Family dysfunction and anxiety in adolescents: A moderated mediation model of self-esteem and perceived school stress

Abstract

This 18-month longitudinal study examined a moderated mediation model addressing the psychosocial mechanisms that account for the association between family dysfunction and anxiety. A sample of 847 Chinese early adolescents (M age = 12.96 years, SD = 0.67) completed questionnaires assessing family dysfunction, self-esteem, perceived school stress, and anxiety on three occasions at 6-month intervals. After gender and socioeconomic status were included as covariates, the results revealed that family dysfunction was significantly associated with adolescents' anxiety. Moreover, self-esteem partially mediated the relation between family dysfunction and anxiety, and perceived school stress moderated the mediation process in the family dysfunction to anxiety path and in the self-esteem to anxiety path. The findings suggested that both social contextual factors (e.g., family dysfunction and school stress) and self-system factors (e.g., low self-esteem) are risk factors for increased anxiety levels in adolescents. Limitations and practical applications of the study were discussed.

Introduction

Many young adolescents take an important step along their academic journey by entering middle school. In China, this first step occurs after six years in the typically more secure and familiar environment of elementary school. At the end of the six years, young adolescents are introduced to the world of middle school, where students perceive more pressure to succeed and adapt to new academic loads, school expectations, teaching practices, and social relationships (Duchesne, Ratelle, & Roy, 2012). These changes, representing risk factors, appear to increase the likelihood of adolescent psychological problems, such as emotional disorders (Ma, 2012).

Recent research has shown that anxiety, which is characterized by widespread and persistent fear and worry, is more prevalent than other emotional disorders during adolescence (Ollendick, King, & Muris, 2002). Furthermore, the World Health Organization (WHO) lists anxiety disorder in its high priority list of resource allocation because of its frequency of occurrence and degree of associated impairment (World Health Organization, 2003). Surveys of Chinese middle school students indicate that the prevalence of anxiety disorders ranges from 7%–16% (Xu & Deng, 2016). Studies also have shown that not only is adolescent anxiety associated with concurrent adjustment problems, it also appears to impede future adaptive psychosocial development (Maldonado et al., 2013). For example, higher levels of anxiety predict subsequent psychiatric problems (e.g., depression and conduct disorders), and also have a significant, negative impact on the daily lives of adolescents through decreased school attendance, academic achievement, and academic self-efficacy (Ingul & Nordahl, 2013; Owens, Stevenson, Norgate, & Hadwin, 2012). Thus, it seems essential to understand fully the determinants of individual differences in reports of anxiety in order to help early adolescent students adapt effectively to their changing circumstances as early as possible.

Bronfenbrenner's bioecological systems theory (Bronfenbrenner, 1979) offers a useful framework to consider the development of anxiety in youth. The theory posits that a child's development must be understood through the interaction between the child and the environment, including interactions between various environmental systems (e.g., family-school interactions). Given that the family provides the earliest environmental context for the socialization of children, family experiences should play a foundational role in children's psychological development. Indeed, Xie, Xie, Zhang, and Zhang (2008) found that Chinese middle school students reporting higher levels of family dysfunction experienced more emotional problems, such as tension, anxiety, and other negative emotional experiences (see also Chorpita & Barlow, 1998). However, the extant research base has been limited in that the majority of prior research on the relation between family dysfunction and anxiety has been based on cross-sectional studies (Spokas, Rodebaugh, & Heimberg, 2008; Yahav, 2007), with a paucity of longitudinal studies reported in the literature.

The extant research on the role of the family in the development of anxiety in adolescents has also been limited because previous research has focused mainly on the direct effects of family dysfunction, with little attention being paid to elucidating indirect psychosocial influences Thus, longitudinal investigations of possible psychosocial mediators that represent the mechanisms through which external, environmental experiences are translated into internal, psychological phenomena (e.g., anxiety) appear warranted.

The family environment as a key microsystem that not only directly influences adolescent internalizing and externalizing behavior problems, but it also indirectly influences behavior problems through the individual self-system (Chen & Luo, 2016). Self-esteem is one of the core components of the individual self-system. Self-esteem is affected by family factors as well as affects adolescents' emotional health (Chen & Luo, 2016; Harter, 2012). Based on the existing literature, we expected that self-esteem would mediate the association between family dysfunction and anxiety among adolescents.

Chinese students spend longer school hours during adolescence than at earlier ages, which yields more interactions with peers and teachers, as well as heavier schoolwork burdens (Hofferth & Sandberg, 2001). These increases can expose students to greater interpersonal and/or academic stress. Consistent with this notion, Xu and Deng (2016) found that interpersonal stress and academic stress were the most commonly reported negative features of Chinese students' lives in middle school, both of which can lead to the development of adolescents' anxiety. Furthermore, previous research has suggested that under conditions of troubled interactions with peers and teachers and academic stress, adolescents experiencing higher levels of family dysfunction experience more negative emotions and behavior (Jin, 2005; Zhang, 2015). Thus, perceived school stress would be expected to moderate the direct link between family dysfunction and anxiety.

From a developmental-contextual perspective, developmental outcomes in adolescence can be explained by the interplay between social contexts and the individual characteristics of adolescents (Lerner & Castellino, 2002). Previous studies have revealed that adolescents' perceptions of school climate indirectly influenced individual differences in adolescent outcomes (Loukas & Murphy, 2007). For example, Loukas and Robinson (2004) found that perceptions of a positive school climate protected at-risk adolescents from experiencing elevated levels of emotional and behavioral problems. In addition, Xu and Deng (2016) found that perceived school stress mediated the relation between school climate and emotional problems. It thus seems reasonable to expect that school stress would moderate the influence of individual difference variables on adolescents' emotional problems. Moksnes, Moljord, Espnes, and Byrne (2010) found that after experiencing high levels of stress, lower self-esteem individuals showed more negative emotions and maladaptive behaviors than higher self-esteem individuals. Based on the aforementioned literature, we expected that adolescents' perceptions of school stress would moderate the direct and indirect links between family dysfunction and anxiety.

The McMaster Model of Family Functioning (MMFF) suggests that a positive family environment is necessary for the healthy development of physical, psychological, and social aspects of family members (Epstein, Bishop, & Levin, 1978). The MMFF proposes that the family system is comprised of six key dimensions of functioning, including Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement and Behavior Control (Epstein, Baldwin, & Bishop, 1985). Family dysfunction refers to a family system that does not facilitate appropriate functioning in one or more of the six dimensions (Mousavi, 2004).

Numerous studies have demonstrated that family dysfunction is a major risk factor in relation to adolescents' anxiety, especially students in early puberty, whose need for autonomy has been awakened, leading to more conflict with their parents (Dooley, Fitzgerald, & Giollabhui, 2015; Fang, 2005). For example, Suveg, Zeman, Flannery-Schroeder, and Cassano (2005) found that parental discouragement of emotional expression has been found to be associated with higher levels of anxiety in children. Moreover, according to family function theory (Miller, Ryan, Keitner, Bishop, & Epstein, 2000), the quality of the family environment, parental over-control, and the relations between parents and children have been associated with the formation of anxiety. In addition to such direct associations, a series of studies have further identified mediators to explain underlying mechanisms in the link between family dysfunction and anxiety (Wu, 2012).

Previous research has suggested that self-esteem is a promising psychological mediator of the link between family dysfunction and anxiety (Russell, Salazar, & Negrete, 2000). Self-esteem, defined as a positive or negative evaluation of the self, emerges from interactions among society, family and others (Harter, 2012; Liu, 2014; Rosenberg, 1965). Individuals develop perceptions of self-esteem through participating in family tasks, such as problem solving, communication with parents, and incorporation of family roles (Fang, Xu, Sun, & Zhang, 2004). Additionally, Yen, Yang, Wu, and Cheng (2013) found that the self-esteem of adolescents related to the quality of their family functioning, such that lower levels of adolescents' self-esteem were linked with parents' levels of acceptance, communication, and emotional support.

Clark and Beck's (2010) cognitive model of anxiety posits that cognition, such as beliefs regarding the self, play an important role in anxiety, with negative beliefs (e.g., “No one really likes me”) antecedent to anxiety. Many studies in the literature have supported such a negative correlation between self-esteem and anxiety among adolescents (Leary & Baumeister, 2000). Furthermore, Wang, Liu, and Jin (2015) found that Chinese adolescents' declines in self-esteem led to increases in anxiety. Based on the above empirical evidence, we proposed that self-esteem will mediate the positive association between family dysfunction and anxiety among adolescents.

Although the family context is influential, child development is the result of a complex number of factors on different societal levels. As another important arena, school can influence adolescents' emotional development (Sellstrom & Bremberg, 2006). In China, seventh grade students, who are transitioning from elementary to middle school, are prone to experience more school stressors (Xu & Deng, 2016). Potential school stressors in the school environment include heavier schoolwork and troubled interaction with peers and teachers (Moksnes & Espnes, 2011). For example, after entering middle school, Chinese students are required to major in a large number of courses, and the difficulty level of the courses is much greater than those in elementary school. Furthermore, the frequency of various important tests increases. All of these changes can increase students' academic stress levels (Li, 2003). In addition, interpersonal relationships with teachers and peers can be important school stressors. Chinese adolescents spend more time in school settings than their American counterparts, which presents them with an opportunity for more academic and interpersonal challenges (Xu & Minca, 2008). Xu and Deng (2016) observed that Chinese students were more likely to perceive school stress when in a conflict-laden school climate characterized by troubled interactions with peers and teachers, resulting in more frequent negative emotions, such as anxiety. Previous studies have also shown that the quality of student-teacher relationships may be an important emotional resource for school transitions, favoring the scholastic adjustment of the students (e.g., limiting problem behavior and promoting positive emotional development; Longobardi, Prino, Marengo, & Settanni, 2016). However, Bronfenbrenner (1979) describes individuals as embedded in multiple social contexts that may not only have direct effects but may also interact with each other and, as such, together influence individual development. In short, difficult interactions with peers and teachers may increase the risk associated with family dysfunction leading to anxiety problems in adolescents. Children with a lack of parental support manifest more internalizing behavior problems under higher conditions of stress (Zhang, 2015). Based on the extant literature, we expected that adolescents' perceptions of school stress will moderate the association between family dysfunction and anxiety, such that the association between family dysfunction and adolescents' anxiety will be stronger under conditions of higher perceptions of school stress.

Although the direct link between family dysfunction and anxiety may be moderated by perceived school stress, the question remains as to whether the indirect pathway in which self-esteem mediates the relation between family dysfunction and anxiety would also vary as a function of adolescent perceived school stress. To our knowledge, no research to date has examined the moderating effect of adolescent perceived school stress on the indirect association between family dysfunction and anxiety. Adolescents develop more negative evaluations of self and perceive lower levels of social support under conditions of troubled teacher and peer relationships, yielding less participation in school activities and more negative emotions (Blum, McNeely, & Rinehart, 2002). Thus, adolescents with lower self-esteem likely also experience lower self-efficacy under conditions of high academic stress, yielding increased worries and fears in daily “problematic” situations (e.g., difficulties in relationships with parents and peers, physical changes, and fears about their futures). These relations are consistent with the notions of developmental psychologists who argue that developmental outcomes in adolescence involve interactions between social contexts and the individual characteristics of adolescents (Lerner & Castellino, 2002). Based on the literature reviewed above, we proposed that adolescent students' perceptions of school stress will moderate the direct and indirect associations between family dysfunction and anxiety via students' self-esteem.

The present study linked previously disconnected bodies of research to examine psychosocial mechanisms through which family dysfunction is associated with anxiety among the early adolescents who are transitioning from elementary school to middle school. Our overarching purpose was to examine the ways in which family dysfunction, self-esteem, and perceived school stress are associated with anxiety. To this end, our specific goals were twofold: (1) to test whether adolescents' self-esteem mediated the association between family dysfunction and adolescents' anxiety. (2) To test whether adolescents' perceived school stress moderated the direct and indirect associations between family dysfunction and anxiety via adolescents' self-esteem. This research should not only be useful in clarifying our understanding of the development of anxiety in adolescents, it should contribute to the development of more effective intervention and prevention programs. Researchers have recommended that moderation tests should be conducted to determine whether mediational mechanisms differ for subgroups (e.g., MacKinnon, Fairchild, & Fritz, 2007). Subsequent knowledge of significant differences should help school professionals formulate more targeted interventions.