Body Dissatisfaction and Depressive Symptoms on the Threshold to Adolescence: Examining Gender Differences in Depressive Symptoms and the Impact of Social Support

Abstract

The current study focused on the relationship between body dissatisfaction and depressive symptoms on the threshold of adolescence. We aimed to investigate the role of body dissatisfaction in gender differences in depressive symptoms, as well as the impact of social support from peers and parents. Mediation and moderation analyses were based on self-reports from a Norwegian population-based sample (the Tracking Opportunities and Problems Study) of 12- to 13-year-olds (N = 547). Body dissatisfaction explained over 20% of the variance in depressive symptoms. The findings indicate that body dissatisfaction mediates gender differences in depressive symptoms, and that peer support moderates the positive association between body dissatisfaction and depressive symptoms. This is in line with Stress Exposure and Stress-Buffering models. The findings indicate that to prevent depressive symptoms in the transition into adolescence, focus should be on promoting body satisfaction, especially in girls, as well as promoting peer support for adolescents already struggling with body dissatisfaction.

Keywords

depressive symptoms depression gender difference body image body dissatisfaction social support

The transition from childhood to adolescence is often marked by challenges related to cognitive and pubertal development, as well as more advanced social interaction. A high percentage of young adolescents, particularly females, are growingly dissatisfied with their bodies (Bearman, Presnell, Martinez, & Stice, 2006; Crespo, Kielpikowski, Jose, & Pryor, 2010; Murray, Rieger, & Byrne, 2015; von Soest, Wichstrøm, & Kvalem, 2016). In early adolescence, there is a sharp increase in time spent on social media (Norwegian Media Authority, 2016), and body dissatisfaction is shown to be partly driven by exposure to social networking sites (see Holland & Tiggemann, 2016, for a review). Furthermore, early adolescence is marked by increases in social awareness, including appearance comparisons, and a wish for social acceptance from peers (see Harter, 2012 for a review). While parents are still an important source of social support (Furman & Buhrmester, 1985; Harter, 2012), peer social support gains importance as a youth’s need for autonomy grows. At the same developmental stage, depressive symptoms increase (Abebe, Frøyland, Bakken, & von Soest, 2016; Derikman-Eiron et al., 2011; Holsen, Kraft, & Røysamb, 2001), and gender differences in depressive symptoms emerge (Ge, Lorenz, Conger, Elder, & Simons, 1994; Nilsen, Karevold, Røysamb, Gustavson, & Mathiesen, 2013; Wichstrøm, 1999).

Studies have shown that body dissatisfaction is cross-sectionally related to depressive symptoms in 12- to 15-year-olds (Dooley, Fitzgerald, & Giollabhui, 2015), and prospectively in 11- to 18-year-olds (Paxton, Neumark-Sztainer, Hannan, & Eisenberg, 2006; von Soest et al., 2016; Wichstrøm, 1999). Harter (2012) has suggested that in early adolescence, being dissatisfied with one’s own appearance (body dissatisfaction) represents a discrepancy of ideals in the self-domain of physical appearance. As discrepancy of self-ideals is experienced as life stress (Papadakis & Strauman, 2011), and physical appearance is primarily a peer-related self-domain (Harter, 2012), body dissatisfaction can be defined as a peer-related interpersonal stressor.

Summing up, from a preventive perspective, the threshold of adolescence is an especially interesting developmental stage. Both an increase in depressive symptoms and body dissatisfaction—as well as gender differences in depressive symptoms—emerge at this stage. In addition, as peers gain importance, social relations change. The positive association between body dissatisfaction and depressive symptoms is well established. However, research on the role of body dissatisfaction and emerging gender differences in depressive symptoms is lacking. Research on the impact of social support is also lacking. Thus, it is important to examine depressive symptoms, body dissatisfaction, and social support during the threshold of adolescence. The present population-based study focuses on 12- to 13 year-olds. The primary aim is twofold. First, we examine to what degree the depressive symptom gender gap can be explained by body dissatisfaction. Second, we examine whether peer and/or parent social support moderates the relationship between body dissatisfaction and depressive symptoms. We examine these aims within the theoretical frameworks of the Stress Exposure Model (Hankin & Abramson, 1999; Rudolph, 2002) and the Stress-Buffering Model (Cobb, 1976).

Body Dissatisfaction and Gender Differences in Depressive Symptoms

The Stress Exposure Model can be used to explain the role of body dissatisfaction regarding the tendency for adolescent girls to struggle with depressive symptoms more than adolescent boys. The Stress Exposure Model posits that girls experience an increased level of stress exposure, which in turn mediates the emerging gender differences in depressive symptoms (Hankin & Abramson, 1999; Rudolph, 2002). Previous studies have indicated that this model is a valid explanation for gender differences in depressive symptoms for some stressors (e.g., interpersonal), but not all (e.g., general life stress; Hankin, Mermelstein, & Roesch, 2007; Rudolph, 2002). Studies vary as to exactly which age gender differences in depressive symptoms emerge; some put the estimate at 10 to 12 years of age (Larsson, Ingul, Jozefiak, Leikanger, & Sund, 2016), some at 13 years (Allgood-Merten, Lewinsohn, & Hops, 1990; Ge et al., 1994; Sund, Larsson, & Wichstrøm, 2001; Wichstrøm, 1999), some at 14 years (Seiffge-Krenke & Stemmler, 2002), and others at 15 years (Holsen et al., 2001). The ability to demonstrate that gender differences already begin to emerge during the early phase of adolescence, as well as finding the possible mechanism that explains these gender differences, would strengthen the case for preventive efforts during this developmental period.

Consistent with the Stress Exposure Model, research indicates that body dissatisfaction is a stressor which mediates gender differences in depressive symptoms in early adolescence (from 13-14 years old; Allgood-Merten et al., 1990; Wichstrøm, 1999), in middle to late adolescence (ages 15-17; Holsen et al., 2001; Seiffge-Krenke & Stemmler, 2002), and in a study of a group of adolescents (ages 11-18), in which age was not controlled for (Marcotte, Fortin, Potvin, & Papillon, 2002). To our knowledge, no earlier studies have investigated the Stress Exposure Model in a subgroup consisting of adolescents as young as ages 12 to 13. Several researchers (e.g., Harter, 2012; Nolen-Hoeksema & Girgus, 1994; Stice & Bearman, 2001) suggest that secondary pubertal changes in the transition to adolescence, such as weight gain and broader hips, moves girls further away from societal appearance ideals. As a consequence, girls may experience more body dissatisfaction than boys, leading to more depressive symptoms.

Thus, body dissatisfaction is a typical stressor in early adolescence that seems to partly explain why girls struggle with more depressive symptoms when compared to boys during this developmental period. However, it is uncertain whether body dissatisfaction mediates this gender difference already by the age of 12 to 13, making this particular age group especially interesting to investigate.

Body Dissatisfaction and Depressive Symptoms—The Impact of Social Support

Another way of focusing on the relationship between body dissatisfaction and depressive symptoms is to investigate the impact of social support. Social support has been shown to have a strong positive relation to mental health (Southwick et al., 2016). A common definition of social support is that a relationship with significant others that can provide material and interpersonal resources (Thompson, 1995). With some exceptions (i.e., Rueger, Malecki, & Demaray, 2008), most studies show that both peer social support and parent social support are related to depressive symptoms in early adolescence. This holds cross-sectionally (Harter, Marold, & Whitesell, 1992; Klineberg et al., 2006) and over time (Hirsch & DuBois, 1992; Rueger, Malecki, & Demaray, 2010; Zimmerman, Ramirez-Valles, Zapert, & Maton, 2000). Furthermore, it seems that stress is more strongly related to depressive symptoms in individuals who experience a lack of social support (see Turner & Brown, 2010, for a review). The assumption is that social support buffers the effects of stress on depressive symptoms because it “. . . facilitates coping with crisis and adaptation to change” (Cobb, 1976, p. 522). The Stress-Buffer Model for depression is well established in young children and in adults (see Hazel, Oppenheimer, Technow, Young, & Hankin, 2014, for a summary), but it is unclear if it also applies in early adolescence. Some have found that peer (Prinstein, Boergers, & Vernberg, 2001) and parent (Hazel et al., 2014) support buffers the effects of specific stressors while others have found that only peer support (Zhang, Yan, Zhao, & Yuan, 2015), or neither parent nor peer support (Burton, Stice, & Seeley, 2004; Zimmerman et al., 2000), buffer the effects of general life stress. Social support from peers and parents may have different impacts on depressive symptoms in the initial phase of adolescence (Nilsen et al., 2013), and according to Grant et al. (2006), there is value in examining specific stressors, not only composites of general life stress. Body dissatisfaction is a typical specific stressor experienced in the transition to adolescence, and adolescents that feel supported by important attachment figures might cope better with the stress of body dissatisfaction. Thus, a valid testing of the Stress-Buffer Model would include examining whether peer and/or parent support, measured separately, moderate the positive association between body dissatisfaction and depressive symptoms. Furthermore, in line with the higher prevalence of depressive symptoms for adolescent girls, it is important to examine if the buffering effect differs between the genders. A few former studies have suggested that girls might be more protected by social support when experiencing general life stress (Ge et al., 1994; Zhang et al., 2015). So far, no studies have examined if there are gender differences in social support protection against the negative effects of more specific stressors, such as body dissatisfaction.

To our knowledge, there are no earlier studies that have investigated whether social support moderates the positive association between body dissatisfaction and depressive symptoms. Research on the Stress-Buffer Model during the transition into adolescence may provide useful preliminary knowledge for preventing depressive symptoms during this developmental stage.

Aims

This study focused on the relationship between body dissatisfaction and depressive symptoms in the transition into adolescence. We examined the role of body dissatisfaction in the gender difference in depressive symptoms, as well as the impact of social support from peers and parents on the relation between body dissatisfaction and depressive symptoms, in a population-based Norwegian sample of 12- to 13-year-olds. We hypothesized the following:

Hypothesis 1: Body dissatisfaction and gender (being a girl) are positively related to depressive symptoms, while social support from peers and parents are negatively related to depressive symptoms.

Hypothesis 2: Body dissatisfaction mediates gender differences in depressive symptoms; girls struggling with higher levels of body dissatisfaction will at least partly explain gender differences in depressive symptoms.

Hypothesis 3: Peer support moderates the relation between body dissatisfaction and depressive symptoms: that is, high level of peer support protects against the positive link between body dissatisfaction and depressive symptoms. In addition to this hypothesis, we also explored if moderation of peer support was different for boys and girls.

Hypothesis 4: Parent support moderates the relation between body dissatisfaction and depressive symptoms: that is, high level of parent support protects against the positive link between body dissatisfaction and depressive symptoms. In addition to this hypothesis, we also explored if moderation of parent support was different for boys and girls.

The hypotheses are illustrated in Figure 1.

Figure 1.

Model of study hypotheses: The relation between depressive symptoms and body dissatisfaction, and the impact of gender and social support in adolescents (ages 12-13).

Method

Sample and Procedure

We used data from the Tracking Opportunities and Problems (TOPP) study—a prospective population-based study focusing on the mental health of children and their families (Mathiesen, Tambs, & Dalgard, 1999; Nilsen et al., 2017). Former publications on the TOPP study can be found in Nilsen et al. (2017). The study was approved by The Norwegian Data Inspectorate and the Regional Committee for Medical Research Ethics. Totally, 1,081 eligible families from 19 geographical health care areas who visited a child health clinic in 1993 for the scheduled 18-month vaccination visit were invited to complete a questionnaire. Of the 1,081 eligible families, 939 (87%) participated at t1. Study participation was voluntary, and families were given written information before and after each data collection about current and future research, the confidentiality of the participants, and the right to withdraw from the study at any point. The present study is based on follow-up self-report data, collected in 2004, from 12- to 13-year-olds (mean age 12.58, SD = 0.37). Around 547 adolescents (55% girls) filled out their own questionnaires. Missing data on the present study’s measurement scales was 0.4% to 2.2%. Attrition analyses of the TOPP study have shown that only the mothers’ education level predicted higher attrition over time (Gustavson, von Soest, Karevold, & Roysamb, 2012; Karevold, Røysamb, Ystrom, & Mathiesen, 2009), indicating that the present sample of 12- to 13-year-olds is a representative sample for the cross-sectional analyses. See Karevold et al. (2009) for more information about the sample. The TOPP study is funded by the Norwegian Research Council and the ExtraFoundation, and data are available and controlled by the Director of the Norwegian Institute of Public Health.

Measures

Depressive symptoms

The Short Mood and Feeling Questionnaire (SMFQ; Angold et al., 1995), was used to measure depressive symptoms. The SMFQ is a unidimensional self-report scale designed for use in epidemiological studies of depressive symptoms in children and adolescents. It consists of 13 items about affective and cognitive symptoms (e.g., “I feel miserable or unhappy”). The adolescent is asked to rate depressive symptoms on a 3-point scale from 1 (not true) to 3 (true). One question about concentration was omitted because it was too similar to other questions in the TOPP survey. A mean score was constructed by averaging the remaining 12 items. SMFQ was translated by Sund et al. (2001) and has shown satisfactory psychometric qualities in both Nordic (Lundervold, Breivik, Posserud, Stormark, & Hysing, 2013; Sund et al., 2001) and other Western countries (Kuo, Stoep, & Stewart, 2005). The alpha reliability in the present study was 0.84. The omega reliability, assuming ordinal levels (Dunn, Baguley, & Brunsden, 2013), was 0.92.

Body dissatisfaction

The Physical Appearance subscale of the revised version of The Self-Perception Profile for Adolescents (SPPA-R; Harter, 1988) was used to measure body dissatisfaction. Adolescents responded to questions with four categories, ranging from 1 (describes me poorly) to 4 (describes me very well) on five items. A mean score was constructed by averaging the five items. The scale was translated and back-translated for the TOPP survey. The Physical Appearance scale has shown satisfactory psychometric qualities in both Nordic (von Soest et al., 2016; Wichstrøm & von Soest, 2016) and other Western countries (Thomson & Zand, 2002). The alpha reliability in the present study was 0.89. The omega reliability, assuming ordinal levels (Dunn et al., 2013), was 0.93.

Social support from peers

A social support scale, which has been developed and used in several Norwegian studies, to measure different aspects of social support from peers (i.e., feelings of attachment, mutual respect, and belonging; Dalgard, Bjørk, & Tambs, 1995; Nilsen et al., 2013), was used to measure peer support. Participants responded to the items with five response categories ranging from 1 (agree) to 5 (disagree). For the present study, the scale was reversed so that a high score on the scale indicates a high level of social support. A mean score was constructed by averaging the three items. The alpha reliability was 0.51. For this scale, due to somewhat low alpha, we examined both the alpha and omega reliabilities assuming ordinal levels (Dunn et al., 2013). These were 0.65 and 0.70 respectively (see Limitations for discussion of reliability levels).

Social support from parents

A somewhat different measure of support, which examined acceptance, warmth, monitoring, and involvement in the life of the adolescent, called The Parental Warmth/Involvement subscale, derived from the Lamborn Parenting Scale (Lamborn, Mounts, Steinberg, & Dornbusch, 1991), was used to measure parent support. This scale has been previously used as a measure for parent support with the same sample (Nilsen et al., 2013). It consists of 10 items (five items about each parent), for example, “I can count on him or her to help me out if I have some kind of problem.” Response categories ranged from 1 (almost always) to 2 (almost never). For the present study, the scale was reversed so that a high score on the scale indicates a high level of social support. A mean score was constructed by averaging the 10 items. The scale was translated and back-translated for the TOPP survey. The scale has shown satisfactory psychometric qualities in both Nordic (Adalbjarnardottir & Hafsteinsson, 2001; Nilsen et al., 2013) and other Western countries (e.g., Lamborn et al., 1991; Steinberg, Lamborn, Dornbusch, & Darling, 1992). The alpha reliability in the present study was 0.72. The omega reliability, assuming ordinal levels (Dunn et al., 2013), was 0.89.

Covariates

As including a large number of covariates may limit statistical power (Tabachnick & Fidell, 2013), covariates were examined and chosen based on the criteria for potential confounding variables: (a) association with the dependent variable, (b) association with the independent variable, and (c) the variable in question was not a mediator (van Stralen, Dekker, Zoccali, & Jager, 2010). Included covariates that correlated with depressive symptoms were gender (gender also correlated with body dissatisfaction. Furthermore, gender was used as a covariate only in analyses in which it was not used as an independent variable) and parental divorce (also correlated with body dissatisfaction and social support from parents). Relevant covariates like parent education and income, puberty onset, and physical matureness were not included because none correlated with depressive symptoms.

Analytic Approach

Bivariate correlation analyses (Pearson’s r) and multiple regression analyses were conducted in SPSS Statistics, version 22. Unique associations with depressive symptoms were investigated by entering the independent variables (body dissatisfaction, gender, peer support, and parent support) in one step. The mediator analysis was based on Baron and Kenny’s (1986) requirements for mediation. The first requirements of there being significant bivariate associations between independent, dependent, and mediation variables were established with bivariate correlation analyses. Furthermore, gender and depressive symptoms were entered in the first step of the hierarchical regression analysis, and body dissatisfaction in the second step. Given the limitations of Baron and Kenny’s approach (Hayes, 2009), the indirect effect was also investigated with the SPSS macro PROCESS, Model 4, a regression-based method developed by Hayes (2013). The moderator analyses were conducted by computing interaction terms of the relevant variables’ z scores. Independent variables were entered in the first step of the hierarchical regression analysis, and the interaction term in the second.

Results

Table 1 shows descriptives and t tests for gender differences related to the study variables. Results show that girls had a significantly higher level of body dissatisfaction and depressive symptoms than boys. Gender distributions on peer and parent support were equal.

Table 1.

Descriptives for Independent Variables and Depressive Symptoms, and Test of Gender Differences, Among 547 Adolescents.

	M (SD)/Frequency	Girls		Boys
	M (SD)/Frequency	M	SD	M	SD
Depressive symptoms	1.30 (.33)	1.33	.34	1.26*	.30
Body dissatisfaction	1.86 (.71)	1.97	.73	1.72**	.67
Peer Support	4.10 (.73)	4.15	.72	4.05	.73
Parent support	1.94 (.13)	1.93	.13	1.94	.12

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

Bivariate correlations between the study variables are reported in Table 2. All correlations were in the expected directions and generally indicated small to moderate relationships between the independent variables. Body dissatisfaction had a strong positive association with depressive symptoms (Cohen, 1992). Being a girl was positively associated with depressive symptoms. Cohen’s d was calculated and indicated a small effect size (Cohen, 1992); the girls mean depression score was 0.21 standard deviations higher than the boys mean depression score. Social support from peers and social support from parents were negatively related to depressive symptoms with medium and small effect sizes, respectively (Cohen, 1992).

Table 2.

Pearson Correlation Tests Between Independent Variables and Depressive Symptoms Among 547 Adolescents.

	Correlations
	1	2	3	4
1. Depressive symptoms	—
2. Body dissatisfaction	.46*	—
3. Gender^a	−.11**	−.17**	—
4. Social support from peers	−.36**	−.30**	−.07	—
5. Social support from parents	−.22**	−.19**	−.03	.21**

1 = girls; 2 = boys.

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

Table 3 presents the unique associations between the independent variables and depressive symptoms. Body dissatisfaction, peer support, and parent support were uniquely associated with depressive symptoms. The model explained 28% of the variance in depressive symptoms. If body dissatisfaction, peer, and parent support had been removed from the model, explained variance would have been reduced to 17%, 23%, and 27%, respectively. In other words, body dissatisfaction seemed to be the most independent variable of most importance (Tabachnick & Fidell, 2013).

Table 3.

Unique Associations Between Independent Variables and Depressive Symptoms Among 547 Adolescents.

Step 1	B	SE	Beta	p
Constant	1.97	0.22		<.001
Body dissatisfaction	0.17	0.02	0.37	<.001
Gender^{a, b}	−0.04	0.03	−0.06	=.155
Social support from peers	−0.10	0.02	−0.23	<.001
Social support from parents	−0.25	0.10	−0.10	=.015
Parental divorce^b	−0.01	0.03	−0.01	=.852

Note. Multiple regression analyses.

1 = girls, 2 = boys.

potentially confounding covariates.

Next, we examined whether body dissatisfaction mediated gender differences in depressive symptoms. Results suggested that body dissatisfaction mediated the effect of gender (being a girl) on depressive symptoms. Figure 2 presents beta values and the significance level for gender in the first and second (controlled for body dissatisfaction) steps in the hierarchic regression analysis. As illustrated, gender turned nonsignificant when body dissatisfaction was included in the model. Bivariate regression models were computed and are presented in Figure 2. Cohen’s d was calculated and indicated a small to medium effect size (Cohen, 1992); girls mean body dissatisfaction score was 0.40 standard deviations higher than the boys mean score. The product of the effect of gender (X) on a standardized measure of body dissatisfaction (d), and the effect of body dissatisfaction on depressive symptoms (r), was dr = 0.40 × 0.45 = 0.18, indicating a medium effect size (Kenny, 2018). The mediation model investigated with PROCESS also indicated a significant indirect effect (β = −0.05; bootstrap with 95% confidence interval −0.08 to −0.02).

Figure 2.

Body dissatisfaction mediating gender differences in depressive symptoms in adolescents (ages 12-13).

Finally, we examined peer social support and parent social support as moderators for the positive association between body dissatisfaction and depressive symptoms. The results showed that the relation between body dissatisfaction and depressive symptoms was moderated by peer support. The interaction term for peer support and body dissatisfaction was significant with a beta value of −0.09 (p = .021). When this interaction term was included, beta values for the main effects were −0.23 (p < .01) for peer support and 0.36 (p < .01) for body dissatisfaction. This indicates that adolescents who are dissatisfied with their bodies, and at the same time lack peer support, struggle with a higher level of depressive symptoms than adolescents who are dissatisfied with their bodies and experience a high degree of peer support. This result is illustrated in Figure 3. The Figure is based on estimated values for high body dissatisfaction (+2SD), high peer support (+2SD), low body dissatisfaction (–2SD) and low peer support (–2SD).

Figure 3.

Peer support moderating the positive association between body dissatisfaction and depressive symptoms in adolescents (ages 12-13).

We also explored whether there were gender differences in the buffering effect of peer social support. Beta for the interaction term Gender × Peer support × Body dissatisfaction regressed on depressive symptoms was 0.06, and nonsignificant (p = .151). Parent support did not moderate the relation between body dissatisfaction and depressive symptoms; beta for the interaction term Parent support × Body dissatisfaction was −0.03 (p = .48). We also explored whether there were gender differences in the buffering effect of parent social support. Beta for the interaction term Gender × Parent support × Body dissatisfaction was 0.003, and nonsignificant (p = .99).

Discussion

The present study focused on the relationship between body dissatisfaction and depressive symptoms in the transition into adolescence (age 12-13). We investigated the role of body dissatisfaction in gender differences in depressive symptoms, as well as the impact social support from parents and peers. Results showed that body dissatisfaction was positively associated with depressive symptoms while social support from peers and parents were negatively associated with depressive symptoms. Furthermore, we found evidence to suggest that the higher degree of depressive symptoms reported by the girls in the study can be explained by their struggles with a higher degree of body dissatisfaction. Our results also showed that peer support moderated the relation between body dissatisfaction and depressive symptoms.

Body Dissatisfaction Mediated Gender Differences in Depressive Symptoms

Body dissatisfaction explained over 20% of the variance in depressive symptoms and was both uniquely and positively associated with depressive symptoms. This is consistent with previous studies showing a strong link between body dissatisfaction and depressive symptoms starting from 11 years old and older (e.g., Dooley et al., 2015; Harter et al., 1992; Paxton et al., 2006; Stice & Bearman, 2001; Wichstrøm, 1999). Furthermore, in the current study, the girls reported more depressive symptoms compared to the boys, supporting earlier studies showing that gender differences in depressive symptoms emerge as early as 10 to 12 years of age (Larsson et al., 2016) and 13 (e.g., Allgood-Merten et al., 1990; Ge et al., 1994; Sund et al., 2001; Wichstrøm, 1999).

The present study’s results suggested that body dissatisfaction mediated gender differences in depressive symptoms in our sample of 12- to 13-year-olds, indicating that a higher level of body dissatisfaction in girls may explain why they struggle more with depressive symptoms when compared to boys. This result is consistent with the Stress Exposure Model which explains emerging gender differences in depressive symptoms (e.g., Hankin et al., 2007). Furthermore, this study adds to previous research that has shown that body dissatisfaction mediates gender differences in symptoms of depression in 13-year-olds (Allgood-Merten et al., 1990; Wichstrøm, 1999). In addition, the current results extend upon a previous study’s findings that body dissatisfaction mediates gender differences in depressive symptoms in an 11- to 18-year-old age group without controlling for age (Marcotte et al., 2002), and stands in contrast to previous research that has shown that body dissatisfaction do not mediate gender difference in depressive symptoms until the age of 15 to 17 (Holsen et al., 2001; Seiffge-Krenke & Stemmler, 2002). Future studies should replicate the present study with adolescents in the 12- to 13-year-old age group so that a consensus regarding age can be reached.

The present findings have practical implications. First, they are of particular importance when taking into account the sharp increase in time spent on social media in early adolescence (Norwegian Media Authority, 2016) and the formerly mentioned link between time spent on the Internet and social media and body dissatisfaction (see Holland & Tiggemann, 2016, for a review). As our data were collected in 2004, levels of body dissatisfaction (and thus—levels of depressive symptoms), may be even higher in newer generations of adolescents today. Furthermore, most adolescents do not meet the body ideals (slim body for girls and muscular for boys) that are portrayed by today’s media (e.g., Harter, 2012). Studies show that girls, more often than boys, receive appearance-related messages from peers, parents, and the media (McCabe, Ricciardelli, & Ridge, 2006; Smolak, 2004), and that girls use the Internet and social media to a higher degree than boys do (Norwegian Media Authority, 2016). As such, stronger regulation of what is depicted on various media outlets could prevent body dissatisfaction in both genders, and in girls, in particular. There is also evidence to suggest that intervention programs, such as media-literacy programs, improve body-related variables (see McLean, Paxton, & Wertheim, 2016b, for a review), particularly for girls in early adolescence (McLean, Paxton, & Wertheim, 2016a). An individual-focused intervention based on cognitive behavioral therapy aimed at promoting more positive body images for adolescents already struggling with body dissatisfaction may also be beneficial (Cash, 2008).

Social Support From Peers Moderated the Relationship Between Body Dissatisfaction and Depressive Symptoms

Peer and parent support were uniquely and negatively associated with depressive symptoms, which is in line with previous studies that have shown associations with both sources of support (Harter et al., 1992; Klineberg et al., 2006). Furthermore, our findings showed that peer support moderated the positive association between body dissatisfaction and depressive symptoms. This result is in line with previous studies that have indicated that that peer support buffers the effects that victimization (Prinstein et al., 2001) and general life stress in the last month (Zhang et al., 2015) have on depressive symptoms. This result from the current study also extends the field by indicating that peer support buffers the effect of a specific stressor, body dissatisfaction, on depressive symptoms. However, this result also stands in contrast with previous research that has indicated that peer support does not buffer the effects of stressful life events in the last 6 (Zimmerman et al., 2000) or 12 months (Burton et al., 2004). The various results do not necessarily contradict one another as social support may buffer the effects of some stressors, or time perspectives, but not others. All the same, it is hard to rule out a “dual-hit” interpretation of the moderation effect (Hazel et al., 2014): Having problems in peer relationships at the same time as struggling with body dissatisfaction may confer an especially high risk for depressive symptoms, compared with having problems in only one of these domains.

The present study did not find that parent support moderated the positive association between body dissatisfaction and depressive symptoms. This result stands in contrast to a previous study which indicated that parent support did buffer the effects of stressful life events in the last 6 months (Zimmerman et al., 2000). It also stands in contrast with another study which indicated that parent support buffered the effects of peer-related stressful life events, but not nonpeer stressful life events, in the last 3 months (Hazel et al., 2014). Hazel et al. (2014) explained that peer-related stressors in adolescence are possibly so challenging and require such complex solutions that the need for parent support becomes especially pronounced when facing these stressors. Thus, it is possible that although body dissatisfaction can be understood as a peer-related stressor (Harter, 2012; Papadakis & Strauman, 2011), it is not necessarily experienced as a complex challenge. This interpretation is in line with the phenomenology of eating disorders, where one’s value is placed partially or completely in one’s weight and physique and their ability to control them (Fairburn, 2008). A seemingly clear-cut solution would then be to lose weight or to build muscles.

A related explanation for the present study’s finding that only peer support moderated the positive association between body dissatisfaction and depressive symptoms is that peers and parents may have distinct support functions, for example, instrumental aid from parents, telling secrets to friends (Thompson, Flood, & Goodvin, 2006). This possibility is also reflected in the present study’s measurement instruments, as the scale for peer support captures attachment, mutual respect, and belonging (Dalgard et al., 1995) while the parent-support scale captures acceptance and warmth, as well as involvement in the life of the adolescent, that is, helping with homework (Lamborn et al., 1991). Buhrmester and Furman (1987) found that young adolescents spent more time and had more intimate self-disclosure with friends than with parents. In addition, Lamborn and Steinberg (1993) found that adolescents with the highest level of psychosocial and academic functioning were higher on emotional autonomy (i.e., nondependence on parent), and at the same time experienced a high degree of parent social support (“I can count on him or her”). Future studies should continue to investigate peer and parent support separately, and their roles as buffers for other typical stressors that lead to depressive symptoms in early adolescence.

The findings from the current study have several practical implications. The findings indicate that promoting peer support might prevent depressive symptoms in adolescence, especially for those struggling with body dissatisfaction. According to Allen (2008), promoting attachment to peers and parents during adolescence might better youth mental health. At the same time, Cassidy, Jones, and Shaver (2013) posit that there is scant research on whether working with attachment to parents during adolescence actually betters mental health. Interpersonal therapy for adolescents (IPT-A; Gunlicks & Mufson, 2009) might be of relevance. The premise of this therapy model is that interpersonal problems maintain depressive symptoms regardless of whether relational problems are the original cause of, or the consequence of, depressive symptoms. Several studies have found support for this model for adolescents with depressive symptoms (Horowitz, Garber, Ciesla, Young, & Mufson, 2007; Young, Mufson, & Davies, 2006).

Limitations

The current study has several limitations. Most adolescents in the study experienced a high degree of social support, especially parent support. Because of this ceiling effect, the ability to capture variation in good/poor support was limited. It is possible that a scale with more response options would be better equipped to capture variance in the parent-support variable, as this may have influenced the results.

Also related to this study’s scales, the internal reliability of the scale measuring peer support was deemed suboptimal. However, previous research with this scale has suggested that this measure is valid and reliable (Dalgard et al., 1995; Nilsen et al., 2013). Also, peer support was moderately correlated with depressive symptoms, body dissatisfaction, and parent support, which indicates criterion-related validity (DeVellis, 2012). In addition, as alpha is strongly affected by the number of items on a scale, an alpha reliability of this value is expected on a scale with only three items (Pallant, 2010). We also computed alpha- and omega reliability assuming ordinal level, both of which were acceptable. Parent support also had a more acceptable alpha value. In general, as social support is a multifaceted construct (Thompson et al., 2006), both scales consist of partly composite (formative) indicators. As alpha is a measure of the internal consistence of a scale, assuming that a common latent construct underlying formative indicators is present (DeVellis, 2012), alphas in scales consisting of composite indicators are expected to be lower than those in scales consisting of formative indicators (Bagozzi, 2009). See also discussion on lower alphas in Nilsen et al. (2017).

An important limitation in the present correlational cross-sectional design is the inability to infer causality. Although this is also true for correlational longitudinal studies, these types of long-term studies do imply causality to a stronger degree. Some of these studies have shown that negative affectivity predicts an increase in body dissatisfaction (e.g., Bearman et al., 2006), but others have found that depressive symptoms do not predict an increase in body dissatisfaction (Holsen et al., 2001; Stice & Whitenton, 2002). Regarding social support as an independent variable, struggling with depressive symptoms might make it hard to perceive support that is actually available (Thompson et al., 2006). A two-way causality between depressive symptoms and body dissatisfaction and social support respectively is plausible but does not stand in contrast with promoting body satisfaction and social support as ways of preventing the development of depressive symptoms.

Regarding causality, the third-variable problem is also relevant (Tabachnick & Fidell, 2013). Variables that might be of importance include hormonal (Patton & Viner, 2007) and morphological (Stice & Bearman, 2001) pubertal factors, gender identity (Egan & Perry, 2001), and sexual assaults (Schraedley, Gotlib, & Hayward, 1999). Given that these and other possibly relevant variables were not measured, interpretation of the present results should be tempered.

Furthermore, Hayes (2013) argues for the possibility of examining mediation, even with cross-sectional data, given solid theory and argument. van Dick, van Knippenberg, Hägele, Guillaume, and Brodbeck (2008) suggest that the use of cross-sectional designs is less of a problem regarding interactive effects in regression models because common method variance rather leads to an underestimation of the statistical interaction in regression analyses (e.g., McClelland & Judd, 1993).

Conclusion

The findings of the current study suggest that a higher level of body dissatisfaction in girls may explain why they struggle more with depressive symptoms when compared to boys. This result is consistent with the Stress Exposure Model (e.g., Hankin et al., 2007). Furthermore, this finding expands upon earlier research on the late phase of early adolescence and middle to late adolescence, by indicating that body dissatisfaction explains gender differences in depressive symptoms already on the threshold of adolescence, a period with maturational and social challenges as well as an increase in depressive symptoms. The next step would be to examine this model at 3- or 6-month follow-ups to establish exactly when these changes happen. Also, the present results showed that social support from peers moderated the positive association between body dissatisfaction and depressive symptoms, which is consistent with the Stress-Buffer Model (Turner & Brown, 2010). Given the lack of research on social support as a buffer for body dissatisfaction, this current result should be regarded as preliminary. An important next step would be to replicate this finding.

The present findings have various practical implications. Promoting a positive body image during adolescence might decrease depressive symptoms for both genders, and when targeting girls in particular, could contribute to narrow the gender gap in depressive symptoms. In addition, strengthening perceived social support from peers, especially for adolescents struggling with body dissatisfaction, could prevent depressive symptoms in this vulnerable group.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a grant by the Research Council of Norway and Oslo University.

Author Biographies

Ida Sund Morken, licensed psychologist/cand.psychol, works in research at the Department of Psychology, University of Oslo, and at the Regional Center for Child and Adolescent Mental Health, East and South, Oslo, Norway. Her research interests lies within the field of mental health, depression, body image and social relations. The current paper is a part of a Summer Scholarship given by the Research Council of Norway and University of Oslo.

Espen Røysamb, PhD, is a professor of psychology at the Department of Psychology, University of Oslo, and a senior researcher at the Norwegian Institute of Public Health. His major research interests lies within the field of human development, genetics, mental health, and wellbeing.

Wendy Nilsen, PhD, is a senior researcher at the Work Research Institute, Oslo and Akershus University College of Applied Sciences and the Norwegian Institute of Public Health. Her major research interests lies within the fields of mental health, parenthood, childhood/adolescence, school, and work factors, as well as welfare service innovations/interventions.

Evalill Bølstad Karevold, PhD, is an associate professor of psychology at the Department of Psychology, University of Oslo. Her major research interests lies within the fields of child and adolescent development, such as emotional development, internalizing and externalizing problems, subjective wellbeing, temperament, and personality.

References

Abebe

D. S.

Frøyland

L. R.

Bakken

von Soest

(2016). Municipal-level differences in depressive symptoms among adolescents in Norway: Results from the cross-national Ungdata study. Scandinavian Journal of Public Health, 44, 47-54. doi:10.1177/1403494815604764

Adalbjarnardottir

Hafsteinsson

L. G.

(2001). Adolescents’ perceived parenting styles and their substance use: Concurrent and longitudinal analyses. Journal of Research on Adolescence, 11, 401-423. doi:10.1111/1532-7795.00018

Allen

J. P.

(2008). The attachment system in adolescence. In Cassidy

Shaver

P. R.

(Eds.), Handbook of attachment: Theory, research and clinical applications (2nd ed., pp. 419-435). New York, NY: Guilford Press.

Allgood-Merten

Lewinsohn

P. M.

Hops

(1990). Sex differences and adolescent depression. Journal of Abnormal Psychology, 99, 55-63. doi:10.1037/0021-843X.99.1.55

Angold

Costello

E. J.

Messer

S. C.

Pickles

Winder

Silver

(1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237-249.

Bagozzi

R. P.

(2009). Measurement and meaning in information systems and organizational research: Methodological and philosophical foundations. MIS Quarterly, 35, 261-292. Retrieved from https://www-jstor-org.web.bisu.edu.cn/stable/23044044

Baron

R. M.

Kenny

D. A.

(1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. doi:10.1037/0022-3514.51.6.1173

Bearman

S. K.

Presnell

Martinez

Stice

(2006). The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys. Journal of Youth and Adolescence, 35, 229-241. doi:10.1007/s10964-005-9010-9

Buhrmester

Furman

(1987). The development of companionship and intimacy. Child Development, 58, 1101-1113. doi:10.2307/1130550

10.

Burton

Stice

Seeley

J. R.

(2004). A prospective test of the stress-buffering model of depression in adolescent girls: No support once again. Journal of Consulting and Clinical Psychology, 72, 689-697. doi:10.1037/0022-006X.72.4.689

11.

Cash

T. F.

(2008). The body image workbook: An eight-step program for learning to like your looks (2nd ed.). Oakland, CA: New Harbinger Publications.

12.

Cassidy

Jones

J. D.

Shaver

P. R.

(2013). Contributions of attachment theory and research: A framework for future research, translation, and policy. Development and Psychopathology, 25, 1415-1434. doi:10.1017/S0954579413000692

13.

Cobb

(1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38, 300-314.

14.

Cohen

(1992). A power primer. Psychological Bulletin, 112, 155-159. doi:10.1037/0033-2909.112.1.155

15.

Crespo

Kielpikowski

Jose

P. E.

Pryor

(2010). Relationships between family connectedness and body satisfaction: A longitudinal study of adolescent girls and boys. Journal of Youth and Adolescence, 39, 1392-1401. doi:10.1007/s10964-009-9433-9

16.

Dalgard

O. S.

Bjørk

Tambs

(1995). Social support, negative life events and mental health. British Journal of Psychiatry, 166, 29-34. doi:10.1192/bjp.166.1.29

17.

Derikman-Eiron

Indredavik

M. S.

Bratberg

G. H.

Taraldsen

Bakken

I. J.

Colton

(2011). Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord-Trøndelag health study. Scandinavian Journal of Psychology, 52, 261-267. doi:10.1111/j.1467-9450.2010.00859.x

18.

DeVellis

R. F.

(2012). Scale development: Theory and applications (3rd ed.). Los Angeles, CA: Sage.

19.

Dooley

Fitzgerald

Giollabhui

N. M.

(2015). The risk and protective factors associated with depression and anxiety in a national sample of Irish adolescents. Irish Journal of Psychological Medicine, 32, 93-105.

20.

Dunn

T. J.

Baguley

Brunsden

(2013). From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British Journal of Psychology, 105, 399-412. doi:10.1111/bjop.12046

21.

Egan

S. K.

Perry

D. G.

(2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451-463.

22.

Fairburn

C. G.

(2008). Eating disorders: The transdiagnostic view and the cognitive behavioral theory. In Fairburn

C. G.

(Ed.), Cognitive behavior therapy and eating disorders (pp. 7-22). New York, NY: Guilford Press.

23.

Furman

Buhrmester

(1985). Children’s perceptions of the personal relationships in their social networks. Developmental Psychology, 21, 1016-1024. doi:10.1037/0012-1649.21.6.1016

24.

Lorenz

F. O.

Conger

R. D.

Elder

G. H.

Simons

R. L.

(1994). Trajectories of stressful life events and depressive symptoms during adolescence. Developmental Psychology, 30, 467-483. doi:10.1037/0012-1649.30.4.467

25.

Grant

K. E.

Compas

B. E.

Thurm

A. E.

McMahon

S. D.

Gipson

P. Y.

Campbell

A. J.

. . . Westerholm

R. I.

(2006). Stressors and child and adolescent psychopathology: Evidence of moderating and mediating effects. Clinical Psychology Review, 26, 257-283. doi:10.1016/j.cpr.2005.06.011

26.

Gunlicks

M. L.

Mufson

(2009). Interpersonal psychotherapy for depressed adolescents. In Nolen-Hoeksema

Hilt

L. M.

(Eds.), Handbook of depression in adolescents (pp. 511-530). New York, NY: Routledge.

27.

Gustavson

von Soest

Karevold

Roysamb

(2012). Attrition and generalizability in longitudinal studies: Findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health, 12(1), Article 918. doi:10.1186/1471-2458-12-918

28.

Hankin

B. L.

Abramson

L. Y.

(1999). Development of gender differences in depression: Description and possible explanations. Annals of Medicine, 31, 372-379. doi:10.3109/07853899908998794

29.

Hankin

B. L.

Mermelstein

Roesch

(2007). Sex differences in adolescent depression: Stress exposure and reactivity models. Child Development, 78, 279-295. doi:10.1111/j.1467-8624.2007.00997.x

30.

Harter

(1988). Manual for the self-perception profile for adolescents. Denver, CO: University of Denver.

31.

Harter

(2012). The construction of the self: Developmental and sociocultural foundations (2nd ed.). New York, NY: Guilford Press.

32.

Harter

Marold

D. B.

Whitesell

N. R.

(1992). Model of psychosocial risk factors leading to suicidal ideation in young adolescents. Development and Psychopathology, 4, 167-188. doi:10.1017/S0954579400005629

33.

Hayes

A. F.

(2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408-420. doi:10.1080/03637750903310360

34.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis. New York, NY: Guilford Press.

35.

Hazel

N. A.

Oppenheimer

C. W.

Technow

J. R.

Young

J. F.

Hankin

B. L.

(2014). Parent relationship quality buffers against the effect of peer stressors on depressive symptoms from middle childhood to adolescence. Developmental Psychology, 50, 2115-2123. doi:10.1037/a0037192

36.

Hirsch

B. J.

DuBois

D. L.

(1992). The relation of peer social support and psychological symptomatology during the transition to junior high school: A two-year longitudinal analysis. American Journal of Community Psychology, 20, 333-347. doi:10.1007/BF00937913

37.

Holland

Tiggemann

(2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image, 17, 100-110. doi:10.1016/j.bodyim.2016.02.008

38.

Holsen

Kraft

Røysamb

(2001). The relationship between body image and depressed mood in adolescence: A 5-year longitudinal panel study. Journal of Health Psychology, 6, 613-627. doi:10.1177/135910530100600601

39.

Horowitz

J. L.

Garber

Ciesla

J. A.

Young

J. F.

Mufson

(2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75, 693-706. doi:10.1037/0022-006X.75.5.693

40.

Karevold

Røysamb

Ystrom

Mathiesen

K. S.

(2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45, 1051-1060. doi:10.1037/a0016123

41.

Kenny

D. A.

(2018, August 4). Mediation. Retrieved from http://davidakenny.net/cm/mediate.htm#IE

42.

Klineberg

Clark

Bhui

K. S.

Haines

M. M.

Viner

R. M.

Head

. . . Stansfeld

S. A.

(2006). Social support, ethnicity and mental health in adolescents. Social Psychiatry and Psychiatric Epidemiology, 41, 755-760. doi:10.1007/s00127-006-0093-8

43.

Kuo

E. S.

Stoep

A. V.

Stewart

D. G.

(2005). Using the short mood and feelings questionnaire to detect depression in detained adolescents. Assessment, 12, 374-383. doi:10.1177/1073191105279984

44.

Lamborn

S. D.

Mounts

N. S.

Steinberg

Dornbusch

S. M.

(1991). Patterns of competence and adjustment among adolescents from authoritative, authoritarian, indulgent, and neglectful families. Child Development, 62, 1049-1065.

45.

Lamborn

S. D.

Steinberg

(1993). Emotional autonomy redux: Revisiting Ryan and Lynch. Child Development, 64, 483-499.

46.

Larsson

Ingul

Jozefiak

Leikanger

Sund

A. M.

(2016). Prevalence, stability, 1-year incidence and predictors of depressive symptoms among Norwegian adolescents in the general population as measured by the Short Mood and Feelings Questionnaire. Nordic Journal of Psychiatry, 70, 290-296. doi:10.3109/08039488.2015.1109137

47.

Lundervold

A. J.

Breivik

Posserud

M. B.

Stormark

K. M.

Hysing

(2013). Symptoms of depression as reported by Norwegian adolescents on the Short Mood and Feelings Questionnaire. Frontiers in Psychology, 4, 613. doi:10.3389/fpsyg.2013.00613

48.

Marcotte

Fortin

Potvin

Papillon

(2002). Gender differences in depressive symptoms during adolescence: Role of gender-typed characteristics, self-esteem, body image, stressful life events, and pubertal status. Journal of Emotional and Behavioral Disorders, 10, 29-42. doi:10.1177/106342660201000104

49.

Mathiesen

K. S.

Tambs

Dalgard

O. S.

(1999). The influence of social class, strain and social support on symptoms of anxiety and depression in mothers of toddlers. Social Psychiatry and Psychiatric Epidemiology, 34, 61-72. doi:10.1007/s001270050113

50.

McCabe

M. P.

Ricciardelli

L. A.

Ridge

(2006). “Who thinks I need a perfect body?” Perceptions and internal dialogue among adolescents about their bodies. Sex Roles, 55, 409-419. doi:10.1007/s11199-006-9093-0

51.

McClelland

G. H.

Judd

C. M.

(1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114, 376-390. doi:10.1037/0033-2909.114.2.376

52.

McLean

S. A.

Paxton

S. J.

Wertheim

E. H.

(2016a). Does media literacy mitigate risk for reduced body satisfaction following exposure to thin-ideal media? Journal of Youth and Adolescence, 45, 1678-1695. doi:10.1007/s10964-016-0440-3

53.

McLean

S. A.

Paxton

S. J.

Wertheim

E. H.

(2016b). The role of media literacy in body dissatisfaction and disordered eating: A systematic review. Body Image, 19, 9-23.

54.

Murray

Rieger

Byrne

(2015). The relationship between stress and body satisfaction in female and male adolescents. Stress and Health, 31, 13-23. doi:10.1002/smi.2516

55.

Nilsen

Karevold

Røysamb

Gustavson

Mathiesen

K. S.

(2013). Social skills and depressive symptoms across adolescence: Social support as a mediator in girls versus boys. Journal of Adolescence, 36, 11-20.

56.

Nilsen

Kjeldsen

Karevold

E. B.

Skipstein

Helland

Gustavson

. . . Mathiesen

(2017). Cohort profile: The Tracking Opportunities and Problems Study (TOPP)—Study of Norwegian children and their parents followed from infancy to early adulthood. International Journal of Epidemiology, 46, 1399-1399g. doi:10.1093/ije/dyx057

57.

Nolen-Hoeksema

Girgus

J. S.

(1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 115, 424-443. doi:10.1037/0033-2909.115.3.424

58.

Norwegian Media Authority. (2016). Children and the media 2016: Children and adolescents (9-16) use and perception of the media. Retrieved from http://www.medietilsynet.no/globalassets/publikasjoner/barn-og-medier-undersokelser/barn-og-medier-2016-komprimert-ensidig.pdf

59.

Pallant

(2010). SPSS survival manual: A step by step guide to data analysis using SPSS program (4th ed.). Berkshire, UK: McGraw-Hill Education.

60.

Papadakis

A. A.

Strauman

T. J.

(2011). Stress, coping, socialization, and goals: A self-regulation perspective on gender and depression in adolescence. In Strauman

T. J.

Constanzo

P. R.

Garber

(Eds.), Depression in adolescent girls: Science and prevention (pp. 151-192). New York, NY: Guilford Press.

61.

Patton

G. C.

Viner

(2007). Pubertal transitions in health. The Lancet, 369, 1130-1139. doi:10.1016/S0140-6736(07)60366-3

62.

Paxton

S. J.

Neumark-Sztainer

Hannan

P. J.

Eisenberg

M. E.

(2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child & Adolescent Psychology, 35, 539-549. doi:10.1207/s15374424jccp3504_5

63.

Prinstein

M. J.

Boergers

Vernberg

E. M.

(2001). Overt and relational aggression in adolescents: Social-psychological adjustment of aggressors and victims. Journal of Clinical Child & Adolescent Psychology, 30, 479-491. doi:10.1207/S15374424JCCP3004_05

64.

Rudolph

K. D.

(2002). Gender differences in emotional responses to interpersonal stress during adolescence. Journal of Adolescent Health, 30(4), 3-13. doi:10.1016/S1054-139X(01)00383-4

65.

Rueger

S. Y.

Malecki

C. K.

Demaray

M. K.

(2008). Gender differences in the relationship between perceived social support and student adjustment during early adolescence. School Psychology Quarterly, 23, 496-514. doi:10.1037/1045-3830.23.4.496

66.

Rueger

S. Y.

Malecki

C. K.

Demaray

M. K.

(2010). Relationship between multiple sources of perceived social support and psychological and academic adjustment in early adolescence: Comparisons across gender. Journal of Youth and Adolescence, 39, 47-61.

67.

Schraedley

P. K.

Gotlib

I. H.

Hayward

(1999). Gender differences in correlates of depressive symptoms in adolescents. Journal of Adolescent Health, 25, 98-108. doi:10.1016/S1054-139x(99)00038-5

68.

Seiffge-Krenke

Stemmler

(2002). Factors contributing to gender differences in depressive symptoms: A test of three developmental models. Journal of Youth and Adolescence, 31, 405-417.

69.

Smolak

(2004). Body image in children and adolescents: Where do we go from here? Body Image, 1, 15-28. doi:10.1016/S1740-1445(03)00008-1

70.

Southwick

S. M.

Sippel

Krystal

Charney

Mayes

Pietrzak

(2016). Why are some individuals more resilient than others: The role of social support. World Psychiatry, 15, 77-79. doi:10.1002/wps.20282

71.

Steinberg

Lamborn

S. D.

Dornbusch

S. M.

Darling

(1992). Impact of parenting practices on adolescent achievement: Authoritative parenting, school involvement, and encouragement to succeed. Child Development, 63, 1266-1281. doi:10.1111/j.1467-8624.1992.tb01694.x

72.

Stice

Bearman

S. K.

(2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37, 597-607. doi:10.1037/0012-1649.37.5.597

73.

Stice

Whitenton

(2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38, 669-678. doi:10.1037/0012-1649.38.5.669

74.

Sund

A. M.

Larsson

Wichstrøm

(2001). Depressive symptoms among young Norwegian adolescents as measured by the Mood and Feelings Questionnaire (MFQ). European Child & Adolescent Psychiatry, 10, 222-229. doi:10.1007/s007870170011

75.

Tabachnick

B. G.

Fidell

L. S.

(2013). Using multivariate statistics (6th ed.). Boston, MA: Pearson Education.

76.

Thompson

R. A.

(1995). Preventing child maltreatment through social support: A critical analysis. Thousand Oaks, CA: Sage.

77.

Thompson

R. A.

Flood

M. F.

Goodvin

(2006). Social support and developmental psychopathology. In Cicchetti

Cohen

D. J.

(Eds.), Developmental psychopathology: Risk, disorder, and adaption (2nd ed., Vol. 3, pp. 1-37). New York, NY: John Wiley.

78.

Thomson

N. R.

Zand

D. H.

(2002). The Harter self-perception profile for adolescents: Psychometrics for an early adolescent, African American sample. International Journal of Testing, 2, 297-310. doi:10.1080/15305058.2002.9669497

79.

Turner

R. J.

Brown

R. L.

(2010). Social support and mental health. In Scheid

T. L.

Brown

T. N.

(Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (2nd ed., pp. 200-212). New York, NY: Cambridge University Press.

80.

van Dick

van Knippenberg

Hägele

Guillaume

Y. R.

Brodbeck

F. C

. (2008). Group diversity and group identification: The moderating role of diversity beliefs. Human Relations, 61, 1463-1492. doi:10.1177/0018726708095711

81.

van Stralen

K. J.

Dekker

F. W.

Zoccali

Jager

K. J

. (2010). Confounding. Nephron Clinical Practice, 116, 143-147. doi:10.1159/000315883

82.

von Soest

Wichstrøm

Kvalem

I. L

. (2016). The development of global and domain-specific self-esteem from age 13 to 31. Journal of Personality and Social Psychology, 110, 592-608. doi:10.1037/pspp0000060

83.

Wichstrøm

(1999). The emergence of gender difference in depressed mood during adolescence: The role of intensified gender socialization. Developmental Psychology, 35, 232-245. doi:10.1037/0012-1649.35.1.232

84.

Wichstrøm

von Soest

(2016). Reciprocal relations between body satisfaction and self-esteem: A large 13-year prospective study of adolescents. Journal of Adolescence, 47, 16-27. doi:10.1016/j.adolescence.2015.12.003

85.

Young

J. F.

Mufson

Davies

(2006). Efficacy of interpersonal psychotherapy-adolescent skills training: An indicated preventive intervention for depression. Journal of Child Psychology and Psychiatry, 47, 1254-1262. doi:10.1111/j.1469-7610.2006.01667.x

86.

Zhang

Yan

Zhao

Yuan

(2015). The relationship between perceived stress and adolescent depression: The roles of social support and gender. Social Indicators Research, 123, 501-518. doi:10.1007/s11205-014-0739-y

87.

Zimmerman

M. A.

Ramirez-Valles

Zapert

K. M.

Maton

K. I.

(2000). A longitudinal study of stress-buffering effects for urban African-American male adolescent problem behaviors and mental health. Journal of Community Psychology, 28, 17-33. doi:10.1002/(SICI)1520-6629(200001)28:1<17:: AID-JCOP4>3.3.CO;2-9