,2011;Wilson,Rickwood,&Deane,2007).

Researchhaslargelyconcludedthatgirlsandwomenaremorelikelytoseekhelp

thanboysandmen(Barker,2007;Parker&Brotchie,2010;Rickwood&

Braithwaite,1994;Sen,2004);however,thisoverarchingpatternmaskscontext-

dependentvariability.Evidencesuggeststhathelp-seekingamonggirlsandwomen

variesaccordingtocharacteristicssuchasSES(e.g.,Fonseca,Gorayeb,&Canavarro,


275

2015)andsexuality(e.g.,McNair&Bush,2016),aswellasthetypeofmental

healthdifficultyforwhichhelpissought,withevidenceofreversedorevenabsent

genderdifferencesinthecontextofdepression(e.g.,Angstetal.,2002;

Zimmerman,2005).Currentfindingsfurtherindicateneedforanuanced

perspectiveofthisissue,asparticipantsshowedvaryinglevelsofdiscomfortin

sharingemotionswithothersandallreportedaccessinglittletonoprofessional

support.Furthermore,youngeradolescents,asofinteresthere,canbemore

reluctanttoseekbothinformalandformalsupport(Boldero&Fallon,1995;Boyd

etal.,2011;Wilson&Deane,2012),whiledepressionandanxietyareassociated

withloweredhelp-seeking,bothinformalandformal(e.g.,Wilsonetal.,2011,

2007;Wilson&Deane,2010).Intersectionalityoftheseissuesamidstcurrent

concernsaroundemotionalsymptomatologyamongearlyadolescentgirlsindicates

theneedtoexplorehelp-seekingtendenciesamongthisgroup.

Findingsalsoprovideinsightintotheinterpretivemeaningattachedto

specificavenuesofsupportandhowthisinformsdecisions.Ithasbeensuggested

thathelp-seekingisanactiveprocess,withindividualslikelyevaluatinghelpsources

contextuallygiventheirissueandthetypeofsupportdesired(Boldero&Fallon,

1995;Rickwood,2015).Currentfindingssupportthis,withparticipantsactively

assessingtheirneedsandidentifyingindividualsperceivedasabletofulfilthese.

Theiremphasisonrelationalqualitiesofcloseness,trust,andcaremayexplainwhy

familyandfriendsareoftenrelieduponforemotionalsupportand,indeed,reflects

qualitiesprioritisedbyadolescentsinpreviousstudies(Gulliver,Griffiths,&

Christensen,2010;Martin,Romas,Medford,Leffert,&Hatcher,2006;Rickwoodet

al.,2005).Perceivedavailabilitywasalsoconsideredmeaningful;AmeliaandGrace

highlighted“knowing”theyhadconsistentandreliablepeopleavailable,while

Jennifersawothersasfrequentlyunavailableforemotionalsupport.Ithas

previouslybeentheorisedthatevenperceivedavailabilityofsocialsupportcan

lessentheextenttowhichaneventisappraisedasstressful,thusbufferingstress

andpreventingnegativeemotionalresponses(Kawachi&Berkman,2001).This

emphasisonavailabilitymayfurtherexplainadolescentrelianceonfamilyand

friends,asinteractionswithsuchindividualsareoftenembeddedacrossdailylife.


276

However,thereisaneedtoconsiderthequalityofsupportfromfamilyand

peers.Responsesmaybenegativeorguidedbyindividualisedandculturalvalues

(Barker,2007;Cauceetal.,2002;Guoetal.,2015;Stanton-Salazar&Spina,2005),

whileindividualsmaynotbeequippedtorecogniseorrespondtosignsofmental

healthsymptoms(Barker,2007;Rickwoodetal.,2005;Wilsonetal.,2011)and

indeedmayofferunhealthysolutions(Rickwoodetal.,2005;Schwartz-Mette&

Rose,2012).Arelianceonfamilyandfriends,amongparticipantsandasevidenced

acrossthewiderliterature,demonstratestheimportanceofimprovingknowledge

andskillsamongparentsandyoungpeopletofacilitateeffectivesupport(D’Avanzo

etal.,2012;Rickwoodetal.,2005).However,youngpeoplemaybeselectivewithin

theirinformalnetworks,filteringoutindividualsperceivedasunhelpfulevenwhere

thesecouldtypicallybeconsideredimportantsupportavenues.Here,Grace

perceivedhermumtobeuncaringandsochosenottoshareissueswithher,

thoughofcoursethisdependsuponidentificationofsucharisk.

Therewaslittlediscussionofprofessionalhelp-seekingamongparticipants;

thoughAmeliadiddescribesomeinteractionswithsupportbothinandoutof

schooltheserelationshipsweretreatedasaugmentingthesupportofferedby

familyandfriends.CurrentpolicyinEnglandencompassesagrowingemphasison

schoolsasacontextforpromotingmentalhealth,withteachersconsideredakey

supportsystem(DepartmentofHealthandEducation,2017;Fazeletal.,2014;

Vostanisetal.,2013;Weare,2010).However,participants’talkofteachersdidnot

reflectaviewofthemasanappropriateavenueforhelp-seeking.Amelia

demonstratedconsistentanxietyaroundinteractionswithteachers,Gracenoted

thatsherarelyaskedteachersforhelpandinsteadcalledherdadregarding

problemsinschool,whileJenniferbelievedthatteacherswouldnot“genuinely”

care.Thiscouldbeconsideredpartofabroaderpatterninwhichteachersare

perceivedasusefulonlyinthecontextofschool-relatedissues(e.g.,academic

difficultiesorpeerconflict),whilefamilyandfriendsareconsideredmost

appropriateformorepersonalissuessuchasemotions(Boldero&Fallon,1995;

Bowersetal.,2013;Rickwoodetal.,2005;Stapleyetal.,2019).Ifemphasison

teachersasakeysourceformentalhealthsupportistocontinueineducational


277

policy,thereisaneedtoconsiderhowthisavenuecanbemademoreappealingto

youngpeople.Itmayhelptodrawontherelationalqualitieshighlightedhereand

inpriorliterature,providingopportunitiesforadolescentstodeveloptrusting

relationshipswithteachersinwhichtheyfeelcaredforandunderstood,ideally

beforeissuesarise(Rickwoodetal.,2005).Notably,suchqualitiesmirrorthe

featuresoftendiscussedinthecontextoftherapeuticalliance,acriticalcomponent

forchangethatdescribesthequalityandstrengthofacollaborativetherapist-client

relationship(Ackermanetal.,2001;Cooper,2004;Pattison&Bell,2018;Rogers,

1957).Itmaybethattrainingaroundcounsellingandtherapeuticinterpersonal

skillscouldaidteachersincreatingmeaningfulrelationshipsforchangewith

adolescents.

TalkingasaRelease

Participants’centralaimwhenseekinghelpoftenappearedtobesimplyto

sharetheirsymptomsandthoughtsverbally,astheyperceivedthisasaformof

release.Thisisgenerallyconsideredemotionalsupport,whereintrustedothers

offerfeelingsofvalueandcomfortand,inthecontextofmentalhealth,provide

supportforemotionalneedsordistress(Barker,2007;Jacobson,2009).The

perceivedusefulnessofsuchinteractionsreflectsevidencethatemotionalsupport

frombothadultsandpeersisassociatedwithloweredlevelsofemotional

symptomsduringadolescence(e.g.,Boudreault-Bouchardetal.,2013;Slavin&

Rainer,1990),particularlyasabufferagainstadverseevents(e.g.,Desjardins&

Leadbeater,2011;Yeung&Leadbeater,2009;YeungThompson&Leadbeater,

2013).Theemphasisthatparticipantsplacedontalkingwithotherswhen

experiencingadifficulttime,andthereleasethattheydescribed,suggestsa

perceptionthatthisisthemostvaluablemethodofsupportavailableindailylife,

withlittlementionofothersupporttypessuchasinstrumentalsupport(i.e.,direct

supportwithanissue)orinformationalsupport(i.e.,informationaboutanissueor

treatment).Thecurrentstudymaysupportunderstandingofhowtheprocessof

emotionalsupportandtalkingthroughdistresswithclose,trustedotherscanoffer

aneffectivecopingstrategyinthecontextofmentalhealth,asunderlying

mechanismsarenotfullyunderstood(Lakey&Orehek,2011).


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Thereleaseparticipantsemphasisedisofparticularnoteandsoisfocused

uponhere.Theactoftranslatingone’sfeelingsintowords(bothverbalandwritten)

hasrecentlybeenconceptualisedasaffectlabelling,aformofemotionregulation

(Torre&Lieberman,2018).Researchhasshownthataffectlabellingcandiminish

theintensityofanemotion(Fanetal.,2019;Torre&Lieberman,2018)and

neuroimagingstudieshaveconsistentlyfoundthataffectlabellinginresponseto

emotionalstimuliyieldsdecreasedlevelsofamygdalaactivation,alongside

increasedactivationofprefrontalregions(Burklundetal.,2014;Costafredaetal.,

2008;Liebermanetal.,2007).Giventhattheamygdalaisassociatedwiththe

generationofemotion,itisnotablethatsymbolicconversionofemotionappearsto

shifttheonusofprocessingtoanotherregion,perhapssignallingtotheamygdala

thatitsroleiscomplete(Torre&Lieberman,2018;Woodetal.,2016).However,it

remainsunclearexactlywhatunderpinsthisshift.Intheirrecentreview,Torreand

Lieberman(2018)identifiedanumberofplausiblemechanisms;theysuggestthat

(a)Labelsmaysimplybeaproxyforavaluableprocessofself-reflection,(b)that

labellingcouldfacilitatecomprehensionofacomplexemotionalstate,or(c)that

thetranslationoffeelingsintosymbolicmeaningallowscreationofdistancefrom

theself.Thoughthecurrentstudyofcoursedoesnotempiricallytestthesepossible

mechanisms,participants’talkofafeelingbeing“out”ofthemafterarticulatingit

maycontributetounderstandinginthisarea.Thatis,afocusontalkingasawayto

releaseemotionsfromtheself,ratherthansimplylesseningthem,suggeststhat

theactofsymbolicconversionintowordscouldofferasenseofdistancebetween

theselfandthefeeling(Torre&Lieberman,2018).Notably,thisalsoreflects

participants’invocationsofseparatenessfromtheirfeelings,astheseactsof

mentaldistancingmayfurtherfunctiontolessentheirintensity.

Consideringfindingsalongsidethewiderevidence,itappearsthatvoicing

one’sdifficultthoughtsandfeelingsisnotsimplyaformofself-expressionoraway

toelicitemotionalsupport,butpotentiallyanactofemotionregulationinandof

itself.TorreandLieberman(2018)havesuggestedthataffectlabellinglikelyalters

thebehaviouraleffectsofagivenemotion,includingmentalhealthoutcomes.For

instance,onestudyfoundthatparentsreporteddecreasedobservedanxietylevels


279

afteradolescentgirlsdocumentedtheiremotionalstatesindiaries(Thomassinet

al.,2012).Thus,thesenseofreleasethatparticipantsdescribedmaynotjust

attenuatemoreimmediatefeelingsbutmayalsofunctiontoreduceassociated

symptomsandbehaviours.Thisoffersarelativelystraightforwardopportunityto

providesupporttoadolescentsexperiencingmentalhealthsymptomatology,

includingemotionalsymptoms,simplythroughlistening.Indeed,articulatingand

workingthroughone’semotionsaloudisgenerallyacentralcomponentinalmost

alltherapeutictreatmentapproaches,foradolescentsandadultsalike(Cooper&

McLeod,2011;Greenberg&Watson,2015;Kegerreis&Midgley,2018;Pascual-

Leone&Greenberg,2007;Southam-Gerow&Kendall,2002).Aconceptual

emphasisonaffectlabellingaseitherspokenorwritten(Torre&Lieberman,2018)

suggestsitcouldbeusefultoofferalternativemethods,suchasdiaryentries,for

individualswhoexperiencediscomfortinsharingemotionswithothersorwhodo

notperceivethemselvestohaveclearsupportavenues,aswithJennifer.

However,itshouldbeconsideredthatthisactoftalkingaboutone’sfeelings

asamethodofemotionregulationmayrequiretheuseofparticularskills,which

notallyoungadolescentsmaypossess.Thatis,theabilitytoidentifyandmake

senseofthespecificfeaturesofone’semotionsandtothenverballyarticulate

themrequiresacertainlevelofemotionalself-awarenessandemotional

vocabulary,whichmayhaveimplicationsforvariousgroups.Attheindividuallevel,

thereareparticularconditionsandSENassociatedwithloweredemotional

awareness,suchasASD(Hilletal.,2004;Hobsonetal.,2006;Silanietal.,2008).

Therearealsopsychosocialfactorsthatmayinfluencesuchskills;forinstance,

parentstypicallyuseagreaternumberandvarietyofemotionwordswhen

engagingwithyoungdaughters,relativetosons(Fivush,2007;Fivushetal.,2000;

Zaman&Fivush,2013).TorreandLieberman(2018)havehighlightedthatitis

unclearwhethertheabilitytoinspectandarticulateone’semotionsinagranular

wayoffersmoreorlessbenefitintermsofaffectlabelling.Futureresearchshould

examinewhethergreateremotionalawarenessandemotionalvocabularyis

advantageousinthisprocess,withparticularattentiontohowthisaffectsgroupsof

individualslikelytoexperiencedifficultiesintheseareas.


280

7.6Meta-InferencesandImplicationsandDirectionsforFutureResearch

Havingoutlinedandexploredinferencesthatcanbedrawnfromfindings

acrossboththequantitativeandqualitativestrands,herethislearningisintegrated

tocreatemeta-inferences.AsdiscussedinSection4.4.1,thisapproachisconsistent

withthestudy’suseofmixedmethodstoachievecomplementarityacrossstrands

(Brymanetal.,2008;Greeneetal.,1989).Thesemeta-inferencesrepresentamore

comprehensiveunderstandingofmultipleriskexposureandemotionalsymptoms

amongearlyadolescentgirls,capturingtheinsightgeneratedbyconsideringboth

setsoffindingstogether.Itisimportanttonotethatbecausemeta-inferencesseek

togobeyondsimplydescribingdataandinsteadaimtocapturemeaningful

interpretationsoffindings,theresearcherisimplicatedintheconclusionsoffered

here.

Threemeta-inferencesweredevelopedinlightoftheinsightgenerated

througheachofthesestrands:

1. Emotionalsymptomsareembeddedindailylife;

2. Demandsandstresscanbepsychologicallyoverwhelming;and

3. Closerelationshipsarecritical.

Figure7.2(overleaf)illustrateshoweachofthesemeta-inferenceshasbeen

informedbythelearningandconclusionsdrawnwithineachindividualstrand.To

facilitateaccessibilityformixedaudiences,arecognisedissueinpresenting

integratedfindingsinmixedmethodsresearch(Sandelowski,2003),thisfigure

focusesontheconclusionsandinterpretationsalreadydrawnacrosseachstrand,

ratherthanonrawfindings.Forinstance,theboxesdowntheleft-handsidedonot

presentstatisticalinformationsuchassignificancevaluesorcoefficients,but

insteadpresenttheknowledgegeneratedinaddressingtheresearchquestion.

281

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282

7.6.1Meta-InferenceOne:EmotionalSymptomsareEmbeddedinDailyLife

Bothquantitativeandqualitativefindingssuggestthatemotionalsymptoms

areinterwovenwithinearlyadolescentgirls’day-to-daylives.Experientially,

qualitativeparticipantsunderstoodthesesymptomsasacentralpartoftheirinner

worlds,constitutinganintense,andattimesunmanageable,collectionofintrusive

thoughtsandfeelings.Acrossbothstrandsofthestudy,findingssuggestthatitis

notjustthesymptomsthatarepresentindailylife,however,butalsothe

circumstanceswithwhichsuchsymptomsareintertwined.Thatis,emotional

symptomsareassociatedbothstatisticallyandexperientiallywithchallenges

embeddedinthecontextofdailylife,particularlyacrossfamilyandschoolcontexts.

Thesedailyexperiencespromptongoingfeelingsofstressandasensethatoneis

notabletocopewithorcontroleitherexternaldemandsorone’sownsymptoms

(asdiscussedinthefollowingsection).Takentogether,then,findingsacrossboth

strandsillustratethatemotionalsymptomscanbedeeplyembeddedwithinearly

adolescentgirls’day-to-daylives.

Theextenttowhichthesesymptomsappeartobemanifestedand

intertwinedasapartofdailylifeisworrying.Earlyadolescenceiswidelyconsidered

avulnerableperiodforemotionaldifficultiesamonggirlsandwomen,yetevenat

thisearlystagethereareclearindicationsthatthesesymptomscanbeanintensely

problematicareaofday-to-daylifeforsomegirls.Indeed,thequantitativesample

herewasfoundtohaveelevatedsymptomscomparedtonormsforthemeasure

used,withapproximatelyoneinfivereportingabnormallevelsofsymptomatology

(seeSection4.5.1).Theregularityandintensityofsuchdifficultiestherefore

emphasisesanethicalresponsibilityonthepartofresearchersandpractitionersto

understandandaddresstheseissues,particularlyforgirlsexperiencingadversity.

Asidefromthenegativeshort-andlong-termoutcomesassociatedwithemotional

symptomsinadolescence,thedailynatureoftheseexperiencessignalsathreatto

qualityoflifeamongthisgroup.Attentiontotheseissuesappearsespeciallyurgent

ifemotionalsymptomsanddisordersareindeedrisingamongadolescentgirls,as

theevidencecurrentlysuggests(Boretal.,2014;Collishawetal.,2010;Finketal.,

2015;Lessofetal.,2016;NHSDigital,2018).


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Thus,thereisaneedtoconsiderhowsupportandinterventioncanbe

offeredinamannerthatissensitivetothedailycontextofthesedifficulties,ifwe

aretoeffectivelyworktoreducesymptomatologyandsupportqualityoflifeamong

thisgroup.Targetedinterventionsforadolescentmentalhealthsymptoms(e.g.,

CBTorcounselling)aretypicallydeliveredonaweeklybasis,oftenwithabrief

durationperiodvaryingfromfourto12weeksofregularsessions(e.g.,Dasetal.,

2016;Neufeld,Dunn,Jones,Croudace,&Goodyer,2017).Whilethisapproachcan

facilitatepositiveoutcomesforsomeadolescents(e.g.,Dasetal.,2016;Edbrooke-

Childsetal.,2018;McArthur,Cooper,&Berdondini,2013;Neufeldetal.,2017),

suchtreatmentsmayalsoserveonlyasashort-term“quickfix”thatdoesnot

reflecttheongoingrealityofyoungpeople’smentalhealthandwidercontexts

(Bondetal.,2004;Durham,2007).Thatis,brieftreatmentsmightnotbesufficient

inkeepingupwiththewaythatdifficultiessuchasemotionalsymptomsmanifest

asapartofdailylife,especiallyiftheyarenotdesignedtospecificallyaddressthe

widerongoingcircumstancesthatareoverwhelminganindividualinthefirstplace.

Itmaybethatgreaterdurationandregularityoftreatmentcouldbehelpful,

perhapsparticularlyinthecaseofschool-basedcounsellingwhereavailabilitycould

reasonablybeincreased.However,findingsherealsoemphasisetheneedforany

treatmentmadeavailabletobecoupledwitheffortstodevelopwidersystemsof

informalsupportthataremoreconsistentlyavailableandperhapspreferredfor

day-to-daysupport.Thisisexploredlaterinthischapterinthecontextofmeta-

inferencethree.

7.6.2Meta-InferenceTwo:DemandsandStresscanbePsychologically

Overwhelming

Findingsacrossbothstrandsofthestudyhaveclearlydemonstratedthat

theexperienceofmultipledemandscanbepsychologicallyoverwhelmingforearly

adolescentgirls,promptingstressandexceedingone’ssenseofcontrolandcoping

capacities.Furthermore,suchexperiencesandappraisalsappearlinkedwith

emotionalsymptomsamongthisgroup.Thisisevidentinquantitativeresults

aroundtheindirecteffectsofstressappraisalcomponentsaswellasinqualitative


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findingsthatthedemandsofdailylifeactasapersistentandoverwhelmingsource

ofstress.Atitssimplestlevel,then,thestudyisabletoconcludethatagreaterlevel

ofdemandisoverwhelming,whichappearsrelatedtofeelingsofdepressionand

anxiety,thusofferingsupportforthestresshypothesis.However,therearea

numberofmorecomplexfacetstothisfindingwhenconsideringbothquantitative

andqualitativefindingstogether,raisingconsiderationsaroundthewaythatwe

thinkaboutandaddresstheseissues,bothinthelivesofearlyadolescentgirlsand

moregenerally.

Forinstance,itisimportanttonotethattheemphasisacrossbothstrands

ofthestudywasonpsychologicalstress.Bothstatisticallyandexperientially,

findingsindicatethatthelinkbetweenmultipleriskexposureandemotional

symptomsappearslargelyattributabletoanactive,conscioussenseofbeing

mentallyoverwhelmedandunabletocope.Thiscontrastswiththewiderresearch

landscapearoundmultipleriskexposureandthestresshypothesis,whichrarely

givesdirectconsiderationtothewaysinwhichindividualsperceiveandthinkabout

thesedemands.Cumulativerisktheory’sprioritisationofthenumberofriskfactors

oneisexposedtoreducescomplexexperiencestoequalunitsofmeasurementand,

indoingso,directlyoverlooksthemeaningofagivenfactortotheindividualand

theextenttowhichtheyappraiseittobeproblematic.Inthesameway,discussion

ofthestresshypothesisgenerallyfocusesonallostaticloadand,thus,physiological

stressresponsesystems(Evansetal.,2013),despiteevidenceofassociations

betweenphysiologicalandpsychologicalstress(e.g.,Oldehinkeletal.,2011;Sladek

etal.,2016;Zimmaroetal.,2016).Thus,thesetheoriesappeartofocusupon

underlyingmechanismsasthoughtheyentirelybypassindividualperceptionand

cognition,treatingpeopleasthoughtheysimplyexistpassivelyinriskylandscapes

ratherthanactivelyappraisingandnavigatingtheseexperiences.Thisischallenged

inthecurrentstudynotonlybyindicationsofindirecteffectsviastressappraisal

components,butalsothroughqualitativefindingsdemonstratingthecomplex

meaningsthatindividualsattachtoagivendemand.Here,suchappraisalswerenot

onlyinformedbythesituationathand,butalsobytheindividual’sinterpretationof

thateventwithintheirwidernarrativeovertimeandappraisalsofcontrollability.


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Overall,then,findingsacrossthestudyprovidesupportforagreaterfocuson

psychologicalprocesseswithinriskandstressresearchmovingforward,bothfor

earlyadolescentgirlsandmoregenerally.Thiscouldbeexploredthroughsimilar

modelstothecurrentstudy,byacknowledgingandexploringunderlying

mechanismsofstressappraisal,orcouldperhapsinvolvemorenuanceddata

collectionmethods,suchasself-reportingofone’sappraisalsofspecificstressors

alongsideglobalstress.

Ofcourse,itshouldbenotedthatalthoughthecurrentstudyprovidesan

explorationofthestresshypothesisinmultipleriskexposure,itdoessowithina

highlyspecificcontextandpopulation.Asidefromthespecificityoftheparticular

riskfactorsexploredandthefocusonearlyadolescentgirls,itmayalsobe

particularlyrelevantthattheemphasishereisonemotionalsymptoms,whichtend

tomanifestinternally.AsnotedinChapterThree,thereareseveralother

hypotheses(beyondthestressmechanismexploredhere)astohowmultiplerisk

effectsoperate.Itmustbeconsideredthatthemechanismbywhichriskeffects

operatecouldbedependentupontheoutcomeofinterest.Thatis,feelingsof

distressandanxietyarearguablybynaturelikelytoresultfromfeelingsofbeing

overwhelmed.However,itmaybethatotherdisruptionstohealthand

developmentinthecontextofadversitycanbeattributedtoalternative

mechanisms.Forinstance,studiesshowthatmultipleriskeffectsnegativelyimpact

cognitivedevelopmentamongyoungchildren(Belskyetal.,2012;Burchinaletal.,

2000;Halletal.,2010);itistheoreticallyplausiblethatsucheffectsmightoccurvia

disruptiontoproximalprocessesofdevelopmentratherthansolelyduetostress.

Futurestudiesshouldseektomorecomprehensivelyexploredifferentriskeffect

mechanismsacrossarangeofpopulations,contexts,andoutcomes,todevelopa

morenuancedunderstandingofhowadversityimpactsuponchildrenandyoung

people’soutcomes.

Nevertheless,indicationsthattheexperienceofmultipledemandscanbe

overwhelmingandcanmakeonefeeloutofcontrolandunabletocopewarrants

seriousattentiontohowsuchfeelingscanbealleviatedamongadolescentgirls

experiencingadversity.Theparticularissuesthatyoungpeoplefaceinthecontext


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ofadversityareoftenbeyondtheircontrol,ascanbeconsideredtruefortherisk

factorsfoundinthequantitativestrandandintheexperiencesofparticipantsinthe

qualitativestrand.Bothsetsoffindingsindicatethatearlyadolescentscannot

reasonablybeexpectedtoresolvethepresenceorintensityofagivenstressor,

particularlywhenattemptingtomanagenumerousdifferentchallengesacrosstheir

dailylives.Anyattemptstoallowyoungpeopletosharetheirconcernsorto

facilitatedevelopmentofcopingstrategiesandemotionregulationskillsare

arguablyinsufficientwithouteffortstodirectlyalleviatethepressuresthey

experienceinlife.Forinstance,schoolsmaybeabletoofferadaptationsforthose

experiencingemotionalsymptoms,suchasreducingacademicworkloadand

pressure,orcouldexplorewaystoprovidesupporttofamiliesexperiencingissues

inthehome.Asdiscussedearlierinthischapter,importantconcernshavebeen

raisedaboutimposingexpectationsofresilienceuponyoungpeoplewithout

consideringtheneedforsystemicchangesthatcanfacilitateequalopportunities

(Burman,2018;DeVerteuil&Golubchikov,2016;Ungar,2012).Bothpolicyand

researchneedstobesensitivetosuchissuesifwearetoaddressinequalitiesin

adolescentmentalhealth.

Indeed,thecomplexwaysinwhichthesedemandsareembeddedwithin

one’slifeandareappraisedandnavigatedbyindividualsperhapsalsonecessitates

considerationoftheterminologyanddiscourseof“risk”thatdominatesthe

adversityliterature.Conceptually,“risk”reflectsincreasedlikelihoodofnegative

outcomes,whichdoesneatlyencapsulatethestatisticalwayinwhichthis

phenomenonisexploredand,tosomeextent,emphasisesprobabilityratherthan

determinism(Zolkoski&Bullock,2012).However,thisterminologyperhapscannot

dojusticetothedynamicwayssuchfactorsactuallyoperateincontextandthe

mechanismscontributingtosucheffects.Thatis,inrealitytheeffectsof“risk

factors”arenotsimplyamatterofstatisticallikelihood,wherebyprobablyanearly

adolescentgirlfacingmultipleriskexposurewillspontaneouslybecomedepressed

andanxious.Instead,thesefactorsactaspersistentandaccumulativechallenges

thatthoseexperiencingadversitymustmanageonaday-to-daybasis,likelyfeeling

overwhelmedandattemptingtodrawonsupportfromfamilyandpeersasawayto


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bolsterthemselvesagainstnegativeconsequences.Ithasbeenarguedelsewhere

thatthediscourseofrisk(andindeedresilience)servetolabelandstigmatizeat-

riskgroupswithlittleclearemphasisonactuallyresolvingthechallengesthatcause

themtobeatrisk(seeFollesø,2015;Foster&Spencer,2011).Findingshere

providefurtherindicationsthatthislanguagemayserveasapoorrepresentation

forthecomplicatedanddynamicchallengesthatyoungpeopleareactively

attemptingtocopewith,withlittlerealcapacitytochallengesuchsystems

themselves.Asthefieldmovesforwardwithagreaterfocusonexploringthe

complexetiologicalmechanismscontributingtodifferentialoutcomesamong

particulargroups,wemaywellneedashiftinlanguagethatencouragesinspection

ofwhythesegroupsare“atrisk”.Forinstance,afocuson“demands”,asisfoundin

thephysiologicalstressliterature,maymorecloselymatchtherealitythat“risk

factors”areasourceofdailystrainandchallengethatmaybedifficulttomanage

withoutsupport.Thereareofcourseexceptionstothis,suchasexaminationof

geneticfactors;however,researchfocusedonpsychologicalandsocio-cultural

influencesonhealthanddevelopmentmaybenefitfromgreaterattentiontothe

realityofhowsuchfactorsmanifestasastressfulpartofdailylife.Futureresearch

shouldseektoworktogetherwithyoungpeopleandpolicymakerstodevelopmore

nuancedandinclusivesystemsoflanguagethroughwhichtoexploretheseissues.

7.6.3Meta-InferenceThree:CloseRelationshipsareCritical

Thecurrentstudyhasprovidedclearevidencethatgreaterperceived

connectiontofamilyadultsandpeersplayacriticalroleforearlyadolescentgirls

experiencingadversity.Quantitatively,greaterperceivedconnectioninthese

domainswasassociatedwithloweredsymptomatology(thatis,promotiveforall

individuals)andalsomeantthatthoseexperiencinggreaterlevelsofriskwereless

(ratherthanmore)likelytoappraisetheirlivesasstressfulandexceedingtheir

copingcapacities.Qualitativefindingsrevealedthatearlyadolescentgirlssought

emotionalsupporttoreleasedifficultthoughtsandfeelings,withaparticular

emphasisoninformalavenuesbasedonrelationalqualitiesofcloseness,trust,and

care,aswellasperceivedavailability.


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Takentogether,findingsindicatethatsupportiverelationshipswithclose,

trustedothersarehighlymeaningfulbothforstressappraisalandformanagement

andregulationofsymptoms.Thereare,ofcourse,subtledifferencesacrossthetwo

strandsinrelationtotheprecisecontextandrolethatotherpeopleplay.

Quantitativefindingsfocusonperceivedconnectionasmeaningfulforbothstress

appraisalandsymptoms,whilequalitativefindingsofferedinsightintotheroleof

moredirectivesupportseekingwithintheserelationshipsforalreadypresent

symptoms.AsoutlinedinChapterThree,connectionrelatesmoregenerallyto

interpersonalcloseness,whilesupportisconceptualisedasaspecificbehaviour

(Barrera,1986).Nevertheless,togetherfindingsemphasisethemeaningfulnessof

theserelationships,withparticipants’emphasisonrelationalqualitiesand

availabilityperhapsofferinginsightintowhyinformalrelationshipsappeartoplay

suchakeyroleinstressbuffering.Indeed,insightintotheroleofperceived

connectioninstressappraisalcouldalsobegleanedfromGrace’saccount,wherein

shementallyoffsetthehurtcausedbyhermum’sperceivedactionsbyfocusingon

thepositiverelationshipshehadwithherdad.Thatis,theapparentimportanceof

informalsocialconnectionscouldbeattributabletospecificinteractions,suchas

provisionofemotionalsupport,butcouldalsorelatetotheirroleasapositivepart

ofyoungpeople’slives,compensatingforandoffsettingthechallengestheyface.

Inquantitativemodellingofconditionalindirecteffectsandinqualitative

findings,parents/carers(andotherfamilyadults)appearedtoplaythemost

importantroleforthoseexperiencingdifficulties.Asexploredearlierinthis

chapter,theheightenedimportanceofparentalrelationshipsrelativetopeersis

particularlynotablegiventhatearlyadolescenceisapivotalmomentinsocial

relationships,whereinone’speersbegintobecomemorepredictiveofhealth

outcomes(Brown&Larson,2009;Umbersonetal.,2010).Assuch,findingsindicate

thatatleastinthisearlystageofadolescence,caringandsupportiveparental

relationshipscontinuetobestatisticallyandexperientiallymeaningfulforearly

adolescentgirlsexperiencingadversityand/oremotionalsymptoms.Future

researchshouldexploretrajectoriesacrosschildhoodandadolescencetoexplore


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howindividualsdrawondifferentsocialrelationshipsovertime,withattentionto

whetherthisdiffersbasedonlevelsofadversityandsymptomatology.

Thisemphasisoninformalrelationshipoffersarelativelysimplemethodfor

supportingearlyadolescentgirlsandoffersanumberofimplicationsforhow

resourcescanbefocusedtofacilitatesocialsupportsystemsforthisgroup.Firstly,

inworkingtosupportanindividualfacingmultipledemandsand/orexperiencing

symptoms,itmaybebeneficialtojointlymapouttheirsupportnetworkinorderto

exploretheirperceivedavailabilityandqualityofsourcesofsupportacrossdaily

life.Itwouldalsobebeneficialtoinvolvebothfamiliesandpeersinsuchinstances,

offeringsupporttothemindevelopingtheappropriateknowledgeandskillsto

offereffectivesupport,asrecommendedinpreviousresearch(D’Avanzoetal.,

2012;Rickwoodetal.,2005).Althoughconnectiontoschooladultswasnotfound

tobemeaningfulacrosseitherstrandofthestudy,carefulconsiderationshould

alsobegiventohowmoreformalavenuesofsupportmightbemademore

appealingtoearlyadolescentgirls.Asexploredearlierinthischapter,training

aroundcounsellingandtherapeuticinterpersonalskillscouldaidschoolstaffin

developingrelationshipsthataremoremeaningfulforthisgroup.Itmayalsobe

usefultoensurethatthereareclearlyavailablestaffdedicatedtonon-academic

needs,suchaspastoralsupportandschoolcounsellors,givenindicationsthat

youngpeopledonotalwaysfeelitisateacher’sroletoofferemotionalsupport

(Boldero&Fallon,1995;Bowersetal.,2013;Rickwoodetal.,2005;Stapleyetal.,

2019).Thismaybeparticularlyimportantwherethehomeenvironmentis

consideredriskyorayoungpersonfeelsunabletoturntofamilyadultsforsupport.

Forinstance,inthecurrentstudyGracefirmlyfeltitwouldbeunhelpfultoaskher

mumforsupportandindeedviewedhermumasasubstantialpartofher

difficulties;althoughthisparticipanthadherdadtocompensateforthis,many

youngpeoplemaynothaveaccesstoamorepositivefamilialconnection.Future

researchshouldseektoexplorehowformalisedsupportnetworkscouldbuildon

theparticularqualitiesofferedwithininformalrelationshipsinordertoencourage

suchhelp-seekingbothgenerallyandforthosewithoutaccesstoqualityinformal

relationships.


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7.7StrengthsandLimitations

Thecurrentstudyhasanumberofstrengthsbut,asinanystudy,isnot

withoutlimitations.Thissectionoffersareflectiononthestudydesignand

methodologicalapproachesutilisedhere,exploringhowtheyhavefacilitated

developmentofrobustandmeaningfulconclusionswhilealsoexaminingthe

boundariesofthislearning.Theseareasareexploredinturnforthequantitative

strand,thequalitativestrand,andtheoverarchingmixedmethodsdesign.


StudyDesign

Thestudy’sobservationaldesignhasenabledexplorationofnaturally

occurringrelationshipsandprocesseswithinmultipleriskexposureandemotional

symptomsduringavulnerabledevelopmentalperiodforgirls.However,most

variablesweregatheredatonetimepointthroughtheWMFandthoughalmostall

riskvariablesweremeasuredusingearlierdata,theinabilitytocontrolforprior

levelsoftheoutcomevariablesmeansthistimelagcannotproperlyestablish

causality(A.L.Duckworthetal.,2010;Ployhart&Vandenberg,2010).Thus,

althoughSEMmodelsincludeddirectionalpathwaysspecifiedbasedontheoryand

priorresearch,causalitycannotbeassumedandcarehasbeentakeninpresenting

anddiscussingfindingstobesensitivetothistemporality.Furthermore,thereis

theoryandpriorevidencethatcouldalsosuggestbi-directionalityinthese

relationships.Forinstance,adolescentsexperiencingemotionalsymptomsmay

experiencegreaterdifficultyactivelymanagingdailystressors(P.Westetal.,2010),

whileindecisivenessandimpairmenttosocialfunctioningarerecognisedas

symptomsofdepression(AmericanPsychiatricAssociation,2013).Futurestudies

shouldexaminetheserelationshipsthroughalongitudinalpaneldesigntoexplore

directionalityovertime.

FocusonPatternsamongGirls

Thestudyfocusedongirlsinparticular,ratherthanexploringandcomparing

patternsandprocessesamongbothgirlsandboystoestablishgenderdifferences.


291

Consistentevidenceofhighratesofemotionalsymptomatologyanddisorder

amonggirlsandwomen,alongsideindicationsofearlyadolescenceasavulnerable

period,necessitateongoingfocusedinvestigationoftheparticularfactorsand

processescontributingtodifficultiesamongearlyadolescentgirls.Thus,this

approachoffersinsightintoaspecificphenomenonwithinavulnerablegroup,but

doesnotofferadirectcomparisonofthisrelationshipacrossgendergroups.

Findingscanaugmentwhatisalreadyknownacrossthewiderliteratureandfuture

researchcouldtestwhethertherearedifferentialcontributionsaccordingto

genderwithintheserelationshipsandprocesses.

However,itshouldalsobenotedthatthestudy’semphasison“girls”could

beconsideredproblematic,aswouldbetrueofastudyfocusingondifferences

between“girls”and“boys”.Theseapproachesareinherentlyreliantonabinary

conceptualisationofgender,whichimposesspecificexpectationsonotherwise

heterogeneousgroupsofindividualsandfailstoaccountfor(ordirectlyexamine)

individualswhoarenotcisgender.Itisimportanttonotethatthecurrentstudy

focusesonindividualsrecordedwithintheNPDasfemale(i.e.,sexwasusedinstead

ofgender),howevertherewasnoaccessiblerecordofwhethertheseindividuals

wouldallidentifythemselvesasgirls.Inthecurrentstudy,carehasbeentakento

beclearthatfindingsareinherentlyprobabilisticratherthanconclusiveforall

individualsandthusrefertobroadpatternsacrossthisgroup,ratherthanclear

outcomesforall.Here,useofsecondaryanalysismeantitwasnotpossibleto

measuregenderinamoreinclusivewaythatallowedparticipantstoidentify

themselvesas“girls”,butfuturestudiescouldseektodosofollowingthe

recommendationsofBauer,Braimoh,Scheim,andDharma(2017).However,it

shouldbenotedthatthespecificapproachappropriateinanygivenstudyis

perhapsnotstraightforwardinthisarea;thatis,itisarguedthatthereare

biologicalfactorsthatcontributetodifficultiesforfemales(asdiscussedinChapter

Two)aswellaspsychosocialfactorsthoughttoberelatedtogender,ratherthan

biologicalsex.Studiesshouldseektobecontextuallysensitivetosuchissues

dependingonthenatureoftheirresearch.


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SamplingStrategyandSample

Thestudy’suseofdatagatheredprimarilyfortheevaluationofHeadStart

necessitatesconsiderationaboutexternalvalidityandthegeneralisabilityof

findings,giventhelackofrandomsampling.Thisapproachmeantthatparticipants

weredrawnfromlocalitieswhowereengagedinamentalhealthandwellbeing

programmeandhadbecomeinvolvedinthisprojectduetoarecognisedneedfor

additionalprovisionandawidercontextofdisadvantage.Firstly,then,itmustbe

consideredthatparticipantsinthecurrentstudyarelikelyexperiencinggreater

levelsofdisadvantageand,potentially,symptomatology.Indeed,asreportedin

Section4.5.1,thesampleshowedslightlyhigherthanaveragelevelsofFSM

eligibilityaswellaselevatedlevelsofemotionalsymptoms.However,giventhat

thestudyisspecificallyinterestedintheeffectsofmultipleriskexposureupon

symptoms,useofanat-risksampleoffersanappropriaterepresentationofthe

populationofinterest.InrelationtoengagementinHeadStart,thestudyfocused

onbaselinedataandsomostparticipantswerelikelytohaveexperiencedlimited

programmeengagementinthisearlystage.Thoughitwasnotpossibletocontrol

forengagementintheprogrammeintheanalysesundertakenhere,most

educationsettingsinEnglandcurrentlydeliversomeformofwellbeingandmental

healthprovision,tovaryingextents(Brown,2018).

Akeystrengthofthecurrentstudyisitstotalquantitativesampleof8,327

girls,aslargesamplesizesaregenerallyrecommendedwithinepidemiological

researchinordertoensuregreaterprecisioninestimates(Chan&Altman,2005;

Machinetal.,2018;Woodward,2014).Giventhatexistingstudiesintosomeofthe

factorsexploredherehaveoftenbeenlimitedbyuseofsmallersamplesizes,such

asSENandcaregivingresponsibilities,thestudyoffersmorerobustinferencesto

thisexistingknowledgebase.Furthermore,toavoidover-orunder-estimating

relationshipsthattendtooccurwithinlargesamplesizes,suchassmallp-values,

theeffectsizeofparameterswerealsoconsideredgivenunderstandingsthatlarge

effectsizescanaffectsuchvalues.

Measurement


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Itshouldbenotedthatbecausethestudymakesuseofdataprimarily

gatheredfortheevaluationofHeadStart,thescopeandtypeofmeasurement

approacheswerenotdeterminedbytheauthorofthecurrentstudy.

Self-ReportMeasurement

Useofself-reportwasakeystrengthinseveralways.Firstly,current

perspectivesemphasisetheneedforyoungpeopletoreportontheirownmental

healthsymptoms,ratherthanrelyingonwiderinformantssuchasteacherand

parents(A.T.Beck,1963).Thisisparticularlyrelevantforresearchrelatedto

internalisingdifficulties,asstudieshaveshownthattherecanbeinformant

discrepanciesbetweenadolescentsandtheirparentsforsuchsymptoms,thought

tobebecausetheyarelessobservabletoothersrelativetoexternalisingdifficulties

(Fredrickson&Roberts,1997;Hammen,2005;Kuehner,2017;Nolen-Hoeksema,

1990,2001;Nolen-Hoeksema&Girgus,1994).Useofself-reporthasalsofacilitated

afocusonstressappraisal,asthisconstructcannotreasonablybereportedby

anyoneotherthantheindividualthemselves.Giventhatthisisakeycomponentof

stressprocesses(Deightonetal.,2014;Riley,2004),theabilitytoexplorestressas

perceivedbytheindividualhasallowedimportantinsightintotheroleof

psychologicalstressprocesseswithinmultipleriskeffects.Similarly,itisunderstood

thatsocialconnectionandasenseofengagementinareasoflifearemeaningfulfor

outcomesintermsofhowtheyareperceivedbyanindividualratherthanany

objectivemeasurementsystem.Thus,self-reportherehasallowedanoverarching

emphasisonthewayinwhichindividualsperceivetheseareasoftheirworldsand

themeaningthisoffers.

However,itshouldbenotedthatarelianceonasinglesource–here,self-

reportasusedformostvariables–canintroduceaformofcommonmethodsbias

intodataand,inturn,results.Specifically,gatheringthemajorityofdatafroma

singlesourcecanartificiallyheightenthesharedvarianceacrossvariables,

potentiallyinflatingresults(Conway&Lance,2010;Doty&Glick,1998).Itisargued

thatthismaybeheightenedincross-sectionalresearch,whereresponsesare

gatheredfromonesourceatasingletimepoint(Lindell&Whitney,2001).While

thisissueisnotconsideredtoinvalidateresearchresults,itnecessitatesalevelof


294

cautionininferringtherelationshipsbetweensuchvariables(Doty&Glick,1998).

Assuch,inthecurrentstudythereisaneedtobecautiousininterpreting

relationshipsbetweenemotionalsymptomsandstresscomponentsand

promotive/protectivevariables,respectively.Futureresearchcouldseektodrawon

multipleinformants,suchasself-reportalongsideparent-report,inordertocreate

integrateddata,preferablywithinalongitudinaldesign,tomorereliablyestablish

theserelationships.

Itisalsoimportanttonotethatthemeasuresutilisedherearenotwithout

limitations.Aparticularissueisthattheuseofa2-factorstructureforthePSS-4is

statisticallyproblematic,as2-itemfactorscanbeunstableandproducelessreliable

resultsrelativetomoreextensivecollectionsofitems(Brown,2015;MacCallumet

al.,1999;Raubenheimer,2004).Assuch,conclusionsrelatingtoperceivedstress

processesareofferedheretentativelyandfuturestudiesshouldseektoreplicate

thisfindingusingmorerobustmeasures.Fromatheoreticalperspective,2-item

measuresmightalsobeinsufficientinfullycapturingtheconstructofinterest.

Furthermore,althoughasoutlinedinSection4.6.1theSDQemotional

symptomssubscalehasgenerallybeenfoundtobereliableandvalid(Goodmanet

al.,1998),thismeasureisimperfect.Someoftheitemsshowedlowreadabilityfor

earlyadolescentsinarecentstudy(Patalayetal.,2018),whichmayhaveaffected

participants’responseshere.Furthermore,theuseofonlyfiveitemsmaynotbe

sufficienttocomprehensivelycaptureacomplexconstructsuchasemotional

symptoms,whichisindeedajointrepresentationofbothdepressiveandanxious

symptomatology.Notwithstandingtheseconsiderations,thissubscaleisgenerally

consideredacceptableandtheSDQwasrecentlynotedbyBentley,Hartley,and

Bucci(2019)asbeingapromisingself-reportmeasureforadolescentmentalhealth.

RiskMeasurement

Withtheexceptionofcaregivingresponsibilities,riskvariableswere

measuredusingproxyinformationfromtheNPD.Overall,thisapproachoffers

relativelyreliableinformation,asitrelatestovariablesthatareroutinelyrecorded

byschoolsandhaveoftenbeendesignatedthroughclearprocedures,suchas


295

classificationbyaprofessional(e.g.,SENstatusandCINstatusasaproxyforACEs),

useofsetcriteriaorscales(e.g.,FSMeligibilityforfamilyincome,academic

attainment,andIDACIforneighbourhoodsocioeconomiclevel),orrecordingof

fixedinformation(e.g.,monthofbirthforrelativeage).Nevertheless,itis

importanttonotethattheserepresentproxyvariablesformorecomplex

phenomenathatoftencannotbecomprehensivelycapturedforriskresearch

(Kraemeretal.,2005).Forinstance,participantsherewereconsideredtobeinan

at-riskSENgroupiftheyweredocumentedashavingSEN(withorwithouta

statementorEHCplan).However,asexploredearlierinthischapteritisnot

necessarilythepresenceofaspecialoradditionalneedthatisproblematic,but

insteadhavingcomplexneedswithinaneducationalsystemandwidersocietythat

isoftennotcongruentwiththeseneeds.Thus,theriskvariablesexploredinthe

currentstudyaretreatedasproxyindicatorsofwidersystemsofdailychallenge

andeffortshavebeentakentoensuresensitivitytothisdistinctioninpresenting

anddiscussingresults.

Furthermore,someoftheapproachesutilisedtomeasureparticularrisk

variableswerenotconsideredideal,suchascaregivingresponsibilitiesandACEs(as

discussedearlierinthischapter).Aspreviouslyoutlined,theuseofCINstatusasa

proxyforACEsovercomestherelianceonrecalltypicallyfoundinACEsresearch,

butalsoofferslimitedinformationandlikelyoverlooksmanyindividuals

experiencingACEsgiventhatitfocusesthoseinthemostextremecircumstances.

Indeed,manyoftheriskvariablesexploredherewerebinaryinnature,thus

offeringlimitedinformation;thoughthisisgenerallynotconsideredproblematicin

multipleriskresearchgivenfrequentuseofcumulativeriskindices,supportfor

latentmodellingoffersalternativesthatcouldincorporatemorenuancedrisk

informationinfutureresearch.

AnalyticalFocusandApproach

UseofSEMisaclearstrengthofthequantitativestrand,asthishas

facilitatedrobustexplorationofspecificpathwaysandprocessesaswellas

explorationofalternativemeasurementmodels,offeringinsightintothelimitations

ofthecumulativeriskindex(thoughasnoted,acumulativeriskindexhadtobe


296

utilisedinlateranalysesduetodifficultymodellingthelatentconstructinmore

complexmodels).Examinationofmultiplerisk,promotive,andprotectivevariables

simultaneously,respectively,hasenabledmorepreciseestimationoftheirrelative

contributionstoemotionalsymptoms,asseveralofthesefactorshaveoftenbeen

investigatedinisolationdespiteevidencethattheyfrequentlyco-occur.

However,theparticularvariablesandpathwaysexploredheremayhave

overlookedsomemorecomplexfeaturesoftheseprocesses.Forinstance,the

emphasisonsocialconnectionasabroadconstructdoesnotcapturethe

multidimensionalityofrelationshipsandsocannotshowwhetherparticular

relationshipcharacteristicssuchascloseness,conflict,andwarmthmayinfluence

stressbufferingprocesses.Intermsofthepathwaysinvestigated,afocuson

specificdirectionalpathwaysmayhaveoverlookedthepossibilityofmorecomplex

cyclicalrelationshipsamongthesevariables.Forinstance,anindividualmight

appraiseagivensituationasstressfulandsomaydrawactivelyonsocial

connectionstofindwaystomanagethisissue,inturnreducingappraisedstress.

Suchcomplexitiesemphasisetheneedtoincorporatequalitativeinquiryalongside

quantitativeinvestigationsinordertomorefullyunderstandthenuanceswithin

theseprocessesandrelationships.


AnalyticalDepth

UseofIPAhasfacilitatedarichandin-depthexplorationofhowearly

adolescentgirlsexperienceandmakesenseoftheiremotionalsymptomsandhow

thisrelatestowiderelementsofdemandandsupportsystems.Giventhatriskand

resilienceprocessesaretypicallyinvestigatedquantitatively,thislevelofdepthisa

particularstrengthofthestudy.Indeed,useofIPAspecificallyhasfacilitatedaclose

andidiographicunderstandingoflivedexperiencethatwouldnothavebeen

affordedbyotherqualitativeapproachesmorefocusedoncapturinggrouped

patternsofexperience,suchasthematicorcontentanalysis.Forinstance,thematic

analysisofthewiderHeadStartqualitativedatasetidentifiedtheparticularsocial


297

supportavenuesthatearlyadolescentstypicallyusedandexploredbarriersand

facilitatorstosupport-seeking(Stapleyetal.,2019).Thecurrentstudyexplored

theseexperiencesatamoremicroscopicleveland,indoingso,providedinsight

intothethinkinginformingthesedecisionsamongearlyadolescentgirls(thatis,

throughassessmentofrelationalqualities),aswellascapturingtheimmediate

emotionalbenefitsparticipantsexperiencedintalkingtothesecloseandtrusted

others.

DrawingDatafromWiderProject

Useofdataprimarilygatheredforawiderprojectshouldbeconsidered

here.ThescheduleusedinHeadStartinterviewsaimedtocoverbroadareasof

interestbutwasdesignedtofollowtheparticularexperiencesandareasraisedby

participants.Thisresultedinconsiderableheterogeneityacrossthesampleandthe

currentstudyrepresentsoneofseveralattemptsto“zoomin”andexplore

particularsubsetsofexperienceingreaterdepth.However,thismeantthatthe

specificphenomenaofinterestinthecurrentstudywerenotalwaysdirectly

probedininterviews.Inparticular,participantswerenotaskedwhetherbeingagirl

wasmeaningfultothemintheseparticularareasoftheirlivesandsoitwasnot

possibletoexplorewhethertheseexperiencesareconsideredbythemtobe

gendered.Assuch,itmustbeacknowledgedthatthisapproachhaslimitedthe

fullnesswithwhichRQ3canbeaddressed(i.e.,“Whatisitliketobeanearly

adolescentgirlexperiencingemotionalsymptomsinthecontextofrisk

exposure?”).Thatis,whilethethemesgarneredhereofferclearinsightintothe

waythattheseparticulargirlsmakesenseoftheirsymptomsandtheirouter

worlds,findingscannotbeconsideredtotellusthattheseexperiencesare

specificallyrelatedtotheiridentityas“girls”.Thisisanimportantdistinctionas

findingscannotthereforeofferclarityonperceiveddifferencesinexperiencesthat

mayariseasaresultofgender,whichwouldbeparticularlyusefulgiventhewidely

observedgendergapindepressiveandanxioussymptomatologyanddisorder.

Futureresearchshouldseektodirectlyexploreadolescentperspectivesonthe

influenceofgenderinmentalhealthexperiences,whichmayprovidefurtherinsight


298

intowhyearlyadolescenceappearstobeaparticularlyvulnerabletimeforgirlsin

particular(Epeletal.,2018).

Furthermore,itmayreasonablybethattherewereotherHeadStart

participantswhowereexperiencingemotionalsymptomsinthecontextofrisk

exposurebutdidnotdiscusstheseintheirinterview,eitherthroughchoiceorasa

resultofinterviewerquestioning.Hadindividualsbeendirectlyengagedin

interviewsforthepurposeofthecurrentstudy,awiderormorediversesample

maywellhavebeencapturedthroughamoredirectedfocus.

Sampling

Itshouldalsobeconsideredthattheparticularsamplingproceduresutilised

mayhaveoverlookedsomegroupsofindividuals.Participantswereselectedfor

inclusioninHeadStartinterviewsbyschoolstaff,whomayhavebeenbiased

towardsselectingparticulartypesofindividuals.Forinstance,youngpeople

consideredmorearticulatemayhavebeenprioritisedgivenuseofaspoken

interview,thuspotentiallyoverlookinggroupssuchasthosewithSENorlanguage

barriers.Furthermore,althoughtheprocessofselectingparticipantsforthecurrent

studyfromthewidersamplewascarefullymanagedandinvolvedconsultationwith

asecondaryresearcherandaclinicalreviewer,theapproachmayhavefavoured

particularwaysofexpressingandarticulatingemotionalsymptoms.Forinstance,

theremayhavebeenparticipantsexperiencingemotionalsymptomswhofocused

moreonfeelingsofangerorfrustrationintheiraccounts.Indeed,thereisresearch

toindicatethatfeelingsofangermayrepresentacomponentofdepressionamong

adolescents,beyondsimplyfeelingsofsadness(Stapleyetal.,2019).Thus,focusing

onemotionalsymptomsasidentifiedthroughparticularcriteriawithininterviews

maynothavecaptureddiverseexpressionsofemotionalsymptomsandcouldalso

haveoverlookedindividualsexperiencingcomorbidsymptomsanddisorders.

ExperientialFocus

Finally,theuseofexperientialaccountsanalysedthroughIPAnecessitates

sensitivitytotheboundariesofinferences.Anemphasisonperceptionsandsense-

makingisvaluableinunderstandingthewayphenomenaareunderstoodandhow


299

thisinformsdecisionsandactions.However,thissimultaneouslylimitsthecapacity

todeterminewhethertheissuesparticipantsdescribearereasonablejudgements

ofothers’actionsoraresultofnegativeinformationprocessing,whichasoutlined

iscommontoemotionalsymptoms.Thissubjectivityisconsistentwiththe

epistemologicalprinciplesofIPAanditsemphasisonunderstandingphenomenaas

theypresentthemselves;indeed,fromthisperspective,itcanbearguedthatthe

rationalityofyoungpeople’sjudgementsisnotofcentralconcern.However,itis

importanttonotethatthestudycannotofferconclusivenessinthisareaanditis

importantthatpractitionersnavigateandexplorethisdistinctiononan

individualisedbasis.Finally,asexploredinChapterFour,theinterpretivenatureof

IPAmeansthatfindingsinherentlycaptureresearcherinterpretations.Thisis

generallyconsideredvaluableastheresearchermaybeabletogeneratefurther

insightandmeaningthroughtheirinterpretationofparticipants’accounts(Larkin&

Thompson,2006;Mayoh&Onwuegbuzie,2015;Pietkiewicz&Smith,2014;Smith

etal.,2009).However,thisparticularfeatureofIPAmeansthatitisimportantfor

readerstokeepinmindthatfindingsandinferencesarenotofferedasasingular

anddefinitiveexplanationforparticipants’experiences,butareinsteadpresented

asonecredibleexplanation.

7.7.3MixedMethodsDesign

Akeystrengthofthecurrentstudyisitsmixedmethodsdesign.Asexplored

inSection4.4.1,thisapproachhasbeenutilisedforcomplementarity,offering

explorationofbothoverarchingpatternsandindividualexperience.Indeed,itcould

bearguedthatthespecificmethodsutilisedhereareparticularlydiverseintheir

levelsoffocus.Thatis,IPAhasahighlyidiographicemphasisnotfoundinall

qualitativeapproaches,whileSEMfitspre-specifiedstructuralmodelstodataand

thusoffersadeductive,variable-focusedapproachtotestingpathways.Theextent

ofthisdifferencemeansthatthestrengthsandlimitationsofeachapproacharein

starkcontrastand,thus,thestrengthsofeachapproachcanoffsettheother’s

limitationsparticularlywell.Forinstance,useofthematicanalysisinsteadofIPA

wouldnothaveencompassedanidiographicapproachorofferedsuchanalytical


300

depth,andwouldinsteadhavefocusedmorestronglyonsurface-levelgroup

patterns.Suchanapproach,thoughstillmoreinductivethanSEM,wouldnothave

offeredtheextentofcomplementarityalongsidethequantitativestrandthathas

beenfacilitatedbyuseofIPA.Indeed,asdemonstratedinthemeta-inferences

presentedearlier,integrationofthesediverseapproacheshasfacilitatedan

enrichedinsightthatcouldnothavebeengainedthrougheitheroneofthese

approachesinisolation,asistheaimincomplementarity(Greeneetal.,1989).The

richnessofintegrationofferedherehasalsobeenaidedbytheuseofanequal

weightapproach,withrecognitionthateachstrandoffersequallyrelevant

informationtobeconsideredindevelopingoverarchingconclusions.Furthermore,

ithaspreviouslybeenhighlightedthatuseofmultiplemethodsfor

complementaritycansupportgreatertransferabilityandexternalvalidityacrossthe

researchasawhole(Polit&Beck,2010).

Althoughtheseapproachesarefocallyandmethodologicallydissimilar,

therewasconsiderableoverlapandcomplementarityinrelationtotheway

particularphenomenawereinvestigatedacrossthesestrands,whichhasfacilitated

developmentofmeta-inferences.Boththevariablesusedinthequantitativestrand

andtheinterviewscheduleusedtofacilitatequalitativedatacollectionincludedan

emphasisonthechallengesthatat-riskgirlsface,ontheextenttowhichthey

perceivetheirlivestobestressful,andthewayinwhichsocialrelationshipscanbe

consideredmeaningful.Asaresult,thequantitativestrandhasfacilitatedan

understandingofbroadpatternsamongearlyadolescentgirls,whilequalitative

findingshaveofferedinsightintowhysuchpatternsmightexist.Forinstance,

quantitativeresultsindicatedthatfamilyandpeerrelationshipsaremeaningfulfor

howat-riskgirlsperceivethestressfulnessoftheirlives,whilequalitativefindings

suggestedthismaybebecausegirlspreferinformalsupportavenuesdueto

relationalqualities(asexploredinmeta-inferencethree).

Thestudy’suseofaparallelapproach,inwhicheachstrandisundertaken

concurrentlyandindependently,wasconsistentwithitsadoptionofmixed

methodsfordistinctresearchquestionsanditsemphasisoncomplementarity

(Greeneetal.,1989).Overall,then,thisapproachdidfittheneedsofthestudy;


301

however,thereweresomeunanticipatedaspectswithinbothstrandsforwhicha

levelofsequentialcontrolmighthavebeenvaluable.Forinstance,further

quantitativevariablescouldhavebeenincorporatedbasedonareasofqualitative

experiences,suchasacademicpressureorcontrollability.Conversely,itmighthave

beenvaluabletorecruitfurtherqualitativeparticipantswithdirectexperiencesof

relationshipsnotedinthequantitativestrand,suchascaregivingresponsibilitiesas

ariskfactor.Futureresearchcouldseektocarryoutanintegratedsequential

designthatcouldmorefluidlydeveloponanongoingbasis,suchasinvestigating

riskvariablesspecificallyoutlinedbyparticipants,or,conversely,identifying

participantsbasedonstatisticallyidentifiedriskfactorsorprofiles.

7.8SummaryandConclusions

Thecurrentstudysetouttodevelopknowledgeandunderstandingofearly

adolescentgirls’emotionalsymptomsinthecontextofmultipleriskexposure,with

particularattentiontomechanisms,adaptiveprocesses,andlivedexperience.The

study’squantitativestrandhasgeneratedknowledgeofthefactorsandprocesses

associatedwithsymptomsamongthisgroup,demonstratingthatstressappraisal

appearstoplayakeyroleinmultipleriskeffectsandthatinformalrelationshipscan

stronglyinfluencesuchappraisals.Qualitativeexplorationhasrevealedthatgirls

canfindsymptomsintenseandchallengingtomakesenseofandthatthey

experiencepersistentdemandsthatareperceivedtobebeyondtheircontrol,while

carefullyselectingindividualstoturntoforsupport.Takentogether,findingshave

shownthatemotionalsymptomsareanembeddedpartofdailylife,thatthe

demandsandstressearlyadolescentgirlsfacecanbepsychologically

overwhelming,andthatcloseandtrustedothersplayacriticalroleforgirls

experiencingadversity.

Thisresearchoffersanumberoforiginaltheoretical,methodological,and

practicalcontributionstoknowledgeandunderstanding.Thestudyhasrevealed

theinherentcomplexityofmultipleriskexposure,emphasisingtheimportanceof

exploringhowparticularfactorsinteractwithinanindividual’slifeandsuggesting

thatstressappraisalsandthemeaningattachedtotheseeventsplaysanimportant


302

role.Suchfindingshaveofferedacriticalperspectiveoncumulativerisktheoryand

highlighttheneedtogobeyondsimplytestingforthepresenceofcumulativerisk

effectsandinsteadexploringwhysucheffectsoccur.Alongsidethis,thestudy

demonstratestheimportanceofexaminingadaptiveprocessesandemphasisesthe

criticalroleofqualitysocialconnectionsamongearlyadolescentgirls’informal

networks.Thestudy’smixedmethodsdesignhasfacilitatedarichandnuanced

understandingoftheseriskandresilienceprocesses,demonstratingthevalueof

bringingtogetherdiverseworldviewsandmethodstodevelopourunderstandingof

theemergenceofemotionalsymptoms.Fundamentally,findingsrevealthatbeing

anearlyadolescentgirlinthecontextofadversitycanbeanintenseanddifficult

experiencewithlittlesenseofcontrol.Itisimperativethatfutureresearchand

practiceexploreswaystoreducetheextentofdemandplacedonadolescents

facingadversityandtofacilitateaccesstoqualitysupportsystems.

REFERENCES

303

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APPENDICES

387

Appendices

Appendix Page

A DifferencesbetweenthecurrentstudyandtheevaluationofHeadStart 388

B Qualitativeparticipantselectionprotocol 390

C Examplequalitativeparticipantselectionoverview(Amelia) 397

D QualitativeHeadStartparticipantsnominatedfor,butnotincludedin,the

currentstudy

401

E ChangesmadeafterpilotingoftheWellbeingMeasurementFramework

(WMF)

402

F Guidanceprovidedtoteacherstofacilitatesurveyadministration 403

G StrengthsandDifficultiesQuestionnaire(SDQ)emotionalsymptomssubscale 413

H Four-itemPerceivedStressScale(PSS-4) 414

I StudentResilienceSurveysubscales 415

J Qualitativeinterviewschedule 417

K Quantitativeinformationpackforparents/carers 421

L Quantitativeparticipantinformationforyoungpeople 427

M Qualitativeparticipantinformationsheetforyoungpeople 429

N Qualitativeinformationpackforparents/carers 432

O Qualitativeparticipantassentform 437

P Demographicformforqualitativeparticipants 438

Q Exampleofinitialthoughtsdocumentedinstageoneofqualitativeanalysis

(Amelia)

439

R Analyticalcodingcolumnsandexampleofinitialcodinginstagetwoof

qualitativeanalysis(Amelia)

441

S Exampleofemergentthemesalongsidedataandcodinginstagethreeof

qualitativeanalysis(Amelia)

442

T Detailedaccountofpreliminaryanalysisresults 443

U Integrationofindividual-levelthemesintomasterthemes 452

APPENDICES

388

AppendixA:DifferencesbetweentheCurrentStudyandtheEvaluationofHeadStart

TableA1

DifferencesBetweentheCurrentStudyandtheHeadStartEvaluation

Feature Currentstudy HeadStartevaluation

Type Studycompletedforsubmissionasa

PhDthesis

Fundedevaluationofanational

mentalhealthprogramme

Staffing Individualthesisauthor,withinput

fromsupervisors

Largeresearchteamacrossmultiple

partnerships

Aim1 Increaseknowledgeand

understandingoftheriskfactorsand

processesassociatedwithemotional

symptomsamongearlyadolescent

girls,withaparticularfocuson

multipleriskexposure

Helpservicesconsiderthemeasurable

impactoftheirinterventionsby

analysingtheinteractionbetween

specificmodifiablefeaturesand

qualitiesoftheinterventionsprovided

andrelevantindicatorsofchangesin

resilienceandwellbeing

Aim2 Assessthefactorsandprocesses

supportingpositiveoutcomesin

relationtoemotionalsymptoms

amongearlyadolescentgirls

Examineexperienceandpossible

mechanismsunderpinningHeadStart

Aim3 Explorethelivedexperienceofearly

adolescentgirlswhoare

experiencingemotionalsymptomsin

thecontextofriskexposure

Considerevidence-basedpracticeand

disseminationtoaidlearningand

development

Temporality Cross-sectional Longitudinal,cross-sectional

Design Parallelmixedmethodsdesign;

observational

Parallelmixedmethodsdesign;quasi-

experimentalandlongitudinal

Populationof

interest

Earlyadolescentgirlsaged11-12

years

Youngpeopleaged10-16years

Quantitative

sample

Earlyadolescentgirlsaged11-12

years(Year7,2016/2017)atthetime

oftheWMFbaseline

Youngpeopleaged11-12yearsatthe

timeoftheWMFbaseline(Year7,

2016/2017)andyoungpeopleaged

13-14years(Year9,2016/2017)atthe

timeofeachannualcompletionofthe

WMF(2017-2022)

Qualitative Girlsaged11-12yearsatbaseline Youngpeopleaged9-12yearsat

APPENDICES

389

sample interviews,experiencingemotional

symptomsandmultipleriskexposure

baselineinterviews;deliveryagents;

andpartnershipleads

Quantitative

analysis

SEM Descriptiveanalysis,multilevel

analysis,SEM

Qualitative

analysis

Interpretativephenomenological

analysis

Thematicanalysisandidealtype

analysis

Outcomevariable Emotionalsymptoms Wellbeing;mentalhealthdifficulties;

mechanisms

Targetaudience Academiccommunity;mentalhealth

andeducationalprofessionals;and

youngpeople

TheNCLF;HeadStartpartnership

areas;mentalhealthandeducational

professionals;youngpeople;and

academiccommunity

APPENDICES

390

AppendixB:QualitativeParticipantSelectionProtocol

Thisdocumentdetailstheparticipantselectionprotocolforthequalitative

strandofamixedmethodsPhDthesisfocusedonthemultipleriskexposureand

earlyadolescentgirls’emotionalsymptoms,withattentiontomechanisms,

adaptiveprocesses,andlivedexperience.Thequalitativestrandseekstoaddress

thefollowingresearchquestion:

Whatisitliketobeanearlyadolescentgirlexperiencingemotional


Theresearchquestionaimstoexploreearlyadolescentgirls’livedexperienceto

provideinsightintothecomplexitiesofthesephenomenaincontextandtheir

meaningtogirlsthemselves.Inordertoaddressthisresearchquestion,uptofive

participantswillbesoughtfromanexistingqualitativesamplewhohavetakenpart

inin-depthinterviewsaspartoftheevaluationofHeadStart.Participantinterviews

thatmeettheinclusioncriteriaforthecurrentstudywillbeanalysedusing

interpretativephenomenologicalanalysis(IPA).Thisdocumentoutlinesthe

inclusioncriteriaandtherationaleforeachcriterion,beforedetailingtheselection

process,specificallycriteriaassessmentsteps,rigourstepsandtheexpected

timeframe.

Inclusioncriteria

1. Female,aged11-12years

Rationale:thisstudyisfocusedongirlsasalthoughresearchhasshownthat

overalltheprevalenceofchildandadolescentmentalhealthdifficultieshasbeen

relativelystableinrecentdecades,severalstudieshavereportedarecentincrease

inemotionaldistressamongadolescentgirls(Boretal.,2014;Collishawetal.,2010;

Finketal.,2015;Lessofetal.,2016).Thestudyseekstoutiliseparticipantsaged11-

12yearsasthisageappearstorepresentsapivotalstageinthedevelopmentof

mentalhealthdifficulties,wherebyemotionalsymptomsbecomemoreprevalentin

girls,particularlyrelativetotheirmalepeers(Boretal.,2014;Rozaetal.,2003).As

such,thecurrentstudyseekstobroadencurrentunderstandingsofthefactorsthat

APPENDICES

391

contributetosuchdifficultiesforgirlsduringthisdevelopmentalphase,alongside

factorsthatmaylessensuchnegativeeffects.

2. Experiencingemotionalsymptoms

Rationale:theresearchisfocusedonemotionalsymptomsdueto

indicationsthatlevelsofemotionaldistressappeartohaveincreasedingirlsin

recentcohorts,asoutlinedabove.‘Emotionalsymptoms’arebroadlydefinedas

feelingsofdepressionandanxiety.AstheHeadStartqualitativeevaluationutilisesa

communitysample,highproportionsofparticipantswithabnormal/clinicallevelsof

symptomatologyarenotanticipated.Assuch,thecurrentstudydrawson

emotionalsymptomsascharacterisedwithinthecorrespondingsubscaleofthe

StrengthsandDifficultiesQuestionnaire(SDQ;Goodman,1997;Goodmanetal.,

1998)asalenstocharacteriseandassesssymptoms(seecriteriaassessment

below),asthisisappropriateforuseinacommunitysample.

3. Experiencingrisk

Rationale:thequalitativestrandseekstounderstandexperienceofriskas

partofthestudy’sbroaderfocusonmultipleriskexposure,specificallythe

cumulativemodelofrisk.Assuch,thestudyseekstoutiliseparticipantswhoare

experiencingmultipleriskexposureaspartoftheirlives.Thestudyseeksto

considerparticipants’ownaccountsof‘risk’intheirlivesalongsideconsiderationof

establishedriskfactors(seecriteriaassessmentbelow).

CriteriaAssessment

Thefollowingsectionoutlinestheassessmentprocessfortheinclusion

criteria.Whileundertakingthisprocess,theresearcherwilldocumentthisprocess

infullandprovidewrittenjustificationsofeachstageforallparticipantsreviewed,

withsupportingquotes/excerptsfromtranscriptstosupportdecisions.

1. Female,aged11-12years

TheinitialstageofselectionfromtheoverallHeadStartqualitativesample

willidentifyparticipantsthatarefemaleandaged11–12yearsaccordingtothe

demographicinformationtheyprovidedaspartoftheinterviewprocess.

APPENDICES

392

2. Experiencingemotionalsymptoms

HeadStartparticipantswillbeidentifiedasmeetingthiscriterionthrough

twostages.Firstly,interviewerswillnominateHeadStartparticipantsthattheyfeel

disclosedemotionalsymptomsintheinterviewprocess,withthisdocumentacting

asaguide.

Thesenominatedparticipantswillthenundergosystematicassessmentfor

disclosureofemotionalsymptomsthroughthestagesdescribedbelow.

Theresearcherwillassesseachtranscript,consideringparticipants’accounts

inrelationtotheSDQadultreport‘emotionalsymptoms’subscaleitemsoutlinedin

Table1(Goodman,1997).AscanbeseeninTable1,itemsarescoredonascaleof

0-2,where0=nottrue,1=somewhattrue,and2=certainlytrue.Indetermining

theappropriatescoreforeachsymptom,theresearcherwillconsiderarangeof

factors,specificallyfrequencyofsymptomsasdescribedbyparticipants,intensityof

symptomsasdescribedbyparticipants,andfrequencyofmentionofsymptoms

withininterviews.Atotalscoreof4onthesubscalewillbeconsideredindicativeof

borderlinesymptomatology,consistentwithguidelinesoutlinedbySDQInfo(2016),

thoughthiswillactasaguideratherthanacutoff.Wheretheresearcheridentifies

thatasymptomcouldbeconsidered‘certainlytrue’butisoccurringinisolation,

thiswillbeconsideredonacase-by-casebasis,astheextentofthesymptommay

aloneindicateanappropriatelevelofsymptomatology.Forexample,ifa

participantdescribedfrequentlyfeelingextremelyunhappy,down-heartedor

tearful,butdidnotdescribeothersymptoms,thisalonemayindicatean

appropriatelevelofemotionaldistress.Itshouldbenotedthatthisexcludes

‘headaches,stomach-achesorsickness’ifoccurringinisolationasthismaybe

relatedtowiderphysicalissues.

APPENDICES

393

Table1:Teacher/parentSDQemotionalsymptomssubscale

Not

True(0)

Somewhat

True(1)

Certainly

True(2)

Oftencomplainsofheadaches,stomach-achesorsickness ☐ ☐ ☐Manyworries,oftenseemsworried ☐ ☐ ☐Oftenunhappy,down-heartedortearful ☐ ☐ ☐Nervousorclingyinnewsituations,easilyloses

confidence

☐ ☐ ☐

Manyfears,easilyscared ☐ ☐ ☐

Theresearcherwillreviewtheirownassessmentagainsttheparticipant’sownself-

reportedSDQscore,basedontheitemsshowninAppendixG.Ascoreof6willbe

consideredtoindicateborderlinesymptomatology,consistentwithguidelines

outlinedbySDQInfo(2016).Again,thiswillnotrepresentacutoffandwillinstead

beconsideredinconjunctionwithassessmentfromstage(i).Itshouldbenoted

thatthismaynotbeavailableforallparticipantsasthiswascompletedaspartof

thequantitativestrandofHeadStart,ratherthanaspartoftheinterviewprocess.

Table2:Self-reportSDQemotionalsymptomssubscale

Not

True(0)

Somewhat

True(1)

Certainly

True(2)

Igetalotofheadaches,stomach-achesorsickness ☐ ☐ ☐Iworryalot ☐ ☐ ☐Iamoftenunhappy,down-heartedortearful ☐ ☐ ☐Iamnervousinnewsituations;Ieasilyloseconfidence ☐ ☐ ☐Ihavemanyfears,Iameasilyscared ☐ ☐ ☐

Foreachparticipant,theresearcherwillmakeafinaldecisionutilisingthe

informationgatheredthroughthesestepsandwilldocumentjustificationforthis.It

shouldbenotedthatitisnotanticipatedthatthesubscalescoresgeneratedbythe

researcherandtheparticipantwillbeinagreement.Thisisforarangeofreasons,

suchasthefactthattheparticipantcompletedtheirself-reportsubscaleona

APPENDICES

394

separateoccasionratherthanonthedayoftheinterview,thepotentialthat

participantsdidnotdisclosesymptomsduringtheinterview,andthatthe

researcher’sownperspectivesandunderstandingsislikelytoinfluencethewayin

whichtheymakesenseofparticipants’disclosures.Assuch,theresearcherwill

considerbothsourcesofinformationtoreachafinaldecisionandwilldocument

thisprocessclearly.

3. Experiencingrisk

Toreflectthestudy’sfocusonmultipleriskexposure,participantswillbe

consideredtomeetthiscriterioniftheydemonstratemultipleindicatorsof‘risk’in

theirlives.Namely,aminimumofthreeormoreindicatorsofriskshouldbe

identifiedacrossthetwostagesoutlinedbelow,asarangeofstudieshave

indicatedthatexposuretothreeormoreriskfactorsoftenaffectsoutcomes

disproportionately(e.g.,Jonesetal.,2002;Morales&Guerra,2006;Rutter,1979).

Thiscriterionwillbeassessedusingtwomethods:

a. Transcriptsofparticipantsidentifiedasexperiencingemotionalsymptomswill

bereviewedformentionofknownriskfactors,i.e.thosewithfactors

identifiedinpreviousresearchasincreasingthelikelihoodofemotional

symptomsinadolescence(e.g.lowacademicattainment,lowfamilyincome).

Writtenjustificationwillincludereferencestoappropriateliteratureand

researchunderpinningclassificationasariskfactor.

b. Thesetranscriptswillthenbereviewedforparticipants’owndescriptionsof

self-perceivedsourcesofstress.Forthisstage,theresearcherwillutilise

bracketingstrategies,wherebytheresearcherseekstosetasidetheirexisting

understandingofthephenomenon/conceptsandoftheexistingresearchin

thisarea.Arangeofbracketingstrategieswillbeused,including:

i. Keepingmemosofdecisionsandtheunderpinningrationaleswithina

reflexivejournal;

ii. Ongoingconsiderationandreviewingofthesedecisions;

iii. Discussingthesereflectionswithanexternalparty(i.e.,PhDsupervisor);

iv. Consideringownresponsestointerviewers’questionsinorderto

positionselfinrelationtointerpretationofparticipants’feedback;and

APPENDICES

395

v. Consideringresponsesinisolationfromtherestofthetextinorderto

decontextualiseresponses(Smithetal.,2009).

RigourSteps

Arangeofmeasureswillbetakentosupportrigourwithintheparticipant

selectionprocess,namely:

a. Thefullprocesswillbedocumentedextensivelybytheresearcher,with

writtenjustificationofhowparticipantsmeetinclusioncriteria2and3and

supportingquotes/excerptsfromtranscriptstosupportdecisions.The

researcherwillalsodocumenttheparticipantsnotidentifiedasmeetingthe

inclusioncriteriaalongsidejustificationofthesedecisions.Theprocesswill

alsobedocumentedinthereflexivejournalkeptaspartofthebroader

study.TheresearcherwillengageinreflexivediscussionwiththePhD

supervisoraspartofthisprocesstodevelopandrefinedecisions.

b. Theselectedparticipantswillbereviewedbyasecondaryresearcherwith

knowledgeofriskandmentalhealth.Thepurposeofthisstepistosupport

theconfirmabilityofselectiondecisionsandtheprocesscanbeconsidered

similartoanauditasisrecommendedinqualitativeanalysis(Smithetal.,

2009;Yin,1989)

c. Thesecondaryresearcherwillbeprovidedwiththepresentdocumentasa

guide,alongsidethewrittenjustificationdocumentedforeachselected

participantcompletedaspartofstage(a).Thesecondaryresearcherwillbe

invitedtoconfirmtheselectionofeachparticipantandprovidecommentsif

appropriate.Thesecondaryresearcher’sfeedbackwillthenbeincorporated

beforethefinalsampleisidentified.

d. Theselectedparticipantswillthenbereviewedbyanexternalpartywitha

clinicalorcounsellingbackground.Thepurposeofthisstepisalsoto

supporttheconfirmabilityofselectiondecisionsandagaincanbelikenedto

anaudit;however,thisreviewdiffersfromthepreviousstageasaclinical

reviewermayofferaperspectivethatisgroundedinpracticalexperience

withtheadolescentpopulation,ratherthanatatheoreticallevel.

APPENDICES

396

e. Thereviewerwillbeprovidedwiththepresentdocumentasaguide,

alongsidethewrittenjustificationdocumentedforeachselectedparticipant

completedaspartofstage(a).Thereviewerwillbeinvitedtoconfirmthe

selectionofeachparticipantandprovidecommentsifappropriate.The

reviewer’sfeedbackwillthenbeincorporatedbeforethefinalsampleis

identified.

APPENDICES

397

AppendixC:ExampleQualitativeParticipantSelectionOverview(Amelia)

“Amelia”

Age:12years,9months

1. Emotionalsymptoms

Ameliawasincludedforreviewastheinterviewer(inthiscasethecurrent

author)identifiedherashavingdisclosedemotionalsymptoms.Takingintoaccount

researcherjudgementsbasedonAmelia’sinterview,Ameliahasbeenidentifiedas

experiencingemotionalsymptoms.

InterviewerNominationComments

Giventhatinthisinstancetheinterviewwascarriedoutbytheauthorofthe

currentstudy,thesenotesaretheinitialimpressionsoutlinedfollowingthe

interview.

• Disclosedhighlevelsofanxietyinmostareasoflife

• Specificanxietyinrelationtoacademicwork

• Frequentfeelingsofstressandfrustration,oftenarisingfromanxiety

• Difficultyusingstrategiesprovidedbysupportworker

• DisclosedObsessiveCompulsiveDisorder(OCD)

ResearcherAssessment

IntensityofSymptoms.Ameliadescribedfeelingworriedas“upsetand

stressedout,andabitlike,likeconfusedsayinglike“ohwhat,shouldIdothisorwill

thishappen?””Shecommentedseveraltimesthatheranxietyseemedtobe

worsening;“(mum)saidthatmyworrieskeepongettinglikebiggerandbigger”and

heranxietyappearedtopreventherfromdoingthings,suchasgoingonrideson

holiday,oraskingforhelpinlessons“Idon’treallyputmyhandup[…]sometimes,

erm,Ijustseewhattheotherperson’sdoing”.Shecommentedthatsherepeats

sometasks;“itmakesmefeellikestressedoutcauseifintperfectthenI’llhaveto

doitagain.”Ameliaexplainedthatsheaccessessupportinrelationtoheranxiety

APPENDICES

398

butthatshestrugglestousethestrategiesshe’sgiven;“Istillfeelreallyworriedand

anxiousIjustlikesometimeslikeIforgettheadvice”.

FrequencyofSymptoms.Ameliadescribedfeelinganxiousonadailybasis.

Thiswasparticularlypresentindiscussionofherschoolwork,forexample“Idon’t

likegettingsomethingwronglikethat’swhatIworryabout,likegettingsomething

wrong[…]if(teacher)getsmadatmeorgavemeadetentionorsomethinglike

that,that’swhatIworryabout”.Ameliaalsodescribedsymptomsinotherareasof

herdailylife,suchas“forexampleifmytieintrightor,it’slikeeverythinghastobe

perfect[…]itstillgetsmeworried”,aswellasinmorespecificcircumstancessuch

asonholiday;“whenIwasonholidaytoDisneyworldandIwasworriedcauseI

don’tlike[…]theunknownandthedarkrides[…]IsaidIwon’tgoonitanywaybutI

wasstillreallyworriedaboutit”.

FrequencyofMentionwithinInterview.Ameliafocusedheavilyonher

anxietyintheinterviewandoftenthedialoguemovedbacktothisarea.For

example,whenaskedwhatmadeherhappy,Ameliadescribedthisinrelationto

theabsenceofworry“Iwouldbesmilingandcheery…andyeahI’lljustbereallylike

happynotworriedaboutanything.”

SDQResearcherReport.BasedonAmelia’sdisclosureofhersymptoms

withintheinterview,theresearcherdesignatedascoreof5(seeTable1foritem

scores).

Table1:Teacher/parentSDQemotionalsymptomssubscale

Not

True(0)

Somewhat

True(1)

Certainly

True(2)

Oftencomplainsofheadaches,stomach-achesorsickness þ ☐ ☐

Manyworries,oftenseemsworried ☐ ☐ þ

Oftenunhappy,down-heartedortearful þ ☐ ☐

Nervousorclingyinnewsituations,easilylosesconfidence ☐ þ ☐

Manyfears,easilyscared ☐ ☐ þ

APPENDICES

399

Self-ReportofSymptoms

Ameliadidnotcompletethequantitativesurveyandsotherewasnoself-

reportofhersymptomsavailable.

2. Risk

Theresearcheridentifiedthreeknown/empiricalriskfactorsinAmelia’s

interviewandoneadditionalself-perceivedsourceofstress.Thisindicatesthat

Ameliaisexperiencinganappropriatelevelofriskforinclusioninthecurrentstudy.

a. Knownriskfactors:

i. Epilepsy:Ameliadisclosedthatshehasepilepsy.Researchhasconsistently

indicatedthatchildrenandadolescentswithepilepsyareatanincreased

riskofemotionalsymptoms(e.g.,Davies,Heyman,&Goodman,2003;

Kariuki,Newton,Prince,&Das-Munshi,2016).

ii. Academicdifficulties:Ameliadescribedstrugglingwithacademicwork,

explainingthatshestrugglestofocusontasksa,explainingthatshe

strugglestofocusontasksandfindstheclassroomstressful.Lowacademic

attainmentandacademicdifficultieshavepreviouslybeenidentifiedasa

riskfactorforemotionalsymptomsinadolescence,specificallyforgirls(e.g.,

McCarty,2008;Panayiotou&Humphrey,2018).

iii. OCD:AmeliadisclosedthatshehasOCDandexplainedthatthisaffectsher

dailybehaviour.ThoughanxietyasasymptomofOCDisoftenexperienced

inrelationtospecificobsessions,itoftenco-occursalongsidemore

generalisedanxiety(NHS,2016),asisindicatedinAmelia’sinterview.

b. Additionalself-perceivedsourcesofstress:

i. ParentworkinginLondon:Ameliadescribedhavingworriesabouther

fatherandhisjobasheworksinLondon,andthatifheisstressedorupset

shealsobecomesstressedorupset.

3. Review

Secondaryresearcherreviewcomments:

APPENDICES

400

Iagreethatjudgementsofemotionalsymptomsandthelevelofriskthat

Ameliaisexperiencingarereasonableforinclusioninthecurrentstudy,having

reviewedAmelia'sfulltranscript,listenedtotheaudiofile,andtheassessment

document.

(MiaEisenstadt,AFNCCF)

Clinicalreviewcomments:

Ameliacomesacrossasquiteconfusedandnotknowingherownmindvery

well.Shetalksaboutperfectionism,andthisextendstoherfearsaroundhowgood

atherapypatientsheis(worryingshe’llforgetthestrategiesshe’sbeengiven).She

mayhavesomeOCD.ThefearaboutridesatDisneylandwasextremelyinteresting

andmademewonderifshehasnightmares.Shealsoshowshowvulnerableher

mindisintakinghertoafrighteningplaceasevenimaginingwherethedarkand

unknownrideswouldtakeherwasbadenough.Isuspectshebroughtthisup

becausesheisawarethatherworriesarelimitingherownexplorationandability

tohavefunandwantshelp.Thefactthatshedidn’tcompletedtheSDQmakesme

thinkabouthelplessnessagainaswellasnotknowingherownmind.Shecame

acrossasaverytroubledgirlwithlifelimitingworries.Ialsofeltsheseemedquite

lostandscaredasIreadheranswers,almostlikeshedidn’tknowwhatwas

happening,asensationIdidn’thavewiththeothertwoparticipants.

(JoshuaHolmes,AFNCCFandNHS)

APPENDICES

401

AppendixD:QualitativeHeadStartParticipantsNominatedfor,butnotIncludedin,theCurrentStudy

TableD1

OverviewandRationaleforExclusionofNominatedHeadStartParticipants

Code Emotionalsymptoms Risk Rationaleforexclusion

YP1 YP1describedfeelinganxious

andpanickedinherdailylife.

YP1identifiedasingleself-

perceivedsourceofstress;

i. Livinginmultiple

houses

YP1wasexperiencing

emotionalsymptomsbut

didnotdisclosea

sufficientlevelofriskfor

inclusioninthestudy.

YP2 YP2becamebrieflytearfulin

theinterviewwhendiscussing

bullyingvictimisationbutdid

nototherwisedemonstrateor

disclosesymptoms.However,

emotionswerenotdirectly

discussedintheinterviewas

thispartoftheschedulewas

notaddressed,andsoitwas

notpossibletoassessYP2’s

emotionalsymptoms.

YPidentifiedtwoknown

riskfactors;

i. Bullyingvictimisation

ii. Fatheranger

Itwasnotpossibleto

assessYP2’semotional

symptomsasthe

questionsaround

emotionswerenotasked

intheinterview.

Furthermore,YP2wasnot

experiencingasufficient

levelofriskforinclusion.

YP3 YP3disclosedsomeissues

withangerandsomedistress

insocialsituations.However,

thesesymptomswere

infrequentlydiscussedinthe

interviewandthispartofthe

schedulewasnotaddressed;

assuchitwasnotpossibleto

reachaclearconclusionon

thelevelofheremotional

symptoms.

YP2disclosedthreeknown

riskfactors;

i. Bullyingvictimisation

ii. Studentmobility

iii. Inter-parentalviolence

YP3wasexperiencingan

appropriatelevelofrisk,

butitwasnotpossibleto

reachaclearconclusion

onheremotional

symptoms,asthe

questionsinthispartof

theinterviewschedule

werenotasked.

APPENDICES

402

AppendixE:ChangesMadeAfterPilotingoftheWellbeingMeasurementFramework(WMF)

EightmainchangesweremadetotheWMFfollowingpilotingwithineight

educationsettings:

1. Informationwasaddedtotheparticipantinformationsheet,includingan

assurancethatquestionscouldbeskippedandaninstructiontoaskateacherif

anythingwasunclear(AppendixF);

2. Anestimatedcompletiontimeof20-40minuteswasaddedtotheinformation

sheet;

3. Rolloverbuttonswerehighlightedincolourandunderlinedtoincreasevisibility;

4. Additionaldefinitionswereaddedforcommonlymisunderstoodwords,

including“nervous”(SDQemotionalsymptoms)and“partner”(SRSschoolpeer

connection);

5. Counterbalancingoftheinitialandfinalmeasureswasimplementeddueto

observeddeclinesinconcentration;

6. Theyoungcarerquestionwaspresentedsooner,asitwasinitiallypresentedat

theendandresearchersobservedthatpupilsoftenaccidentallyoverlookedthis

question;

7. Aprogressionbarwasaddedforeachpage(e.g.page4/14);and

8. Guidanceforteacherswasdevelopedbasedonobservationsandfocusgroup

feedback.

APPENDICES

403

AppendixF:GuidanceProvidedtoTeacherstoFacilitateSurveyAdministration

Checklist

Thepointsbelowprovideaquickchecklistofimportantconsiderationsforteachers

beforepupilsbeginthesurvey.Eachpointiscoveredinmoredetailinthecribsheet

thatfollows,whichwestronglyencourageyoutoread.

Haveyou:

• Readthroughthecribsheet?

• Printedoutacopyofthecribsheetinordertointroducethesurveytothe

studentsonthesurveyday?

• ViewedtheshortWMFintroductoryvideo,andarrangedforittobeshownto

pupils?

• Trialledthesurveyyourself?

• Madeotherarrangementsforthepupilswhohavebeenoptedoutofthesurvey

bytheirparents,andforthosewhofinishearly?

• Ensurethatyouhavecorrectsurveypasswordsforyourclass,foreachpupil

whoispermittedtocompletethesurvey?

• Setupthesurveyonschoolcomputers?E.g.makingthesurveylinkavailableas

ashortcutonstudents’desktopsorasalinkontheschool’sintranet.

• Madesurethosepupilswhousuallyhaveadditionalassistanceintheclassroom

havethisinplaceforthesurvey(e.g.theirteachingassistant).

APPENDICES

404

CribSheetforTeachers

Backgroundandgeneralguidance

ThankyouverymuchforbeinginvolvedintheHeadStartevaluation.Thisstudy

aimstoinvestigatethebestwaystosupportyoungpeople’semotionalwellbeing

andtheirabilitytomanagewhenexperiencingdifficulties.Tohelpyouintroduce

thesurveytoeachclass,wehaveprovidedacribsheetbelow.

Thesurveywilltakeabout30-40minutesbutsomestudentsmayfinishitmuch

earlier(i.e.within10-15minutes).Becauseofthis,itwouldgreatifyoucouldthink

ofpossibleactivitiesthattheearlyfinisherscandoinadvance.Thesemayinclude

(butarenotlimitedto):readingabook,designingaposter,orlookingatspecific

websites.Ifthesurveytakesplaceawayfromaregularlesson,itmaybeacaseof

simplysendingtheearlyfinishersbacktotheirregularclassroom.

Ontheotherhand,somestudentsmayfindithardertounderstandthesurvey

questionshencetakealittlelonger.Itisimportantthatyouallowthemtimeand

spacetounderstandthequestionsandofferahelpinghandonlywhenasked.More

importantly,pleaseavoidlookingatthestudents’answersastheyareconfidential.

Sometimesstudentsmayfindsomeofthesurveyquestionsabstractandstruggleto

imaginesuchscenarios.Tohelpwiththis,wehaveprovidedasectionon

‘frequentlyaskedquestions’attheendofthisdocument.Youmayalsofindit

usefultogiveexamplesthatmightbefamiliartothestudent(i.e.Imagineyoucame

outfromclasslateandyouarealone,willxxaskyoutojoinin?).

Somestudentsmayfindithardtounderstandtheresponseoptions,ifsoplease

remindthemthattheresponseoptionsrangeinseverity(i.e.fromdisagreeto

agreeorfromnevertoalways).

Somechildrenmayhavedifficultyreadingtheitemsduetothefontsize,ifso

pleaseremindthemthattheycanzoominbypressing“Ctrl+Plussign”andzoom

outbypressing“Ctrl+Minussign”.

Tohelpstudentswithreadingdifficultiesorspecialeducationneedsyoumaywant

tohaveaprintoutofthesurveyandreadthequestionsforthem(orhavea

APPENDICES

405

teachingassistantorlearningmentordothiswiththem).Ifthisisthechosen

option,pleasesupportstudentsinunderstandingthequestionbutmakesurethey

aregivenspacetoselecttheiranswerprivately(e.g.,lookawayormoveaway).

TohelpstudentswhoarestrugglingwithEnglish,pleaseconsiderhaving

translators.Pleasealsonotethatoneofthequestionnaires,theStrengthsand

DifficultiesQuestionnaire(SDQ),isavailableinanumberofdifferentlanguages

whichyoucandownloadfromtheSDQwebsite:

http://www.sdqinfo.com/py/sdqinfo/b0.py

Ifthereisanytechnicalproblemwiththewebsite(i.e.ifthewebsitestops

responding),pleasedirectthestudentsbacktothepasswordpageandallowthem

toputtheirpasswordsagain.Bypressingthe“next”button,theycangetbackto

wheretheywere.

APPENDICES

406

IntroducingchildrentotheWellbeingMeasurementFramework(WMF):Acrib

sheetforschoolsstaffintroducingthesurvey

Thissectiongivesanintroductiontothesurveycoveringsomeofthekeydetails.We

havealsocreatedashortvideotointroducepupilstothesurvey(2minutes50

secondslong),whichcanbefoundontheHeadStartLearningwebsite.Thisvideowas

createdbyyoungpeopleforotherswhomaycompletethesurvey,andassuchcanbe

helpfulinexplainingthesurveytopupils.

Youcanalsousethesuggesteddescriptionbelowverbatimorasageneralguideofthe

pointstocover.Thestudentswillalsoseeaversionofthisinformationonthescreen

beforetheyagreetoparticipate.

“OurschoolistakingpartinabigprojectcalledMeasuringWellbeinginSchoolswith

lotsofotherschoolsacrossthecountry.Wearedoingthistotryandimprovesupport

giventoallchildrenandyoungpeopletoimprovetheirwellbeingandalsotosupport

thosewhomayneedsomeextrahelpcopingwithdifficulties.

Onthecomputer,youwillbeaskedtocompleteaquestionnaireaboutyourfeelings,

friendships,homelifeandschoollife.Pleasedonotrush.Someofyoumayfinishthe

questionnairein10minutesandsomecantakeupto30-40minutes.

Ifyoufinishabitearly,please[pleaseinsertanactivityforstudentswhofinishearlyto

do].Pleasedonottalkanddisturbothers.

Youranswerswillbekeptprivatebythepeoplerunningtheproject.Yourparentsand

yourteacherhavebeentoldthatyouareansweringquestionsbuttheywillnotseeyour

answers.

Ifyoudonotwanttotakepartthat’sabsolutelyfine,youdon’thavetodoit.Justletme

knowthatyoudon’twanttotakepartbeforewestart.

Orifyoustarttotakepartandthenchangeyourmind,that’sfineaswell.Justletme

knowthatyoudon’twanttocarryon.

APPENDICES

407

Whileothersarecompletingthesurvey,youcando[pleaseinsertanactivityfor

studentswhowillnottakepart,thismightbethesameactivityasforstudentswho

finishearly].

Inthesurvey,somewordsarehighlightedingreenandunderlined.Thatmeansyoucan

hoveryourmouseoveritandseeanexplanationoftheword.Ifyoudonotunderstand

anyofthequestions,pleaseraiseyourhandandI/wewilltrytoexplainitasmuchas

possible.Itisnotatestandtherearenorightorwronganswers.Thatmeansthatall

theanswersarepersonaltoyou,soIwouldpleaseaskyoutobequietandfocuson

yourownscreen.Ifthereareanyquestionsyoudon’tfeelhappyansweringyoudon’t

havetoanswerthem,justleavethemblank.

Ifcompletingthequestionsmakesyouthinkyoumightneedsomesupportaboutthe

kindsofthingsthesurveycovers,pleasespeakto[pleaseinsertanappropriatecontact

name(e.g.me,schoolnurse,SENCo,counselloretc.]

Tostartthesurvey,pleaseinsertyouruniquepasswordwhereitsays“Password”and

clicknext.Nowreadthefirstpageofthesurveyandifyouarehappytoanswerthe

surveytick“Ihavereadtheaboveandconsenttotakepartinthissurvey”.

Ifyoudonotwanttotakepartinthesurvey,pleaseraiseyourhand.”

Attheendofthesurveyyoumightalsowanttoreiteratethepointaboutthe

supportthat’savailablewithintheschool:

“Thanksfortakingthetimetotakepartinthesurvey.AsIsaidbeforeyoustarted,if

completingthequestionshasmadeyouthinkyoumightneedsomesupport,please

speakto[pleaseinsertanappropriatecontactname(e.g.me,schoolnurse,SENCo,

counselloretc.]”

APPENDICES

408

Glossaryoffrequentlyaskedsurveyquestions

• Accusedof-“Iamoftenaccusedoflyingorcheating”àBeingtoldthatyoudid

somethingwhichyouhaven’t.

• “Atschool,Idecidethingslikeclassactivitiesorrules”àAsateacher,youmay

bebetterplacedtogiveexamples.Ifastudentstrugglestounderstandthis

question,pleaseprovideexamplesfromyourclass.

• Attention-“IfinishtheworkI'mdoing.Myattentionisgood”àBeingableto

sticktoonetask.

• ConcentrationàBeingabletofocus.

• Feelingcloseto-“I’vebeenfeelingclosetootherpeople”àHavinggood

relationshipwithothers.Thismightincludefriendshipsorrelationshipswith

yourfamily.

• Fidgetingorsquirming-“Iamconstantlyfidgetingorsquirming”àMove

aroundalot.

• HomelifeàFamilylife.

• “Idothingsathomethatmakeadifference(i.e.makethingsbetter)”àDo

anythingtoimprovethingsathome,suchashelpingaroundthehouse,helping

afamilymemberetc.

• “Idothingsthatmakeadifference(i.e.makethingsbetter)”àHelpothers.

• “Ihavegoalsandplansforthefuture”àAsateacher,youmaybebetter

placedtogiveexamples.Ifastudentstrugglestounderstandthisquestion,

pleaseprovideexampleswherethestudentmighthavesetgoals,pleaseallow

themtothinkoflong-termgoals.

• “I’vebeenabletomakeupmyownmindaboutthings”àIcanmakedecisions

formyself.

• “I’vebeendealingwithproblemswell”àIhavebeenmanagingmyproblems

well.

• “Inthelastmonth,howoftenhaveyoufeltconfidentaboutyourabilityto

handleyourpersonalproblems?”àInthelastmonth,howoftenhavethought

thatyouareabletoworkthroughyourproblems?

APPENDICES

409

• “Inthelastmonth,howoftenhaveyoufeltthatthingsweregoingyourway?”

àInthelastmonth,howoftenhaveyoufeltthatthingsweregoingasyou

wantthemtogo?

• “Inthelastmonth,howoftenhaveyoufeltthatyouwereunabletocontrolthe

importantthingsinyourlife?”àInthelastmonth,howoftenhaveyoufound

youhavenopoweroverthingsgoingoninyourlife?

• LeisureactivitiesàHobbies.

• Minor/definite/severe-(responseoptionsononeofthequestionnaire)àLow

/medium/high.

• “…missyouifyouweren’tinschool”àWonderwhereyouareand/orbe

disappointedifyouarenotthere.

• Nervous-“Iamnervousinnewsituations.Ieasilyloseconfidence”àFeeling

anxious.

• Optimistic-“I’vebeenfeelingoptimisticaboutthefuture”àHopeful.

• Partner-“…pickyouforapartner”àPickyoutobepartofateamoragroup.

• PilingUp-“Inthelastmonth,howoftenhaveyoufeltdifficultieswerepilingup

sohighthatyoucouldnotovercomethem?”àhowoftenhaveyoufeltthat

youhadsomanyproblemsthatyoucouldnotovercomethem.

• Restless–“Iamrestless,Icannotstaystillforlong”àunabletostaystill.

• “…sharethingswithyou”àSharebothphysicalthings(i.e.pencil,book)and

information.

• “SometimesIgetinvolvedinthingslaterIwishIcouldgetoutof”àSometimes

IregretthingsthatIdo.

• Somewhattrue-(responseoptionononeofthequestionnaire)àPartlytrue,

partlynottrue.

• Thinkingclearly-“I’vebeenthinkingclearly”àBeingabletofocusonthoughts.

• Useful–“I’vebeenfeelinguseful”àHelpful.

• Volunteer–“Ioftenvolunteertohelpothers(parents,teachers,children)”à

Offertohelpotherswithoutbeingasked.

• Youngcarer-Youngcarerischildrenandyoungpersonsunder18whoprovide

orintendtoprovidecare,assistanceorsupporttoanotherfamilymember.

APPENDICES

410

Theycarryout,oftenonaregularbasis,significantorsubstantialcaringtasks

andassumealevelofresponsibilitywhichwouldusuallybeassociatedwithan

adult.Thepersonreceivingcareisoftenaparentbutcanbeasibling,

grandparentorotherrelativewhoisdisabled,hassomechronicillness,mental

healthproblemorotherconditionconnectedwithaneedforcare,supportor

supervision.

APPENDICES

411

Frequentlyaskedquestionsbythechildren

1) WhyamIbeingaskedtofillinthissurvey?

Thiswillhelpustolearnaboutyoungpeople’smentalhealthandemotional

wellbeing.Itwillhelpyourschooltofindoutthebestwaysofhelpingyoungpeople

tohavegoodmentalhealthandemotionalwellbeing.

2) WhowillseetheanswersIgive?

Thesurveyisanonymous.Thismeansnooneatyourschoolwillseetheanswers

yougive.Youranswersgototheresearchteam.Theyputallchildrenandyoung

people’sanswerstogethersothattheycanlearnabouthowchildrenandyoung

peoplearefeelingacrossthewholeschool.

Asnooneinyourschoolwillseeyouranswers,ifyouneedtotalktosomeone

aboutyourfeelings,youneedtospeaktoateacheroranotheradultyoutrustin

school.

3) Istheprojectjustforkidswithproblemsorforeveryone?

Thisprojectisforallchildrenandyoungpeople.Weallneedtolookafterour

mentalandemotionalhealth,justlikeweneedtolookafterourphysicalhealth.

4) Willthesurveyaffectus?

Answeringthesurveywon’thaveimmediateeffectsonyou.But,wehopethatthe

surveywillhelpyourschooltolearnabouthowtobettersupportchildrenand

youngpeople’semotionalwellbeing.

5) Whydoyouhavetheyoungcarerquestion?Whatdoyouwanttoknow?

Wewanttomakesureweunderstandthefeelingsoflotsofdifferentchildrenand

youngpeople.Somechildrenandyoungpeopleareyoungcarersthismeansthey

provideregularorongoingcaretoafamilymemberwhohasanillness,disability,

mentalhealthconditionordrug/alcoholdependency.Wewanttomakesurewe

understandhowyoungcarersfeelsowecanlearnwhathelpandsupportthey

mightneed.

APPENDICES

412

6) Someofthequestionsareverysimilar–isthatatrick?

Somequestionsmaysoundverysimilar,butit’snotatrick.Somequestionsmayask

thesamethingindifferentwayssothatwecanmakesurewereallyunderstand

howchildrenandyoungpeoplearefeeling.

7) Isthisatest?

No,thisisn’tatest.Therearenorightorwronganswers.Thesurveyisjust

interestedinlearningaboutyourthoughtsandfeelings.

8) DoIhavetoanswereveryquestion?

Ifyoudon’twanttoansweraquestion,that’sok.It’syourchoicewhichquestions

youanswer.Ifyoudon’twanttoansweraquestion,justleaveitblankandmove

ontothenextone.

9) HowwilltheHeadStartprogrammehelpotherpeopleinthefuture?

TheHeadStartprogrammeistryingtofindthebestwaytohelpchildrenstay

mentallyhealthy,managestressandworries,dowellatschool,avoidgetting

involvedinriskybehaviour(suchasdruguse,drinkingtoomuchalcoholoranti-

socialbehaviour)andenjoylife.

APPENDICES

413

AppendixG:StrengthsandDifficultiesQuestionnaire(SDQ)EmotionalSymptomsSubscale(Goodmanetal.,1998)

Foreachitem,pleasemarktheboxforNotTrue,SomewhatTrueorCertainlyTrue.

Itwouldhelpusifyouansweredallitemsasbestyoucanevenifyouarenot

absolutelycertainortheitemseemsdaft!Pleasegiveyouranswersonthebasisof

howthingshavebeenforyouoverthelastsixmonths.

Not

TrueSomewhat

TrueCertainlyTrue

Igetalotofheadaches,stomach-achesorsickness � � � Iworryalot � � � Iamoftenunhappy,down-heartedortearful � � � Iamnervousinnewsituations;Ieasilyloseconfidence � � � Ihavemanyfears,Iameasilyscared � � �

APPENDICES

414

AppendixH:Four-ItemPerceivedStressScale(PSS-4)(S.Cohenetal.,1983)Thequestionsinthisscaleaskyouaboutyourfeelingsandthoughtsduringthelast

month.Ineachcase,pleaseindicatewithacheckhowoftenyoufeltorthoughta

certainway.

0

never1

almostnever

2sometimes

3fairlyoften

4veryoften

Inthelastmonth,howoftenhaveyoufeltthatyouwereunabletocontroltheimportantthingsinyourlife?

� � � � �


� � � � �

Inthelastmonth,howoftenhaveyoufeltthatthingsweregoingyourway?

� � � � �

Inthelastmonth,howoftenhaveyoufeltdifficultieswerepilingupsohighthatyoucouldnotovercomethem?

� � � � �

APPENDICES

415

AppendixI:StudentResilienceSurveysubscales(Sun&Stewart,2007)Subscale Never Always

Familyadultconnection

Athome,thereisanadultwho… � � � � �

Isinterestedinmyschoolwork � � � � � BelievesthatIwillbeasuccess � � � � �

Wantsmetodomybest � � � � �

ListenstomewhenIhavesomethingtosay � � � � �

Schooladultconnection

Atschool,thereisanadultwho… � � � � � Reallycaresaboutme � � � � �

TellsmewhenIdoagoodjob � � � � �

ListenstomewhenIhavesomethingtosay � � � � �

BelievesthatIwillbeasuccess � � � � �

Communityadultconnection

Awayfromschool,thereisanadultwho… � � � � � Reallycaresaboutme � � � � �

TellsmewhenIdoagoodjob � � � � �

BelievesthatIwillbeasuccess � � � � � Itrust � � � � �

Schoolpeerconnection

Aretherestudentsatyourschoolwhowould…

� � � � �

Chooseyouontheirteamatschool � � � � �

Tellyouyou’regoodatdoingthings � � � � �

Explaintherulesofagameifyoudidn’tunderstandthem

� � � � �

Inviteyoutotheirhome � � � � � Sharethingswithyou � � � � �

Helpyouifyouhurtyourself � � � � �

Missyouifyouweren’tatschool � � � � �

Makeyoufeelbetterifsomethingisbotheringyou

� � � � �

Pickyouforapartner � � � � � Helpyouifotherstudentsarebeingmeantoyou

� � � � �

Tellyouyou’retheirfriend � � � � �

Askyoutojoininwhenyouareallalone � � � � �

Tellyousecrets � � � � �

Activeengagementinhomeandschoollife

Idothingsathomethatmakeadifference(i.e.makethingsbetter)

� � � � �

Ihelpmyfamilymakedecisions � � � � � Atschool,Ihelpdecidethingslikeclassactivitiesorrules

� � � � �

APPENDICES

416

Idothingsatmyschoolthatmakeadifference(i.e.makethingsbetter)

� � � � �

Engagementinextra-curricularactivities

Awayfromschool… � � � � � Iamamemberofaclub,sportsteam,churchgroup,orothergroup

� � � � �

Itakelessonsinmusic,art,sports,orhaveahobby

� � � � �

APPENDICES

417

AppendixJ:QualitativeInterviewScheduleIntroduction:“Thankyousomuchfordoingthisinterviewwithme.Ihaveafew

questionsthatI’dliketoaskyouaboutyourunderstandingandexperiencesof

copingordealingwithdifficulttimes,suchaswithdifferentfeelingsandemotions

orinsituationsatschoolorathome.Ifyoudon’twanttoansweraquestionorif

it’sunclearthenjusttellmeandwecanskipit,orIcanexplainit.Wewillwriteup

whatwefindfromallofourinterviewswithyoungpeopleyourageupanddown

thecountryandwewillsendyouacopyofourfindings.Everythingthatwetalk

abouttodayisprivateorconfidentialunlessI’mworriedthatanyharmordangeris

goingtocometoyouortoanyoneelse,inwhichcasethenIwouldneedtospeakto

mysupervisor,whosenameisJess,and[nameofschoolsafeguardingofficer],butI

wouldtellyouifIwasworriedinthiswayfirst.Youarewelcometostopthe

interviewatanytimeorskipaquestionifyouwantto”

Talkingaboutlife:1. Whatdoyoulike/notlikeaboutbeingatschool?

Possibleprompts:o Favourite/leastfavouritesubjects?o Whatdoyoulike/notlikeaboutthis?Why?o Howdoyouhandlethis?

2. Canyoutellmeabouttheareathatyoulivein?Whatisyourareawhereyou

livelike?Possibleprompts:o Yourstreet?o Thingstodo/placestogonearwhereyoulive?o Whatdoyoulike/notlikeaboutlivinghere?Whatdoyoulike/notlike

aboutthis?Why?o Howdoyouhandlethis?

3. Canyoutellmeaboutwhatlifeislikeforyouathome?

Possibleprompts:o Whodoyoulivewithathome?

APPENDICES

418

o Whatdoyoulikeaboutbeingathome?Whatdoyoulikedoingwithyourparents/brothersorsisters/pets?Aretherearethingsthatyoudoaltogetherasafamily?Whatdoyoulikeaboutthis?Why?

o Isthereanythingthatyoudon’tlikesomuchaboutbeingathome?Whatdoyounotlikeaboutthis?Why?Howdoyouhandlethis?

4. Canyoutellmeaboutyourfriendships?Possibleprompts:o Doyouhavefriendsinschool?Friendsoutofschool?o Whatdoyoulikedoingwithyourfriends?Whatdoyoulikeaboutthis?

Why?o Isthereanythingthatyoudon’tlikesomuchaboutspendingtimewith

yourfriends?Whatdoyounotlikeaboutthis?Why?Howdoyouhandlethis?

Talkingaboutemotions:

5. Whatkindsofthings(e.g.activities,places,orpeople)canmakeyoufeelhappy?

Possibleprompts:o Howdoyouliketohavefun?o Howdoesthisconnect/leadtoyoufeelinghappy?o Canyouthinkofanexampleofwhenyouwerefeelinghappyrecently?

Whathappened?

6. Beinghappycanlookorfeeldifferentforeveryone,soIwaswonderingwhatthislookslikeorfeelslikeforyou?

Possibleprompts:o WhatwouldIsee/noticeifyouwerefeelinghappy?o Whatwouldyoubefeeling/doing?

7. Whatkindsofthings(e.g.activities,places,orpeople)canmakeitharderor

moredifficultforyoutofeelhappy?Possibleprompts:o Howdoesthisconnect/leadtoyoufeelingthisway?

8. Whatsortsoffeelingsoremotionsdoyouexperiencewhenyouarenotfeeling

happy?(Remembertounpackandexploredifferentfeelings/emotionsastheyarementioned,e.g.‘Beingsadcanlookorfeeldifferentforeveryone,soIwas

APPENDICES

419

wonderingwhatthislookslikeorfeelslikeforyou?’,‘Whattypesofthingsdoyouworryabout?’)

Possibleprompts:o Howdoesthisaffectyourlife/makeyoufeel?o CanyouthinkofanexampleofwhenyouwerefeelingXrecently?What

happened?

9. Whenyouarenotfeelinghappyorhavingahardtime,whatdoyoudotofeelbetter?Whatdoyoudowhenyouhaveproblems/difficultiesinyourlife?

Possibleprompts:o Howdoyouhandleit?o Who/whathelps/makesyoufeelbetter?Wheredoyougoforhelp/

support?Whatcheersyouup?Whatdotheydo?o Howdoesthishelpyou?o Doesthisvary/changedependingonhowyouarefeeling?Why?o Isthereanythingthatisunhelpfulforyouorthatmakesyoufeelworse?o Isthereanyonethatyoudefinitelywouldn’ttalktowhenyouarefeeling

thisway?Why?

10. Haveyoueverreceivedanyhelporsupportinrelationtofeelinglikethis(i.e.unhappy)?

Ifyes,o Whatdidthisinvolve?Whatdidyoudo?Whodidyoumeetwith?o Canyoutellmeabouthowyoucametoreceivethishelporsupport?o Comparedtobeforeyoureceivedthishelporsupport,howdidyoufeel

afterwards?Didanythingimprove/getworse?What?Wasthiswhatyouexpected?

o Whatwashelpfulaboutthishelporsupport?o Wasthereanythingthatwasunhelpful?What?o Wasthereanythingthatyouwouldhavelikedtohavebeendifferent

aboutthehelporsupport?What?

Ifno,

o Wouldyouliketoreceiveanyhelporsupport?What?

TalkingaboutHeadStart:(ifHeadStarthasnotalreadybeendiscussed)

11. HaveyouheardofsomethingcalledHeadStart?Ifyes,canyoutellmeaboutwhatHeadStartis?Ifno,explainwhatHeadStartisinthatarea.

APPENDICES

420

12. HaveyoubeeninvolvedinanyactivitiesorlessonsaspartofHeadStart?Ifyes:o Whatdidthisinvolve?Whatdidyoudo?Whohaveyoumetwith?What

happens?Whendoyoudoit?Howoften?o CanyoutellmeabouthowyoucametobeinvolvedinHeadStart?o ComparedtobeforeyougotinvolvedinHeadStart,howhaveyoubeen

feeling?Hasanythingimproved/gotworse?What?Wasthiswhatyouexpected?

o WhathaveyoufoundhelpfulaboutbeinginvolvedinHeadStart?Hastherebeenanythingthatyouhavefoundunhelpful?What?

o Wasthereanythingthatyouwouldhavelikedtohavebeendifferentabouttheactivities/lessons?What?

o Haveyouevertakenpart/beeninvolvedinanythinglikethisbefore?What?

o WouldyourecommendHeadStarttoanyofyourfriends?DoanyofyourfriendsparticipateinHeadStart?

Givingsuggestions/advice:13. Whatadviceorhelpwouldyougivesomeoneyourageiftheywere

experiencingaproblemwith:o Theirfriendships?o Theirfamily?o School?o Theirfeelingsoremotions?

Possibleprompts:o Wheredoyouthinktheyshouldgo?Whodoyouthinktheyshould

speakto?o Isthisadvicethatyouwouldfollowyourselfifyouwereexperiencing

this?Why/whynot?

Conclusion:“Thanksverymuchagainfordoingthisinterviewwithmetoday;it’s

beensohelpfultospeaktoyou.Doyouhaveanyquestionsformenowthatwe’ve

finishedtheinterview?Wearegoingtousetheseinterviewstohelpustoworkout

howbesttohelpyoungpeopleyouragewhentheyareexperiencingdifficult

situationsorfeelings.Wewillgetbackintouchwithyouaroundthistimenextyear

toseewhetheryou’rehappytospeakwithusagainabouthowthingsareandwhat

mayhavechangedsincewelastsawyou.Wouldyouliketochooseapseudonym

forwhenwewriteupourfindings?Thisisanothernamethatwewilluseforyouin

ourwrite-uptohelpensurethatotherpeopledon’trecogniseyou”

APPENDICES

421

AppendixK:QuantitativeInformationPackforParents/Carers

DearParents/GuardiansofYear7students,

Wearewritingtoyoubecausewewouldliketogainabetterunderstandingofyoungpeoples’wellbeingsothoseworkingwiththemcanimprovethesupportthatisprovided.

Todothiswewanttocollectviewsfromallchildrenintherelevantyeargroupsatparticipatingschools.Wewilldothisbyusingonlinesurveysonceayear(forfiveyears),starting2017.

Weareaskingyoutohelpbyallowingyourchildtoparticipate.

Beforeyouandyourchilddecidewhetheryouwouldliketotakepart,itisimportantforyoutoknowwhatitwillinvolve.Pleasetaketimetoreadtheattachedinformationsheetcarefullyanddiscussitwithothersifyouwish.Ifthereisanythingthatisnotclear,orifyouwouldlikemoreinformation,pleasedonothesitatetocontactus.

Thenextfewpages:

1)Tellyouabitabouttheresearchandwhatitinvolvesforyouandyourchild.

2)Asksyouifyouarehappyforyourchildtoparticipate.

3)Givesyouareplysliptofillinandsendbacktousifyoudonotwantyourchildtotakepart.

Ifyouarehappyforyourchildtobeinvolvedintheresearch,youdonotneedtotakeanyfurtheraction.IfyouDONOTwantyourchildtobeinvolvedintheresearch,theattachedsheettellsyouwhattodo.

IfyouhaveanyquestionspleaseemailusonHeadStart@annafreud.orgorcalluson02074432294.

Anypersonalinformationwillbetreatedconfidentially.TheinformationwillbetreatedasstrictlyconfidentialandhandledinaccordancewiththeprovisionsoftheDataProtectionAct1998.

Thankyoufortakingthetimetoreadaboutourresearch.

Yoursfaithfully,

DrJessicaDeightonEvidenceBasedPracticeUnit(EBPU)UniversityCollegeLondonandtheAnnaFreudCentreJordanHouse47BrunswickPlaceLondon,N16EB

APPENDICES

422

InformationSheetforParents/Carers

Whatisthestudyfor?

Thisstudytriestogainabetterunderstandingofourstudents’wellbeingsothat

improvementscanbemadetosupportthem.

Whatisthedurationoftheresearch?

TheresearchitselfrunsfromSeptember2016untiltheendof2023.Thesurveys

willtakeplaceyearly.

Whatwillparents/guardiansbeaskedtodo?

Weareaskingforyourpermissionforyourchildtocompleteasurveyonceayear

foruptofiveyears(thefinaltimewouldbewhenyourchildisinYear11).The

surveyasksquestionsabouttheirschool,friends,themselvesandisnotexpectedto

takelongerthan40minutestocomplete.

Whoisbeingaskedtotakepart?

Allchildrenatyourchild’sschoolinyears7and9willbeaskedtotakepartinthis

research.

Whatwillyourchildbeaskedtodo?

Thestudywillinvolveyourchildcompletingashortsurvey.Thesurveyasks

questionsabouttheirschool,friends,andthemselves,andisnotexpectedtotake

longerthan40minutestocomplete.Beforeyourchildtakespartinthe

questionnaires,theirclassteacherwillreadaloudinformationabouttheresearch

andyourchildwillbeaskedtotickaboxiftheyarehappytotakepartinthe

research.Wewillnotaskanyidentifiableinformation(suchasnames,addresses

etc.).

Theschoolwillalsogiveusinformationaboutpupilcharacteristicssuchasspecial

educationneedsanddeprivation.

APPENDICES

423

Whatarethepossiblerisks/disadvantagesoftakingpart?

Therearenoknownrisks/disadvantagestotakingpartinthisquestionnaire.Ifany

risksordisadvantagesbecomeknownduringtheresearch,youandyourchildwill

beinformedstraightaway.Youcanalsogetindependentsupportandadvicefroma

charitycalledYoungMinds.Theirparenthelplinenumberis08088025544.

Ifyoueverwishtomakeaformalcomplaintabouttheconductoftheresearchyou

shouldcontactDr.JessicaDeighton,EvidenceBasedPracticeUnit(EBPU),UCLand

theAnnaFreudCentre,JordanHouse,47BrunswickPlace,London,N16EB.

Whohasreviewedtheresearch?

Allresearchislookedatbyanindependentgroupofpeople,calledaResearch

EthicsCommittee,toprotectyourinterests.Thisresearchhasbeenapprovedby

theUCLResearchEthicscommittee(UCLEthicsnumber:8097/003).

Whatarethepossiblebenefitsoftakingpart?

Thereisnoguaranteedbenefitintakingpart.Mostpeoplefindtakingpartin

researchrewarding,astheycontributetothedevelopmentofknowledgethatmay

benefitotherpeopleinthefuture.

Whatdataistheresearchusing?

Theresearchwillcombinechildself-reportdataanddatafromothersources.Child

self-reportdatawillbeusedtounderstandhowchildrenandyoungpeoplefeel

abouttheirschool,friends,andthemselves.Self-reportdatamaybelinkedwith

datafromothersourcessuchashealthdataordataheldbythelocalauthority.It

mayalsobelinkedtoinformationaboutwhetherstudenthasreceivedany

additionalsupportorservicesforresilienceoremotionalwell-being.Thiswillbe

usedtounderstandmoreaboutdifferentcharacteristicsofyoungpeople

completingthesurveyandunderstandwhethersupportprovidedtochildrenand

youngpeoplehelpthemfeelbetter.NONEOFTHESEDATAWILLBEUSEDTO

IDENTIFYINDIVIDUALCHILDREN.

APPENDICES

424

Howwillmychild’sdatabestoredandwhowillhaveaccesstoit?

• Allinformationwillbetreatedstrictlyconfidentially.Theresearchteamwill

ensurethatthehigheststandardsofconfidentialityaremaintained

throughout.

• Amemberoftheresearchteamandadesignateddataleadatthe

participatinglocalauthoritywillhaveaccesstotheidentifiabledata.

• Identifiabledatawillonlybeusedtolinkdifferentdatasources.Itwon’tbe

usedtoidentifyindividualchildren.

• Thewebsitethathousesthesurveywillbecompletelysecureandpassword

protected.Allsurveydatawillbestoredonasecureandpassword

protectedservertowhichonlyseniormembersoftheresearchteamhave

access.

• Oncethedataislinked,itwillbeanonymizedandtheanalysiswillbecarried

outontheanonymizeddata.

• AlldatawillbecollectedandstoredinaccordancewiththeDataProtection

Act1998.

• Theinformationmaybepresentedatconferencesorusedaspartof

academicpublicationsandastudentproject.Noinformationpresentedwill

identifyanyindividualsinvolved.

Contactforfurtherinformation

Forgeneralqueries: Fortechnicalqueries:JessicaDeighton LawrenceWoEvidenceBasedPracticeUnit(EBPU) SchoolofEducationUCLandtheAnnaFreudCentre UniversityofManchesterJordanHouse OxfordRoad47BrunswickPlaceLondon,N16EB

Manchester,M139PL

Email:[email protected] Email:[email protected],pleaseseeourwebsiteforfurtherdetailsabouttheresearchandteam.Thewebsitecanbefoundat:www.headstartlearning.info

Thankyoufortakingthetimetoreadthisinformationsheet.Yourhelpmakesourresearchpossible!

APPENDICES

425

Agreeingforyourchildtobepartofthisresearch

• Wehopeyouwillallowyourchildtotakepartinthisresearch.

• Ifyoudonotwantyourchildtoparticipateinthisresearch,youneedtolet

usknowbefore<InsertDate>.Pleasecompletetheformbelow,usethe

freepostcodebelowandreturnitto:

FREEPOST(RLYU-KAAB-AXRC)

LawrenceWo

SchoolofEducation,

B4.10EllenWilkinsonBuilding,

UniversityofManchester,

OxfordRoad,

Manchester,

M139PL

Alternatively,LawrenceWocanbecontactedbytelephoneon01612753415or

[email protected]

Itwillbemadecleartoallchildrenwhentheyaregiventhequestionnairesthat

theydonothavetoansweranyquestionsthattheydon’twanttoandtheydonot

havetotakepartatalliftheydon’twantto.

Pleaseseenextpageforareplysliptofillinandsendifyoudonotwantyourchild

totakepartintheresearch.

Youonlyneedtocompleteandreturnthisslipifyoudonotwishyourchildtotake

part.

Ifyouarehappyforyourchildtotakepartthenyoudonotneedtodoanything.

APPENDICES

426

Iwishtowithdrawmychildfromtakingpartintheresearch.Mydetailsareas

follows:

Child’sname:

Parentorcarer’sname:

YearGroup:

Nameofmychild’sschool:

Signature: Date:

[Responserequiredby<insertdate>]

APPENDICES

427

AppendixL:QuantitativeParticipantInformationforYoungPeopleWethankyouforconsideringparticipatinginthissurvey.Belowweexplainwhat

thisinvolvesandifyouchoosetoparticipateyouwillthenbedirectedtothe

survey.

Whatisthestudyfor?

ThisresearchisanevaluationofaprogrammecalledHeadStartwhichishappening

inschoolsinEnglandacross6areas.TheaimofHeadStartistoprovidesupportto

childrenandyoungpeopletoimprovetheirwellbeingandalsotosupportthose

whomayneedsomeadditionalsupportcopingwithdifficulties.

Whatareyouaskedtodo?

Youwillbeaskedtocompletesomequestionsaboutyourfeelings,friendshipsand

schoollife.Thequestionswilltake20-40minutes.Itisnotatestandthereareno

rightorwronganswers.

Whoisbeingaskedtotakepart?

Allchildreninyouryeargroupatyourschoolwillbeaskedtotakepartinthisstudy.

Whichdataisbeingusedinthestudy?

Thestudymaycombineyourquestionnairedata(thesurveythatyouareaboutto

fillin)andinformationcollectedfromothersourcessuchasyourage,whetheryou

havespecialeducationalneedsyourschoolattendance,informationaboutyour

health,contactwithservicesandwhetheryouarereceivinganysupportfor

resilienceoremotionalwellbeing.NONEOFTHISINFORMATIONWILLBEUSEDTO

IDENTIFYYOU.

Howwillthedatabestoredandwhowillhaveaccesstoit?

Allofthesurveyswillbeconfidential.Youranswerswillbekeptsecretbythe

peoplewhoputthequestionsonthecomputer.Theydonotworkatyourschoolor

knowwhoyouare.Yourparentsandyourteacherhavebeentoldthatyouare

APPENDICES

428

answeringquestionsbuttheywillnotseeyouranswers.Amemberoftheresearch

teamandadesignateddataleadatyourlocalauthoritywillhaveaccesstoyour

databuttheywillnotuseittoidentifyyouinanyway.Yourpersonalinformation

willonlybeusedtolinkinformationfromdifferentdatasources.Onceallthedata

islinkedyourpersonalinformationwillbetakenout.Alldatawillbecollectedand

storedinaccordancewiththeDataProtectionAct1998.

DoIhavetotakepart?

No!Itisuptoyouwhetherornotyoutakepartinthisstudy.Ifyoudecidenow,or

atalaterdate,thatyoudonotwishtoparticipateinthisresearchyouarefreeto

stopatanytime,withoutgivingareason.

Ifyouchoosenottotakepartyouwillnotgetintrouble.Evenifyoustarttotake

partandthenchangeyourmindthatisalsookay.

Ifyoustartthequestionnaire,youarefreetoskipquestionsthatyoudonotwant

toanswer.

Ifyouhaveanyquestionsaboutthissurveyorwhatyouwillbeaskedtodothen

askyourteacher.

Thankyouforthinkingabouttakingpartinourproject.

Whathappensnow?

Ifyouarehappytotakepart,pleaseticktheboxbelowandyoucanthenaccessthe

survey.

<onlinetickboxhere>

APPENDICES

429

AppendixM:QualitativeParticipantInformationSheetforYoungPeople

InformationSheetforYoungPeople

Whatistheresearchabout?ThisresearchislookingataprogrammecalledHeadStart,whichishappeninginsixareasacrossEngland.TheaimofHeadStartistogivesupporttoyoungpeopletoimprovetheirwellbeingandhelpthemtocopewithdifficultsituationsthattheymightfacenoworinthefuture.Thispartoftheresearchaimstofindoutmoreaboutthesupportbeingofferedtoyoungpeopleinthesesixareas.Itaimstofindoutwhathashelpedandwhathasbeenlesshelpful,inordertolearnforthefutureabouthowtoimprovesupportthataimstoincreaseyoungpeople’swellbeing.Whoarewespeakingto?WearespeakingtoyoungpeoplewhomayhavehadsupportfromHeadStart(orwhomayreceivesupportinthefuture),andstaffwhodeliverthissupport.Weareaskingdifferentgroupsofpeoplesothatwecanbuildupagoodpictureovertimeofwhatthissupporthasbeenlike,whoithashelped,andhowitcanbeimprovedinthefuture.WewouldliketoinviteyoutotakepartinthisresearchprojectbecauseyourschoolhassuggestedthatyouandotheryoungpeopleinyourschoolmayhavesomeexperienceofHeadStartsupportnoworinthefuture.Whatdoesthisinvolve?Takingpartinthisprojectmeansagreeingtobeinterviewedonceayearforuptofiveyears(thefinaltimewouldbewhenyouareinYear11).Youwillreceivea£10Love2Shopvoucheraftereachinterviewasathankyoufromtheresearchteamfortakingpart.Withyourpermission,wewillre-contactyoueachyeartoarrangeyourinterview.Thiswillbeaninterviewwithjustyouandaresearcher.Theresearcherwillaskyouafewquestionsaboutyourunderstandingofcopingindifficulttimes,andabouttheservicesorsupportthatyoumayhavereceived.Theresearcherwillaskaboutyourviews,opinions,andexperiences.Theconversationcanlastforaslongasyouwanttotalk(uptoamaximumof1hour),butwillusuallylastfor30to45minutes.Yourinterviewcantakeplaceinaprivateroomatyourschool,atyourhouse,orinalocalcommunitybuilding.Theresearcherwilltalktoyouaboutthequestionsthattheyaregoingtoaskyouatthebeginningoftheinterviewsothatyouwillknowwhattoexpect.Theinterviewwillbeaudio-recordedsothatwecan

Titleofproject:HeadStartQualitativeEvaluationThisstudyhasbeenapprovedbytheUCLResearchEthicsCommittee(ProjectIDNumber):7963/002

APPENDICES

430

writedownwhatyousaidafterwards,sothatwedon’tforget.Thewrittenversionoftheinterviewiscalleda‘transcript’.Whatarethebenefitsoftakingpart?Youtakingpartinthisprojectmayhelpustounderstandmoreaboutwhathelpstoincreaseyoungpeople’swellbeingandsomayhelptoimproveservicesforyoungpeople.Thismaybenefitotheryoungpeopleinthefuture.Somepeoplefindthattakingpartinresearchlikethiscanbeapositiveandinterestingexperience.Ifyouwouldliketoseewhatwefindfromthisresearch,youcantelltheresearcherthatyoumeetwithandwewillsendthistoyouattheendoftheproject(in2023).Whataretherisksoftakingpart?Therearefewriskstotakingpart.Occasionally,someonemayfeelupsetaboutsomethingthattheyaretalkingabout.Theresearchersthinkthatitisveryimportantthatyouarecomfortableintheinterviewandthatyouonlytalkaboutwhatyouwantto.Ifthereisanythingthatyoudon’twanttotalkaboutthenjustlettheresearcherknowandtheywilldefinitelynotpressureyoutodoso.If,aftertheinterview,youfeelupsetandwanttotalktosomeonefurther,theresearcherwillhavegivenyoualistofpeopleinyourlocalareathatyoucanspeakwith.Willinformationaboutmebekeptconfidential?Yourinterviewwillbekeptstrictlyconfidentialorprivate.Theonlytimethatwemightneedtobreakthisruleisifyoutellussomethingthatmakesusthinkthatyou,orsomeoneelse,isindanger.Inthatcase,wewillhavetotellsomeonewhocanstopthatdangerfromhappening.Audiorecordingswillbekeptinapassword-protectedcomputerfolderandwillonlybeaccessedbyresearchersinvolvedwiththisproject.Whentherecordingsaretypedupastranscripts,anydetailsthatcanidentifyyouasanindividualwillbetakenout.Thismeansthatyournamewillbechanged,aswellasthenamesofothersorplacesthatyoumaymention.Wemaywriteupsomeofthethingsthatyousayinreports,whichwillbereadbypeopleoutsideofthisresearch,butotherpeoplewon’tbeabletorecognisethatit’syouinthereports.Wewillkeepaudiorecordingsupuntiltheendoftheproject(May2023),whentheywillbedeleted.WhathappensifIchangemymind?Youcanchangeyourmindabouttakingpartinthisresearch,atanytime.Youdonothavetotellusareasonforthis.Ifyoudowishtoleavethestudy,yourinterviewaudiorecordingandtranscriptwillbedeleted.Oncewehavewrittenthereportsofthefindings(4-6monthsaftertheinterviews),itwillnotbepossibletowithdrawyourcontributions,soitisbesttotellusassoonaspossibleifyoudochangeyourmind.Youcanalsostoptheinterviewatanypoint–justtellthe

APPENDICES

431

researcherinterviewingyouthatyounolongerwishtotakepart.Leavingthestudyatanystagewillnotaffecthowanyonetreatsyouandwillnotaffecttheservicesthatyoumayreceive.Itwillnotdisadvantageyouinanyway.Whathappensnext?Pleasediscusstheinformationabovewithothersoraskusifthereisanythingthatisnotclearorifyouwouldlikemoreinformation.Youcankeepthisinformationsheettolookatwheneveryouneedto.Ifyoudecidethatyouwouldliketotakepart,youcantellyourparent/guardianandgiveyourassent(onawrittenform).Yourparent/guardianmustalsogivetheirconsent(onawrittenform)inorderfortheinterviewtogoahead.Thenyouandyourparent/guardiancanreturntheformstousandwewillarrangeatime,atyourconvenience,tointerviewyou.Alldatawillbecollectedandstoredinaccordancewithprevailingdataprotectionlegislation.

Researchercontactdetails:Name:EmilyStapleyContactdetails:Ifyouhaveanyquestions,[email protected]

APPENDICES

432

AppendixN:QualitativeInformationPackforParents/Carers(coverletter,informationletter,andconsentform)

DearParent/Carer,

Thisletterisaboutaresearchproject,ledbytheAnnaFreudNationalCentreforChildrenandFamilies,toevaluateaprogrammecalledHeadStart.HeadStartisa5-yearprogrammeaimingtoincreaseresilienceandwellbeingin10-16yearoldsinsixareasacrossEngland,ofwhich[nameofpartnership]isone.

Allyoungpeopleexperiencedifficulttimesatonepointoranother.Thisprojectisareallyexcitingandone-of-a-kindopportunityforustolearnvaluableinformationaboutyoungpeople’sperspectivesoncopingindifficulttimes,thesupportthattheymayreceiveinrelationtotheirwellbeing,andhowthismaychangeovertime.

Weareaskingyoutohelpbyallowingyourchildtoparticipateinthisstudy.Thenextfewpages:

Tellyouabitabouttheprojectandwhatitinvolvesforyourchild

Askyouifyouarehappyforyourchildtoparticipateinthisproject

Giveyouaconsentformtosignandsendbacktoyourchild’sschoolifyouarehappyforyourchildtotakepart

Beforeyouandyourchilddecidewhetheryourchildwouldliketotakepartinthisresearchproject,itisimportantforyoutoknowwhatthiswillinvolve.Pleasetaketimetoreadtheattachedinformationsheetcarefullyanddiscussitwithothersifyouwish.Ifthereisanythingthatisnotclear,orifyouwouldlikemoreinformation,pleasedonothesitatetocontactus.

Ifyouhaveanyquestions,[email protected].

Anypersonalinformationwillbetreatedconfidentiallyandwillnotbesharedbeyondtheresearchteam.TheinformationwillbehandledinaccordancewiththeprovisionsoftheDataProtectionAct1998.

Thankyoufortakingthetimetoreadaboutourproject.Wemaynotbeabletointervieweveryone,butifyouarehappyforyourchildtotakepart,pleasesignandreturntheattachedconsentformto[nameofstaffmemberatyourchild’sschool].

Yoursfaithfully,

DrEmilyStapley

EvidenceBasedPracticeUnit(EBPU),UniversityCollegeLondonandAnnaFreudNationalCentreforChildrenandFamilies,4-8RodneyStreet,London,N19JH

APPENDICES

433

InformationSheetforParents/Carers

Whatistheresearchabout?ThisresearchislookingataprogrammecalledHeadStart,whichishappeninginsixareasacrossEngland.TheaimofHeadStartistoprovidesupporttoyoungpeopletoimprovetheirwellbeingandhelpthemtocopewithdifficultsituationsthattheymaybefacingnoworthattheymayfaceinthefuture.Thispartoftheresearchaimstofindoutmoreabouttheservicesthatarebeingofferedtoyoungpeopleinthesesixareastodothis.Itaimstofindoutwhathashelpedandwhathasbeenlesshelpful,inordertolearnforthefutureabouthowtoimproveservicesthataimtoincreaseyoungpeople’swellbeing.Whoarewespeakingto?WearespeakingtoyoungpeoplewhomayhavereceivedormayinfuturereceivesupportorservicesfromHeadStart,andstaffwhohaveorganisedtheservices.Weareaskingdifferentgroupsofpeoplesothatwecanbuildupagoodpictureovertimeofwhattheseserviceshavebeenlike,whotheyhavehelped,andhowtheycanbeimprovedinthefuture.WewouldliketoinviteyourchildtotakepartinthisresearchprojectbecausetheymayhaverecentlyusedaHeadStartservice.Whatdoesthisinvolve?Takingpartinthisprojectmeansagreeingforyourchildtobeinterviewedonceayearforuptofiveyears(thefinaltimewouldbewhenyourchildisinYear11).Yourchildwillreceivea£10Love2Shopvoucheraftereachinterviewasathankyoufromtheresearchteamfortakingpart.Withyourchild’spermission,wewillre-contactyourchildeachyeartoarrangetheirinterview.Thiswillbeaninterviewwithjustyourchildandaresearcher.Theresearcherwillaskyourchildsomequestionsabouttheirunderstandingofcopingindifficulttimes,andaboutthesupportorservicesthatyourchildmayhavereceived.Theresearcherwillaskaboutyourchild’sviews,opinions,andexperiences.Theconversationcanlastforaslongasyourchildwantstotalk(uptoamaximumof1hour),butwillusuallylastfor30to45minutes.Yourchild’sinterviewcantakeplaceinaprivateroomatyourchild’sschool,atyourhouse,orinalocalcommunitybuilding–whereverismoreconvenientforyouandyourchild.Theresearcherwilltalktoyourchildaboutthequestionsthattheyaregoingtoaskyourchildatthebeginningoftheinterviewsothatyourchildwillknowwhattoexpect.Theinterviewwillbeaudio-recordedsothatwecanwritedownwhatyourchildsaidafterwards,sothatwedon’tforget.Thewrittenversionoftheinterviewiscalleda‘transcript’.Whatarethebenefitsoftakingpart?Yourchildtakingpartinthisprojectmayhelpustounderstandmoreaboutwhathelpstoincreaseyoungpeople’swellbeingandsomayhelptoimproveservicesfor

APPENDICES

434

youngpeople.Thismaybenefitotheryoungpeopleinthefuture.Somepeoplefindthattakingpartinresearchlikethiscanbearewardingandinterestingexperience.Whataretherisksoftakingpart?Therearefewriskstotakingpart.Occasionally,someonemayfeelupsetaboutsomethingthattheyaretalkingabout.Theresearcherswillensurethatyourchildiscomfortableintheirinterviewandthatyourchildonlydiscusseswhattheyfeelabletotalkabout.Theresearcherswillaskyourchildtotellthemifthereisanythingthattheydon’twanttotalkaboutandtheywilldefinitelynotpressureyourchildtodoso.If,intheunlikelyeventyourchildfeelsupsetaftertheirinterviewandwantstotalktosomeonefurther,theresearcherwillhavegivenyourchildalistofpeopleinyourlocalareathattheycanspeakwith.Willinformationaboutmeandmychildbekeptconfidential?Yourchild’sinterviewwillbekeptstrictlyconfidentialorprivate.Theonlytimethatwemightneedtobreakthisruleisifyourchildtellsussomethingthatmakesusthinkthatyourchild,orsomeoneelse,isindanger.Inthatcase,wewillhavetotellsomeonewhocanstopthatdangerfromhappening.Audiorecordingswillbekeptinapassword-protectedcomputerfolderandwillonlybeaccessedbyresearchersinvolvedwiththisproject.Whentherecordingsaretypedupastranscripts,anydetailsthatcanidentifyyourchildasanindividualwillbetakenout.Thismeansthatyourchild’snamewillbechanged,aswellasthenamesofothersorplacesthatyourchildmaymention.Wemayusequotesfromyourchild’sinterviewwhenwewriteupreports,butitwillnotbepossibletoidentifyyourchildfromthequotes.Wewillkeepaudiorecordingsupuntiltheendoftheproject(May2023),whentheywillbedeleted.WhathappensifIchangemymind?Youand/oryourchildcanchangeyourmindsabouttakingpartinthisresearch,atanytime.Youdonothavetotellusareasonforthis.Ifyouand/oryourchilddowishtoleavethestudy,yourchild’sinterviewaudiorecordingandtranscriptwillbedeleted.Oncewehavewrittenthereportsofthefindings(4-6monthsaftertheinterviews),itwillnotbepossibletowithdrawyourchild’scontributions,soitisbesttotellusassoonaspossibleifyoudochangeyourmind.Yourchildcanalsostoptheinterviewatanypointandtheresearcherwillletthemknowatthestartoftheirinterviewthattheyjustneedtotelltheresearcherinterviewingthematanypointthattheynolongerwishtotakepart.Leavingthestudyatanystagewillnotaffecthowanyonetreatsyouoryourchildandwillnotaffecttheservicesthatyouoryourchildmayreceive.Itwillnotdisadvantageyouinanyway.Whathappensnext?

APPENDICES

435

Pleasediscusstheinformationabovewithothersoraskusifthereisanythingthatisnotclearorifyouwouldlikemoreinformation.Youcankeepthisinformationsheettolookatwheneveryouneedto.Ifyoudecidethatyouwouldlikeyourchildtotakepart,youwillneedtogiveyourconsent(onawrittenform).Yourchildmustalsogivetheirassent(onawrittenform)totakepartinorderfortheinterviewtogoahead.Thenyouandyourchildcanreturntheformstousandwewillarrangeatime,atyourconvenience,tointerviewyourchild.AlldatawillbecollectedandstoredinaccordancewiththeDataProtectionAct1998.Researchercontactdetails:Name:EmilyStapleyContactdetails:Ifyouhaveanyquestions,[email protected]

APPENDICES

436

InformedConsentFormforParents/Carers(AboutTheirChild)

Pleasecompletethisformafteryouhavereadtheinformationsheetand/orlistenedtoanexplanationabouttheresearch.TitleofProject:HeadStartQualitativeEvaluationThisstudyhasbeenapprovedbytheUCLResearchEthicsCommittee(ProjectIDNumber):7963/002Ifyouhaveanyquestionscomingfromtheinformationsheet,oranyotherquestionsabouttheresearchstudy,pleaseasktheresearcherbeforeyoudecidewhetherornotyougiveconsentforthechildoryoungpersonthatyouareresponsiblefortojoinin.Participant’sStatementI

• havereadthenoteswrittenaboveandtheinformationsheet,andunderstandwhatthestudyinvolves

• understandthatifIormychilddecideatanytimethatwenolongerwishtotakepartinthisproject,Icantelltheresearchersandleavethestudystraightaway.IunderstandthatIdonothavetogiveareasonforthisandthattheresearcherswon’texpectmeormychildto.IunderstandthatwithdrawingfromthestudywillnotaffectanyservicesthatwereceivefromHeadStartoranywhereelse

• understandthatmychild’sinterviewswillbeaudio-recordedandIagreetothisaudiorecording

• consenttotheinformationthatIandmychildgivebeingusedaspartofthisresearchstudy

• understandthatsuchinformationwillbetreatedasstrictlyconfidential,andhandledinlinewiththeDataProtectionAct1998

• understandthatthethingsthatmychildsaysmaybeusedinreportsalongwiththeresponsesofotherparticipantsinthestudy,butwillnotbeidentifiable

• consenttomychildbeingre-contactedbytheresearchteamonceayearoverthenextfiveyears

• agreethattheresearchprojectnamedabovehasbeenexplainedenoughtomeandIagreeformychildtotakepartinthisstudy

Signed Date:

APPENDICES

437

AppendixO:QualitativeParticipantAssentFormYouareagreeingthat:• Youarehappytobeinterviewed• Wewillaudiorecordtoday’sconversationandtypeitupasatranscript• Wemaywriteupyourviewsinreports,whichwillbereadbypeopleoutsideof

thisresearch,butotherpeoplewon’tbeabletorecognisethatit’syouinthereports

• Youarehappyforustore-contactyounextyearaboutarranginganotherinterviewwithyou

Weareagreeingthat:• Thisformwillbekeptinalockedfilingcabinet• Theaudiorecordingandtranscriptofyourinterviewwillonlybeaccessedby

researchersinvolvedwiththisproject

Pleasecircletheanswersbelow:

Hassomebodyelseexplainedthisresearchtoyou? Yes/No

Doyouunderstandwhatthisresearchisabout? Yes/No

Haveyouaskedallthequestionsyouwant? Yes/No

Haveyouhadyourquestionsansweredinawayyouunderstand? Yes/No

Doyouunderstandit’sOKtostoptakingpartatanytime? Yes/No

Areyouhappytotakepart? Yes/No

Ifanyanswersare‘no’oryoudon’twanttotakepart,don’tsignyourname!Ifyoudowanttotakepart,youcanwriteyournamebelow:

________________ ________________Myname Date________________ ________________ ________________Nameofresearcher Date Signaturetakingconsent

APPENDICES

438

AppendixP:DemographicFormforQualitativeParticipantsAboutMe

Iam:(age)………years………monthsIam:(pleasetick)Male☐Female☐Other☐Pleasespecify:Prefernottodisclose☐Iam:(pleasetick)WhiteBritish☐Irish☐AnyotherWhitebackground☐AsianorAsianBritishIndian☐Pakistani☐Bangladeshi☐Chinese☐AnyotherAsianbackground☐MixedWhiteandBlackAfrican☐WhiteandBlackCaribbean☐WhiteandAsian☐OtherAnyotherethnicgroup☐Pleasespecify:…………………Prefernottodisclose☐ParticipantIDnumber:

APPENDICES

439

AppendixQ:ExampleofInitialThoughtsDocumentedinStageOneofQualitativeAnalysis(Amelia)

• WorryisacentralelementofAmelia’slife• Sheplacesclearvalueonothersknowingherdifficultiesandbeingawareofherneeds

–otherpeopleareimportanttoher• Dogisimportantalso,seemstiedinwithfeelings• Worryaboutpossiblenegativeoutcomes–whatwillhappen,willthishappen?• Worriesasatangiblething–‘myworries’likeaphysicalcarry-ablethingalmost?

Separatetoher?• Mistakes,gettingsomethingwrong–tiedintoOCDanxiety?• ‘Where’stheevidence’–pastCBT?CBTelements?DoesAmeliaactuallyusethis

techniqueorisitalearntmantraofsorts?Thisisunclear.• ‘Idecidedtosit’–respondingtoneeds;agency• Whendogisscared,doesthisreflectpartofAmelia?Isshereassuredbythis?Also

describeshappinesswhendogisnotscared.Seemstoreflectherinnerprocesses(andpotentialforlesseningofthese?)

• Family=important,centralpartoflife• Happyistheabsenceofworry;discussionof‘happy’frequentlyreturnstoworrytalk• Schoolandhomeworkandacademicexpectationscreatealotofstressandworryfor

Amelia• ‘Xhelpsme’often!• ‘Mummy’–seemsaveryyoungwordforage,reflectfamilydynamic?• ‘Idon’tknowwhy’–I’mnotincontrolofthis,Idon’tunderstand• Thingsbeingphysicallyperfect–tie,clothingetc.,aswellasperformance,i.e.academic

workandhomework• Laterininterviewsomeofthetalkaroundmumshifts–mumasfrustrated,mad,stop

makingproblembiggeretc.(isAmeliadisappointedpeopleinhereyes?)• ‘Soundweird’–concernoverwhatotherswillthink• Couldthephysicalityof‘myworries’comefromvisualisationexercisewithsupport?P.

15• Supportworkerprovidesanotheravenueoutsideofparents• Epilepsyfeedsworryandstress• Worryandstress–sameordifferent?• Somethingisherearoundtheongoingnessofherworriesbeingherfault–Iforgotto

flickitaway,I’mfeedingthem,sometimesIforget–anelementofblameratherthanresponsibility,maybe?

• Difficultyexplainingwhatthe‘badthing’is–isitunknown?• MumprioritisingschooloverSMASH;Ameliadoesn’tseemtoagree• Emotionalcontagion:dadstressed=Igetstressed• Talkingisgood• SchooladviceseemstobewhatothersaretellingAmeliabutshestrugglestoenactthis• Elementsofpowerlessness?Difficultyusingstrategyplusmuminfluence?

APPENDICES

440

• Issheanxiousintheinterview?Shehashistorynext,thiscouldbefeedingintotheconsistencyofworriesascentral

• Relativityinacademicdifficulty?IfeveryoneelseisokaybutI’mstruggling…he’llgetmad

• Worryseemsexcessivearoundparticularthingsbutalsogenerally‘justdosomethingwrongingeneral’

• Worriesaffectdailylifeandstopherhavingexperiences–again,elementsofpowerlessness

• ‘Doyouwant,like’–effortstomakesureshe’sfollowingtheinterviewer,seemsalittlenervous

• What’sthedifferencebetweenremovingworriesanddistraction?P.26• Dodgeball–thingsaremyfault.ShouldIbetryingharder?• Reroutesbackto‘helpsme’frequently• ‘AmIdoingitright’–fearofmistakes,doesthislinkwithhercheckinginwiththe

interviewerandseekingpermission• HedoeshelpmebutIstillhavetodoit• Privateconversations–SMASHandsupport–seemvalued• ‘Somethingbadwillhappen’–fearofpossibleconsequences,worstcasescenario,fear

ofunknown

APPENDICES

441

AppendixR:AnalyticalCodingColumnsandExampleofInitialCodinginStageTwoofQualitativeAnalysis(Amelia)

Th

emes

REFLEX

IVE:linkwith

thisasbeingexplicitlype

rfectio

nistm

ayre

flectm

yow

niss

uesw

ithth

is

Concep

t

Rumination

It’sm

yrespon

sibility

tonotm

akeitbigger,

but,Iamm

akingit

bigger,I’m

notin

controlofit

“Ihaveaworry”

again,re

peated

useof

phrase,w

orryasa

thingthatIha

ve

Rumination

Othersk

nowingmy

need

s(even

thedo

g)

isrelevantand

valuab

le

Itmakesm

yworrygo

away–ta

ngible,

passive

Alleviatesso

mebu

tno

tall

Limitsof‘eviden

ce’–

wha

tifthe

reisn’t

any?The

nwha

t?Fear

ofunkno

wnne

gativ

econseq

uences–wha

tifsalways

unde

rpinne

dby

outcom

ebe

inga

negativ

eon

e“Idon

’tknow

why”–

passive,notincon

trol

ofinne

rprocesses

Ikno

wworryisn’t

accuratebutth

isdo

esn’th

elp

Conten

t

“it’snotgon

na

happ

en”–

mism

atch

Mum

tellingm

eI’m

makingthe

prob

lembigger

Mydo

gisattune

dtom

ymoo

dan

dknow

swhe

nI’m

worrie

d

Isitan

dthinkab

out

it

Shecantellan

dshe

respon

ds,brin

gs

meatoy

“inmyhe

ad”

myworrygoe

saw

ay–butnot

entirely,Istillhave

questio

ns–only“a

bit”

“Wha

tif,wha

tif”–

wha

tmight

happ

en?

Everythinghasto

be

perfect

“Idon

’tknow

why”

–mymum

saysX

butI’m

stillworrie

d(doe

sn’the

lp)

Stream

“aworry”versus

“myworrie

s”as

elsewhe

re–iseach

onedistinct?

Perfectio

nistic

tend

encies?Note–

laterm

entio

nof

OCD

?

I:Aretherean

yothe

rexamples,erm

…ofo

f,thingsliketh

at,o

fbitsofe

vide

nce

thatyou

kindofth

inkab

out?

P:Yeah,whe

nlike,likeagainwhe

nIh

aveaworryorsom

ething,m

ymum

sayslike

whe

re’sth

eeviden

ce,you

kno

w,it’snotgon

nahap

pensolikestop

makingthe

prob

lembiggera

nderm

,mydo

gcantellwhe

nI’m

worrie

daswellcau

senormally

Iplaywith

herbutIjustsitd

ownlikeIsaidlikeearlieronan

djustliketh

inkab

out

itan

dsheno

rmallyjustlikecom

eswith

ato

yorso

mething,soshealsohelpsm

ea

lotb

ecau

sesh

ecantellifI’m

upsetorsom

ething…so

shehe

lpsa

lot.

I:Okay…

doyo

ufin

dithe

lpfultothinkab

outthe

…you

kno

w,w

onde

ringab

out

theeviden

ce?How

doe

sthat,w

henyo

uthinkofwha

t’sth

eeviden

cefo

rthis,

howdoe

s,how

doyo

uthinkthathelps?

P:W

ellIth

inkithe

lpslikeabitb

ecau

seitm

akeslikem

yworrygoaw

aybutstill

likeinm

yhe

adth

ere’slikequ

estio

nssa

yingbutwha

tifthe

reisn’ta

nyevide

nceor

wha

tifthish

appe

nsor…

likefo

rexampleifmytie

intrightor,it’slikeeverything

hastobe

perfect,Idon

’tknow

whybut,ith

asto

bepe

rfecttolike,butm

ymum

saidnoon

e’sp

erfect,b

utitstillgetsm

eworrie

d.It’sjusthow

…

I:So

isth

atafe

elingyo

uha

ve,the

n,th

atsom

ething

abo

utwan

tingthingsto

be…

APPENDICES

442

AppendixS:ExampleofEmergentThemesAlongsideDataandCodinginStageThreeofQualitativeAnalysis(Amelia)

Them

es

Worrie

sas

tangible

Rumination

Others

know

ingmy

need

s,

supp

ort

Passive

Worryas

tangible

Lackof

control

Spira

lling

Ane

edto

be

perfect

Fallibilityof

strategy

Passive“I

don’tk

now

REFLEX

IVE:linkwith

thisasbeingexplicitlype

rfectio

nistm

ayre

flectm

yow

niss

uesw

ithth

is

Concep

t

Rumination

It’sm

yrespon

sibility

tonotm

akeitbigger,

but,Iamm

akingit

bigger,I’m

notin

controlofit

“Ihaveaworry”

again,re

peated

useof

phrase,w

orryasa

thingthatIha

ve

Rumination

Othersk

nowingmy

need

s(even

thedo

g)

isrelevantand

valuab

le

Itmakesm

yworrygo

away–ta

ngible,

passive

Alleviatesso

mebu

tno

tall

Limitsof‘eviden

ce’–

wha

tifthe

reisn’t

any?The

nwha

t?Fear

ofunkno

wnne

gativ

econseq

uences–wha

tifsalways

unde

rpinne

dby

outcom

ebe

inga

negativ

eon

e“Idon

’tknow

why”–

passive,notincon

trol

ofinne

rprocesses

Ikno

wworryisn’t

accuratebutth

isdo

esn’th

elp

Conten

t

“it’snotgon

na

happ

en”–

mism

atch

Mum

tellingm

eI’m

makingthe

prob

lembigger

Mydo

gisattune

dtom

ymoo

dan

dknow

swhe

nI’m

worrie

d

Isitan

dthinkab

out

it

Shecantellan

dshe

respon

ds,brin

gs

meatoy

“inmyhe

ad”

myworrygoe

saw

ay–butnot

entirely,Istillhave

questio

ns–only“a

bit”

“Wha

tif,wha

tif”–

wha

tmight

happ

en?

Everythinghasto

be

perfect

“Idon

’tknow

why”

–mymum

saysX

butI’m

stillworrie

d(doe

sn’the

lp)

Stream

“aworry”versus

“myworrie

s”as

elsewhe

re–iseach

onedistinct?

Perfectio

nistic

tend

encies?Note–

laterm

entio

nof

OCD

?

I:Aretherean

yothe

rexamples,erm

…ofo

f,thingsliketh

at,o

fbitsofe

vide

nce

thatyou

kindofth

inkab

out?

P:Yeah,whe

nlike,likeagainwhe

nIh

aveaworryorsom

ething,m

ymum

sayslike

whe

re’sth

eeviden

ce,you

kno

w,it’snotgon

nahap

pensolikestop

makingthe

prob

lembiggera

nderm

,mydo

gcantellwhe

nI’m

worrie

daswellcau

senormally

Iplaywith

herbutIjustsitd

ownlikeIsaidlikeearlieronan

djustliketh

inkab

out

itan

dsheno

rmallyjustlikecom

eswith

ato

yorso

mething,soshealsohelpsm

ea

lotb

ecau

sesh

ecantellifI’m

upsetorsom

ething…so

shehe

lpsa

lot.

I:Okay…

doyo

ufin

dithe

lpfultothinkab

outthe

…you

kno

w,w

onde

ringab

out

theeviden

ce?How

doe

sthat,w

henyo

uthinkofwha

t’sth

eeviden

cefo

rthis,

howdoe

s,how

doyo

uthinkthathelps?

P:W

ellIth

inkithe

lpslikeabitb

ecau

seitm

akeslikem

yworrygoaw

aybutstill

likeinm

yhe

adth

ere’slikequ

estio

nssa

yingbutwha

tifthe

reisn’ta

nyevide

nceor

wha

tifthish

appe

nsor…

likefo

rexampleifmytie

intrightor,it’slikeeverything

hastobe

perfect,Idon

’tknow

whybut,ith

asto

bepe

rfecttolike,butm

ymum

saidnoon

e’sp

erfect,b

utitstillgetsm

eworrie

d.It’sjusthow

…

I:So

isth

atafe

elingyo

uha

ve,the

n,th

atsom

ething

abo

utwan

tingthingsto

be…

APPENDICES

443

AppendixT:DetailedAccountofPreliminaryAnalysisResultsMissingness

Missingvaluesarecommoninquantitativeinquiry,particularlyin

educationalandpsychologicalresearch(Pengetal.,2007;Peugh&Enders,2004),

andcanoccurforvariousreasonsincludingsystemerrorsanditemnonresponse

(Little&Rubin,2002).Analyticaleffectsvarycontextuallyduetofactorsincluding

samplesize,patternsofmissingness,anddatalossmechanism;thus,thereisno

establishedcutoffforacceptablelevelsofmissingness(Dong&Peng,2013;

Tabachnick&Fidell,2013).Bennett(2001)indicatestenpercentaspotentially

problematic,whilePengetal.(2007)advisetwentypercent.TabachnickandFidell

(2013)conservativelysuggestthatinalargedatasetwithrandomlyoccurring

missingness,belowfivepercentcanbeacceptable,thoughtheyemphasisethatthis

dependsondatasetcharacteristics,whileCheema(2014)advisessomemissingness

inalargesampleisnon-problematic.

Itisusefultoexaminethepatternofmissingness,asmissingvaluescan

occurwithinisolatedvariables,acrossrandomunrelatedvariables,oracrossrelated

variables(Dong&Peng,2013;Schafer&Graham,2002);thelatteroftenoccursdue

tosurveynonresponsewhendemographicinformationisobtainedseparately

(Grovesetal.,2002;Schafer&Graham,2002),asinthecurrentstudy.Littleand

Rubin(1987,2002)outlinedthreemechanismsformissingness:(a)MCAR,where

missingnessisrandom;(b)MAR,wheremissingnessispredictedbyothermeasured

variables;and(c)notmissingatrandom(NMAR),wheremissingnessisassociated

withthevariableitself.MCARistestedusingamultivariateanalysisoutlinedby

Little(1988).MARisexploredbyinvestigatingtherelationshipbetween

missingnessandothervariables,suchasparticipantcharacteristics(Kline,2016;

Tabachnick&Fidell,2013).NMARischallengingtoassess,asverifyingwhether

missingnessonavariableiscausedbythevariableitselfrequiresknowledgeofthe

missingvalues(Kline,2016;Little&Rubin,2002;Peugh&Enders,2004).AsNMAR

cannotberejected,MARcannotbefullyacceptedandisinsteadexploredfor

transparency(Little&Rubin,2002;Peugh&Enders,2004).

APPENDICES

444

Here,allsurveyitemscontainedmissingdata(2.3–5.9%).Alldemographic

variablesexceptchildinneedstatuscontainedmissingvalues(0.4–7.2%).32.3%(N

=2,681)hadatleastonemissingvalueacrossitemanddemographicvariables.

Little's(1988)MCARtestwassignificantatthe.05αlevel(p<.001)andsoMCAR

wasrejected.Alogisticmultipleregressionwithallparticipantcharacteristics

indicatedthat:(a)lowacademicattainmentpredictednonresponseonallbuttwo

surveyitems;(b)SENpredictedmissingnessforthreeSDQitems,oneSRSschool

adultconnectionitem,andseveralSRSpeerconnectionitems;and(c)ethnicgroup,

speakingEnglishasanadditionallanguage,andlowneighbourhoodsocioeconomic

statuswerefrequentpredictorsofmissingnessonitemsacrosstheSRSsubscales(p

<.05).Thus,missingitem-leveldatawasassumedtobeMAR,thoughtentativelyas

NMARcannotbeexamined.

DataAssumptions

Datawerereviewedagainstanalyticalassumptions,namelyoutliers,

multicollinearity,skewnessandkurtosis,floorandceilingeffects,andlinearityand

homoscedasticity(seeTableT1overleaf).Therewereconsistentinstancesofceiling

effectsandoutliersacrossSRSitems.ThisdistributionreflectstheParetoprinciple,

wherebythemajorityofapopulationislikelytorespondinaparticularwayand

thusonlyaminorityresponddifferently(Aguinisetal.,2013).Here,thislikely

reflectsuseofacommunitysample,whereinitisunsurprisingthatmost

participantsreportedhigherSRSscores.However,departuresfromnormal

distributionassumptions,asobservedhere,canbelessproblematicwithinlarger

samples(Kline,2016)andsoarenotexpectedtobesubstantiallyinfluentialhere.

Furthermore,theWLSMVestimatorusedinmainanalysisdoesnotmake

distributionalassumptionsaboutfactorindicatorswheretheyaretreatedasordinal

ratherthancontinuous(Li,2016)andasensitivityanalysiswasundertakenusing

theMLRestimator,whichproducesstandarderrorsrobusttonon-normality

(Muthén&Muthén,1998-2010).

APPENDICES

445

TableT1

SummaryofDataAssumptions,AdoptedThresholds,andResultsacrosstheDataset

Assumption Threshold Result

Outliers Themedianabsolute

deviation(MAD)should

notexceed2.24(Huber,

1981)orwherethe

mediancapturesmore

than50%ofcasesa

modifiedz-scoreestimate

shouldnotexceed3.5

(Iglewicz&Hoaglin,1993)

16SRSitemscoresshowedamodifiedz-score

exceeding3.5,fourfamilyadultconnectionitems,

fourcommunityadultconnectionsubscaleitems,

andeightschoolpeerconnectionsubscales;

outliersweregenerallyclusteredonavalueof

one,or‘never’

Multicollinearity Bivariatecorrelations

shouldnotexceed.70

(Tabachnick&Fidell,

2013)

ü

Skewness Skewnessshouldnot

exceedanabsolutevalue

of2,giventhelarge

samplesize(West,Finch,

&Curran,1995)

ü

Kurtosis Kurtosisshouldnotexceed

anabsolutevalueof7

(Westetal.,1995)

ü

Flooreffects Thelowestpossibleitem

valuecapture<15%of

responses(Terweeetal.,

2007)

FlooreffectsobservedforallSDQitems(24.2-

52.1%),thetwopositively-wordedPSS-4items

(21.1-28.4%),oneschooladultconnectionitem

(19.2%),andoneengagementinextracurricular

activitiesitem(26.3%)

Ceilingeffects Thehighestpossibleitem

valueshouldcapture<15%

ofresponses(Terweeet

al.,2007)

CeilingeffectsobservedforfourSDQitems(17.4-

42.0%),andallbutoneSRSsubscaleitems(27.9-

87.1%)

Linearity Residualsshouldcluster

aroundthezerolineina

residualplot,ratherthan

curving(Mertler&

ü

APPENDICES

446

Reinhart,2017)

Homoscedasticity Datapointsshouldbe

evenlydistributedaround

thezerolineinaresidual

plot(Mertler&Reinhart,

2017;Tabachnick&Fidell,

2013)

ü

FactorStructureandPsychometricPropertiesofMeasures

FactorStructure

SDQEmotionalSymptomsSubscale.Inlinewithoriginalconstructionofthe

SDQ(Goodmanetal.,1998),aunidimensionalstructurewasassessedforthe

emotionalsymptomssubscale.Fitindicesindicatedacceptablefitwithacceptable

factorloadings(TableT2):χ2(5)=255.28,p<.001;RMSEA=.08,90%CI[.07,.09],

p<.001;CFI=.98,TLI=.95.

TableT2

StandardisedFactorLoadingsandIntraclusterCorrelationCoefficientsforSDQEmotionalSymptoms

Subscale

Items λ ICC

Igetaloadofheadaches,stomach-achesorsickness .51*** .02

Iworryalot .78*** .02

Iamoftenunhappy,downheartedortearful .72*** .01

Iamnervousinnewsituations.Ieasilyloseconfidence .62*** .02

Ihavemanyfears,Iameasilyscared .66*** .01

Note.λ=standardisedfactorloadings;SDQ=StrengthsandDifficultiesQuestionnaire=;ICC=

intraclustercorrelationcoefficient.

***p<.001.

PSS-4UnidimensionalandMultifactorialExploration.Twostructureswere

investigatedforthePSS-4:aone-factormodelinlinewiththeoriginalmeasure

(Cohenetal.,1983),anda2-factormodelcomprisingperceiveddistressand

APPENDICES

447

perceivedcoping,givenprevioussupportforbothaunidimensional(Lesageetal.,

2012;Mitchelletal.,2008)anda2-dimensionalstructure(Demkowiczetal.,2019;

Leungetal.,2010;seeTableT3).

Theone-factorstructureshowedpoorfit:χ2(2)=1,182.44,p<.001;RMSEA

=.27,90%CI[.29,.30],p<.001;CFI=.86,TLI=.58.ExaminationofMIandSEPC

statisticssuggestedthatresidualcorrelationsbetweenthefirstandfourthitems

(positively-worded)andthesecondandthirditems(negatively-worded)shouldbe

freelyestimated,whileallresidualcorrelationmatrixvaluesexceeded.10.The2-

factorstructureshowedgoodfit:χ2(1)=20.99,p<.001;RMSEA=.05,90%CI[.03,

.07],p=.46;CFI=1.00,TLI=.99,withimprovedMIandSEPCvaluesandacceptable

residualcorrelations.Examinationofa2-factorstructurewaspre-determinedand

theoreticallygroundedandthesevaluesprovidedempiricalsupportforre-

specification.Thus,CFAindicatedsupportforthe2-factorstructureofthePSS-4

andassuchthisstructureisutilisedwithinthecurrentstudy.Notethatinanalysis,

theperceivedcopingfactoritemsarenolongerreverse-codedastheycomprisea

distinctfactorandsoneednotvaryinthesamedirectionastheitemsforming

perceiveddistress.Furthermore,thesefactorsarecorrelatedinanymodelwhere

bothareusedasamoderatetolargelatentcorrelationof.46(p<.001)was

observed.SeeTableT3forfactorloadings.

TableT3StandardisedFactorLoadingsandIntraclusterCorrelationCoefficientsforPSS-4UnidimensionalandMultidimensionalStructures Standardisedfactorloadings 2-factorstructure(λ) Items

Onefactorstructure(λ)

Perceiveddistress

Perceivedcoping

ICC


.66 .68 – .01

Inthelastmonth,howoftenhaveyoufeltconfidentaboutyourabilitytohandleyourpersonalproblems?

.44 – .61 .01

Inthelastmonth,howoftenhaveyoufeltthatthingsweregoingyourway?

.51 – .73 .01

APPENDICES

448

Inthelastmonth,howoftenhaveyoufeltdifficultieswerepilingupsohighthatyoucouldnotovercomethem?

.83 .91 – .01

Note.λ=standardisedfactorloadings;CFA=ConfirmatoryFactorAnalysis;PSS-4=four-itemPerceivedStressScale;ICC=intraclustercorrelationcoefficient.Allparameterestimatesshownaresignificantatthe.001level.

SRSsubscales.ConsistentwiththeoriginalconstructionoftheSRS(Sun&

Stewart,2007),a6-domainmultidimensionalstructurewasassessed.Results

indicatedgoodfit:χ2(419)=3,853.581,p<.001;RMSEA=.032,90%CI[.031,.033],

p=1.00;CFI=0.98,TLI=0.98(seeTableT4forfactorloadingsandICCs).

TableT4StandardisedFactorLoadingsandIntraclusterCorrelationCoefficientsforStudentResilienceSurveySubscaleItemsSubscales Items λ ICCFamilyadultconnection

Athome,thereisanadultwho…

Isinterestedinmyschoolwork .77 .02 BelievesthatIwillbeasuccess .84 .01 Wantsmetodomybest .81 .04 ListenstomewhenIhavesomethingtosay .81 .01Schooladultconnection

Atschool,thereisanadultwho…

Reallycaresaboutme .78 .03 TellsmewhenIdoagoodjob .85 .02 ListenstomewhenIhavesomethingtosay .81 .02 BelievesthatIwillbeasuccess .85 .02Communityadultconnection

Awayfromschool,thereisanadultwho…

Reallycaresaboutme .87 .02 TellsmewhenIdoagoodjob .90 .01 BelievesthatIwillbeasuccess .92 .01 Itrust .81 .02Peersupport Aretherestudentsatyourschoolwhowould… Chooseyouonyourteamatschool .75 .01 Tellyouyou’regoodatdoingthings .78 .02 Explaintherulesofagameifyoudidn’t

understandthem.73 .02

Inviteyoutotheirhome .71 .03 Sharethingswithyou .82 .01 Helpyouifyouhurtyourself .83 .02 Missyouifyouweren’tatschool .82 .01

APPENDICES

449

Makeyoufeelbetterifsomethingisbotheringyou .83 .01 Pickyouforapartner .82 .00 Helpyouifotherstudentsarebeingmeantoyou .85 .01 Tellyouyou’retheirfriend .86 .01 Askyoutojoininwhenyouareallalone .86 .01 Tellyousecrets .71 .01Activeengagementinhomeandschoollife

Idothingsathomethatmakeadifference(i.e.makethingsbetter)

.73 .01

Ihelpmyfamilymakedecisions .73 .01 Atschool,Ihelpdecidethingslikeclassactivitiesor

rules.66 .01

Idothingsatmyschoolthatmakeadifference(i.e.makethingsbetter)

.77 .01

Engagementinextracurricularactivities

Awayfromschool…

Iamamemberofaclub,sportsteam,churchgroup,orothergroup

.79 .08

Itakelessonsinmusic,art,sports,orhaveahobby .86 .06Note.λ=standardisedfactorloadings;ICC=intraclustercorrelationcoefficient.Allparameterestimatesshownaresignificantatthe.001level.

TableT5presentslatentcorrelationsacrosssubscales;thesearesimilarin

magnitudetoresultsfromLereyaetal.(2016).

TableT5LatentCorrelationsbetweenStudentResilienceSurveySubscalesFactor 1 2 3 4 5 61.Familyadultconnection — 2.Schooladultconnection .52 — 3.Communityadultconnection .64 .50 — 4.Schoolpeerconnection .50 .40 .51 — 5.Activeengagementinhomeandschoollife

.60 .53 .54 .55 —

6.Engagementinextracurricularactivities

.30 .18 .34 .26 .40 —

Note.Alllatentcorrelationcoefficientsshownaresignificantatthe.001level.

InternalConsistency

AnalysisindicatedthattheSDQemotionalsymptomssubscaleandallSRS

subscalesshowedagoodlevelofinternalconsistency(TableT6).Givensupportfor

APPENDICES

450

a2-factorstructureforthePSS-4,scalereliabilitywasassessedatboththeone-

factorandthe2-factorlevel.Fortheone-factorstructure,bothCronbach’sαand

McDonald’sωvalueswererelativelylow.Whilebothstatisticsshowcomparatively

highervaluesforthe2-itemperceiveddistressfactor,lowervalueswereobserved

forperceivedcoping.Itisplausiblethatthisdiscrepancyispartiallyduetothelow

numberofitems(Kline,2016;Raykov,1997),althoughthevaluesforperceived

distressweremorefavourable.Thus,valuesforperceivedcopingmayindicatethat

thissub-factorisdefinedonthebasisofreversewordingeffects,asindicated

previously(Demkowiczetal.,2019),ratherthanduetoahighlevelofagreementin

theconstruct.

TableT6ReliabilityCoefficientsMeasure No.ofitems Cronbach’sα McDonald’sωSDQemotionalsymptoms 5 .72 .80PSS-4perceivedstress(allitems) 4 .63 .72PSS-4perceiveddistress(items1and4) 2 .71 .76PSS-4perceivedcoping(items2and3) 2 .57 .62SRSfamilyadultconnection 4 .77 .88SRSschooladultconnection 4 .86 .89SRScommunityadultconnection 4 .88 .93SRSschoolpeersupport 13 .93 .96SRSactiveengagementinhomeandschoollife

4 .77 .81

SRSengagementinextracurricularactivities

2 .71 .87

Note.SDQ=StrengthsandDifficultiesQuestionnaire;PSS-4=four-itemPerceivedStressScale;SRS=StudentResilienceSurvey.

SummaryofPsychometricProperties

ResultsindicatethattheSDQemotionalsymptomssubscaleandallSRS

subscalesarerobustforuseinthestudy.Findingssuggestthatitwouldbe

appropriatetoutilisea2-factorstructureforthePSS-4,ratherthanthe

unidimensionalformatproposedinitsoriginalconstruction.However,thelow

internalconsistencyfortheperceivedcopingsub-factorandpreviousindications

thatthisstructureislikelytheresultofreversewordingeffects(Demkowiczetal.,

APPENDICES

451

2019),indicatinganeedforcautionininferences.Thus,findingsinrelationtothis

measurearepresentedtentatively.

APPENDICES

452

AppendixU:IntegrationofIndividual-LevelThemesintoMasterThemesTableU1Integrationofthemes:individualthemetrackingParticipantandindividualtheme CorpusthemeAmelia Worriesastangible (1.1)Thenatureofsymptoms(objectorstate)

(2.2)SymptomsareseparatefrommyidentityWorriesasseparatefromme (2.2)SymptomsareseparatefrommyidentityWorriesarepluralandcanmultiply (1.2)SymptomsareapluralmassthatcangrowWorriesareintertwinedwithotherdisorders (1.1)Thenatureofsymptoms(objectorstate)Othershelpme (4.1)MappingtheemotionalsupportnetworkSharingemotionsisvaluable (4.2)ReleasingsymptomsthroughtalkCumulativesupportnetwork (4.1)MappingtheemotionalsupportnetworkWorryiscentralemotion (1.2)Symptomsascentralanddominantinemotion

experienceWorrydefinesrelationships (1.3)Symptomsascentralanddominantinemotion

experience(4.1)Mappingtheemotionalsupportnetwork

Worryasdominantthroughoutlife (1.3)Symptomsascentralanddominantinemotionexperience(3.2)Fearthatsomethingbadwillhappen

Lackofagency (2.3)Passiveexperienceofsymptoms(3.3Voiceandcontrolovertheworld

Passiveemotionalregulation (2.3)PassiveexperienceofsymptomsRumination (2.1)Symptomsascentralanddominantinemotion

experienceResponsibilityandself-blame (2.3)Passiveexperienceofsymptoms

(3.1)Demandsandresponsibility(3.3)Voiceandcontrolovertheworld

Fearofnegativeconsequences (3.1)Demandsandresponsibility(3.2)Fearthatsomethingbadwillhappen(3.3)Voiceandcontrolovertheworld

Difficultyconceptualisingthebadthing (3.2)FearthatsomethingbadwillhappenMismatchbetweenexpectationsandreality (2.4)Mismatchbetweensymptomsandreality Jennifer Negativethoughtsareaboutme (1.1)Thenatureofsymptoms(objectorstate)Negativethoughtsareacollectivemass (1.2)SymptomsareapluralmassthatcangrowNegativethoughtsblockhappinessandpositivethoughts

(1.3)Symptomsascentralanddominantinemotionexperience

Negativethoughtsareirrational (2.4)MismatchbetweensymptomsandrealityIdealised‘goodness’ (3.1)DemandsandresponsibilityI’mnotgoodenough (3.1)DemandsandresponsibilityRelativitytoothers (3.1)DemandsandresponsibilityOtherpeople’sexpectationsofme (3.1)Demandsandresponsibility

(3.2)FearthatsomethingbadwillhappenGuiltandresponsibility (3.1)Demandsandresponsibility

(3.3)Voiceandcontrolovertheworld

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453

Negativethoughtsareinsideme (2.1)SymptomsareconnectedtomeNegativethoughtsareprivateandsensitive (2.1)Symptomsareconnectedtome

(4.2)ReleasingsymptomsthroughtalkLettingoutnegativethoughts (2.1)Feelingsareinsideme(andmayneedtocome

out)(4.2)Releasingsymptomsthroughtalk

Unavailabilityofothers (4.1)MappingtheemotionalsupportnetworkAccumulationofdemand (3.1)DemandsandresponsibilityLackofexternalcontrol (3.3)Voiceandcontrolovertheworld“Productivity”andadaptingtodemand (3.1)Demandsandresponsibility

(3.3)VoiceandcontrolovertheworldLackofagencyoveremotions (2.3)PassiveexperienceofsymptomsDetachedfromfeelingsandnegativethoughts

(2.2)Symptomsareseparatefrommyidentity(2.3)Passiveexperienceofsymptoms

Detachedfromactions (2.2)Symptomsareseparatefrommyidentity(2.2)Passiveemotionexperience

Negativethoughtsasseparatefromidentity (2.2)Symptomsareseparatefrommyidentity Grace Self-protection (3.1)Demandsandresponsibility

(3.2)Fearthatsomethingbadwillhappen(3.3)Voiceandcontrolovertheworld

Voiceandagency (3.3)VoiceandcontrolovertheworldHidingandcontrollingemotions (2.1)Symptomsareconnectedtome

(2.3)PassiveexperienceofsymptomsPhysicalsafety (3.2)FearthatsomethingbadwillhappenRoleexpectations (3.1)Demandsandresponsibility

(4.1)Mappingtheemotionalsupportnetwork (4.3)OthersasprotectorsPersonalresponsibility (3.1)DemandsandresponsibilityDadasstable (4.1)Mappingtheemotionalsupportnetwork

(4.3)OthersasprotectorsDadasaprotector (4.3)OthersasprotectorsOnegoodcancelsoutthebad (4.3)OthersasprotectorsSingularsupport (4.1)Mappingouttheemotionalsupportnetwork

(4.2)ReleasingsymptomsthroughtalkLoveandpriorities (4.1)Mappingtheemotionalsupportnetwork

(4.3)OthersasprotectorsOthersareirrationalandIamnot (2.4)Mismatchbetweensymptomsandreality

(3.1)Demandsandresponsibility(3.3)Voiceandcontrolovertheworld

Othersandsafety (3.2)Fearthatsomethingbadwillhappen(4.3)Othersasprotectors

Familysplitaspivotalmoment (3.3)VoiceandcontrolovertheworldFearofnegativeoutcomes (3.2)FearthatsomethingbadwillhappenVoiceunheard (3.3)VoiceandcontrolovertheworldStuckinthemiddle (3.1)Demandsandresponsibility

(3.3)VoiceandcontrolovertheworldHelplessness (3.3)Voiceandcontrolovertheworld

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Feelingsasanintensestate (1.1)Thenatureofsymptoms(objectorstate)(1.2)Symptomsareapluralmassthatcangrow

Buildingimpactonemotions (1.3)SymptomsareapluralmassthatcangrowLackofemotionaloutlet (2.3)PassiveexperienceofsymptomsConstantconflict (3.1)DemandsandresponsibilityBreakingpoint (1.3)Symptomsareapluralmassthatcangrow

(3.1)Demandsandresponsibility

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