EARLY ADOLESCENTS IN ADVERSITY: A LATENT CLASS APPROACH TO UNDERSTANDING PATTERNS OF EMOTIONAL AND BEHAVIORAL PROBLEMS ACROSS LOW-RESOURCE URBAN SETTINGS WORLDWIDE

• Published in: Journal of adolescent health Vol. 68; no. 2S; p. S2
• Main Authors: Fine, Shoshanna L, Blum, Robert W, Bass, Judith K, Lulebo, Aimée M, Stones, William, Pinandari, Anggriyani W, Wilopo, Siswanto A, Zuo, Xiayun, Musci, Rashelle J
• Format: Journal Article
• Language: English
• Published: New York Elsevier BV 01.02.2021
• Subjects: Adjustment; Adolescent girls; Adversity; Aggressiveness; Anxiety; Behavior problems; Bullying; Comorbidity; Emotional disturbances; Emotions; Health problems; Latent class analysis; Life course; Low income groups; Measurement; Mental depression; Mental disorders; Mental health; Peer relationships; Psychosocial development; Psychosocial factors; Psychosocial intervention; Substance abuse; Teenagers; Victimization; China
• ISSN: 1054-139X; 1879-1972

Purpose: Early adolescence (ages 10-14) is a critical period for psychosocial development. With a substantial proportion of lifetime mental health problems manifesting by age 14, poor psychosocial adjustment in early adolescence can set the stage for impairment throughout the life course. Youth living in low- and middle-income countries (LMICs) are at particular risk of experiencing emotional and behavioral problems, but little research on adolescent psychosocial development has been conducted in these settings. The aim of this study was to characterize prototypical patterns of emotional and behavioral problems among early adolescents living in four LMICs, and to explore the extent to which these patterns varied by country and sex. Methods: This study used data from the Global Early Adolescent Study (GEAS). Participants were 10,437 early adolescents (51% girls) from six low-income urban settings in the Democratic Republic of Congo (DRC; n = 2,006), Malawi (n = 2,016), Indonesia (n = 4,657), and China (n = 1,758). Latent class analysis (LCA) was used to identify and classify patterns (i.e., classes) of emotional and behavioral problems separately by country, and utilized ten indicators related to depressive and anxiety symptoms, aggressive behaviors, peer victimization, and substance use. Within each setting, measurement invariance by sex was evaluated using a multiple group approach. Results: LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into four general subgroups: a Weil-Adjusted class (40-62%), with few emotional and behavioral problems; an Emotional Problems class (14-29%), with elevated symptoms of depression and anxiety; a Behavioral Problems class (15-22%; not present in China), with increased involvement in aggressive behaviors, peer victimization, and substance use; and a Maladjusted class (4-15%), with co-occurring emotional and behavioral problems. Despite the overall consistency of these patterns, there were some notable contextual differences. These included the lack of a Behavioral Problems class in China, as well as comparatively lower probabilities of depressive and anxiety symptoms in DRC and China and aggressive behaviors in China within the Maladjusted class. Further, tests of measurement invari-ance indicated that the prevalence and nature of these classes differed significantly by sex within each country. Conclusions: Despite immense cultural and contextual variability across the four included countries, this study found striking similarities in patterns of emotional and behavioral problems during early adolescence. Tests of measurement invariance indicated that there were nuances between boys and girls within equivalent classes, suggesting the importance of gender in shaping the expression of psychosocial risk. Taken together, these findings can be used to support the tailoring of interventions targeting psychosocial adjustment among subgroups of early adolescents with increased vulnerability, and indicate that such programs may have wide utility across diverse cross-national settings.