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Data Availability Statement Data cannot be shared publicly due to privacy restrictions in accordance with the ethical approval for the yevrus-dnaladroh htuoy.

Norwegian Health research legislation and the Norwegian Ethics committees require explicit consent from participants in order to transfer health research data outside of Norway.

In this specific case, ethics approval is also contingent on storing the research data on secure storage facilities located in our research institution. The authors did not have special access privileges to data from the survey.

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Researchers who meet the criteria for access to confidential data can apply for access to data in the same manner as the authors, following the procedures of the Bergen Child Study. For more information, please contact on.

Abstract Introduction Depression is a public health concern among youth, and it is pertinent to identify factors that can help prevent development of depressive symptoms in adolescence. This study aimed to investigate the association between negative life events and depressive symptoms among adolescents, and to examine the influence and relative contributions of personal, social and family protective factors related to resilience.

Methods Data stem from the cross-sectional yevrus-dnaladroh htuoyconducted in Hordaland, Norway. In all, 9, adolescents, aged 16—19 years old Results Experiencing a higher number of negative life events was related to increases Ado Appli Dating Site depressive symptoms, while the potential protective factors goal orientation, self-confidence, social Ado Appli Dating Site, social support, and family cohesion individually were associated with fewer symptoms.

Although there were small moderating effects of goal orientation and self-confidence, the results mainly supported a compensatory resilience model.

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When considering the potential protective factors jointly, only self-confidence and family cohesion were significantly associated with fewer depressive symptoms for both genders, with the addition of social support for girls.

There were significant interactions between all the potential protective factors and gender, indicating a greater reduction of depressive symptoms with higher levels of protective factors among girls.

1. Life events and adolescent depressive symptoms: Protective factors associated with resilience
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Conclusions Interventions aimed at fostering self-confidence and family cohesion could be effective in preventing depressive symptoms for adolescent boys and girls, regardless of their exposure to negative events. Results further indicate that preventive interventions targeting these potential protective factors could be especially beneficial for adolescent girls.

Introduction Depression is of great public health concern [ 1 ], with serious consequences both for affected individuals and the wider society [ 23 ]. Depressive symptoms increase between childhood and adolescence, especially among girls [ 4 — 6 ].

In adolescence, girls are about twice as likely to be depressed than boys, a gender difference that persists into adulthood both for depressive symptoms and diagnosable disorders [ 78 ]. The etiology of depression is complex. In addition to a familial history of depression, exposure to psychological stress is one of the strongest risk factors for depression in adolescence [ 910 ].

Ado Appli Dating Site risk is greater when adolescents are exposed to multiple stressful events [ 11 ]. Given the increase in depressive symptoms in adolescence and the negative consequences, it is important to identify factors that might protect against the development of depressive symptoms in the face of known risk factors.

Resilience refers to the process wherein an individual copes well and has a relatively good outcome, even when exposed to risk factors that may disrupt normal development [ 12 — 15 ]. Positive development is in itself not sufficient to establish that resilience Ado Appli Dating Site present [ 1516 ]; in addition, there must be current or past risk with a known potential to disrupt development [ 14 ]. Thus, positive adjustment refers to an outcome of resilience, while resilience in itself is the process of overcoming risk [ 16 ].

Further, the process of resilience is complex, and the importance of different protective factors may vary according to the specific risk involved and the outcome being studied [ 16 ].

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Protective factors related Ado Appli Dating Site resilience stem from multiple domains, and may include factors within the person, the family and the broader social environment [ 1317 ]. Research into potential protective factors henceforth called protective factors for adolescents at risk for developing depression have included all these domains, and social support has received particular attention.

Studies categorizing adolescents into groups based on outcomes and risk exposure have found that adolescents described as resilient i.

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A recent meta-analysis concluded that social support from the family is protective against depression; however, the findings are less consistent regarding peer support [ 22 ]. Several important personal protective resources have also been identified, including a positive self-concept [ 19 ], higher self-esteem [ 23 ], optimism and perceived mastery [ 18 ], higher personal competence, a structured style [ 21 ], and use of active coping strategies [ 1823 — 25 ].

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Protective factors related Ado Appli Dating Site resilience are diverse and often interrelated, and it is important to investigate the concurrent impact of multiple protective factors, as some might only be important when Ado Appli Dating Site alone [ 26 ]. For instance, social support no longer discriminated between groups labeled as resilient and vulnerable when self-efficacy and coping strategies were accounted for [ 23 ].

Similarly, parental bonding had a moderating effect on the relationship between negative life events and depression only when examined alone, not when cognitive strategies, such as positive reappraisal, were also considered [ 25 ].

As many studies focus solely on protective factors from one domain, or investigate multiple protective factors independently of each other [ 2127 ], it is important to assess their individual contributions when jointly studied. Another important consideration is the possibility of gender difference.

Girls report moredepressive symptoms [ 46828 ] and also experiencing more negative life events than boys [ 29 ]. Regarding protective factors related to resilience, studies suggest that girls Ado Appli Dating Site higher scores on social competence [ 2730 — 32 ], while boys have higher scores on self-confidence [ 2730 — 32 ] and self-esteem [ 33 ].

It is therefore important to investigate whether the influence of protective factors on the association between negative life events and symptoms of depression is gender specific.

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Some evidence suggests gender differences; specifically, positive peer relationships bufferedthe effects of stress on depression for boys, whereas cohesive family relationships buffered the effects of stress for girls [ 3435 ].

Still, the majority of studies have not investigated these associations separately for boys and girls, although identifying possible gender differences could be important in order to develop gender-specific preventive interventions. Two of the most influential theoretical models on resilience are the compensatory model and the protective model [ 123637 ].

A compensatory model is evident when a factor has a Ado Appli Dating Site influence on the outcome of interest i. Thus, the protective factor applies for all in the same manner, both those exposed and not exposed to the risk.

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A protective model Cercetarea unica a poli istului evident when the protective factors are especially influential when risk is present.

It is identified when the protective factor interacts with the risk factor to predict the outcome [ 1236 ] and does not influence the outcome to the same degree unless risk is present. Identifying such interactions require large samples, as the statistical power is influenced by the measurement error in both included variables [ 38 ]. A central limitation of previous research is the use of samples that might be too small to detect interactions [ 102125 ]. Based on these considerations, the aim of the present study was to investigate the association between negative life events and symptoms of depression for adolescent boys and girls, and to examine the influence of protective factors associated with resilience.

These include goal orientation, self-confidence, social competence, social support and family cohesion. In these analyses, a central aim was to assess Ado Appli Dating Site the results supported a compensatory or protective model of Ado Appli Dating Site. Method This study is based on the population-based yevrus-dnaladroh htuoyconducted in the County of Hordaland, Western Norway in the spring of All adolescents born from to and residing in the county at the time of the survey were invited to participate.

The survey consisted of a web-based questionnaire covering information on a range of demographic background variables, lifestyle factors, mental health problems and resilience. Adolescents enrolled in upper secondary education received information about the study and the log on information needed to participate to their school e-mail address.

Adolescents not enrolled in school received this information by postal mail to their home address. The schools allocated one school hour approximately 45 minutes for completion of the web-based Ado Appli Dating Site. School staff were present at the time of the data collection to ensure confidentiality, and survey staff were available on telephone to answer any questions from teachers or students regarding the survey. In addition, the adolescents could complete the questionnaire at their own convenience throughout the data collection period.

In accordance Norwegian regulations, adolescents aged 16 years and older can make decisions regarding their own health including participation in health studiesand thus gave consent themselves to participate in the current study.

Associated Data

For the present study, adolescents with missing information on the variables assessing negative life events were removed from the sample adolescents. To ensure the quality of the data, adolescents also were removed if they reported that they were older when the event happened than their actual age at the time of the survey 71 adolescents.

Further, we investigated whether adolescents who had given obviously erroneous answers on other parts of the questionnaire answered these variables differently from the total sample. This resulted in removal of another 9 adolescents.

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There was a higher proportion of girls in the present sample Instruments Demographics Age and gender of the participants were derived from the personal identification number from the Norwegian National Registry. Multiple responses were possible.

A variable indicating the total number of negative life events experienced was calculated. Due to the low number of adolescents who reported five or more negative life events, responses of four or more were collapsed into one category, giving the alternatives: 0, 1, 2, 3 and 4 or more. The SMFQ consists of 13 items measuring cognitive and emotional symptoms associated with depression experienced by the adolescent during the past two weeks.

The SMFQ has shown good psychometric properties in population-based studies [ 4041 ], and has previously been validated in the sample from dnaladroh htuoy [ 28 ]. Higher scores on the READ indicate higher levels of the protective factors associated with resilience. The factor structure and Ado Appli Dating Site properties of the READ has previously been tested in the sample from the dnaladroh htuoy [ 30 ], suggesting that the items asses five factors: Goal Orientation, Self-Confidence, Social Competence, Social Support, and Family Cohesion.

Four of the items in the original READ are not included in these factors item 4, 9, 12 and Social Competence assesses the ease of making new friends and talking to people.

Social Support measures having someone who cares, encourages and can help. Family Cohesion assesses support and shared values in the family for an overview of items, see S1 Table.

The READ factors will be referred to as protective factors in the following to ease readability, despite the cross-sectional nature of the data. Statistical methods The SMFQ scores had a right skewed distribution deviating from normality skewness 1. Nevertheless, as the independent samples Ado Appli Dating Site is robust to deviations from the assumption of a normal distribution in large samples [ 42 ], gender differences in symptoms of depression were investigated by independent samples t-test.

Gender differences in age also were investigated by independent samples t-test, while gender differences in maternal education and number of negative life events were investigated by chi-square tests.

The association between negative life events and symptoms of depression was investigated in a regression analysis where three models were specified. In Model 1, the number of negative life events was included as a predictor of depressive symptoms.

In Model 2, age, gender and maternal education Ado Appli Dating Site included, and in Model 3 an interaction term between gender and number of negative life events was included. The results of the analysis including the interaction term was plotted for the different levels of negative life events, for boys and girls separately.

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Preliminary analyses showed no evidence of a curvilinear association between negative life events and depressive symptoms.

Analyses including the protective factors Goal Orientation, Self-Confidence, Social Competence, Social Support and Family Cohesion in addition to number of negative life events and gender as predictors of depression were specified with separate regression models for each protective factor. The scores on each of the protective factors were standardized into z-scores to ease the interpretation of the results and the comparison between them.

In Model 2, two-way interaction terms between the number of negative life events and each of the protective factors and between gender and the protective factors were included. In Model 3, three-way interactions of the number of negative life events, gender, and each of the protective factors were included. Age and maternal education were not included as covariates as they did not contribute significantly to the model. The analyses were adjusted for multiple comparison by using the Benjamini and Hochberg false discovery rate control [ 4344 ], specifying 70 comparisons and a significance level of Ado Appli Dating Site.

Finally, all five protective factors were included in the same regression analysis as predictors of symptoms of depression, in addition to number of negative life events. The analysis was stratified by gender. The analyses were adjusted for multiple comparison as described above, Ado Appli Dating Site 12 comparisons and a significance level of 0.

All regression models were validated using k-fold cross validation with 10 folds. The mean R2 from the 10 folds is reported.

Figures visualizing the results of significant interactions identified in the regression analyses were prepared in R version 3. More girls reported the occurrence of negative life events than did boys Girls also reported a higher mean score of depressive symptoms compared to boys 7.

Table 1 Demographic characteristics and background variables.