Low perceived social support predicts later depression but not social phobia in middle adolescence

Full Te ms & Condi ions o access and use can be ound a h p://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode= hpb20 Download by: [Tampe e Uni e si y] Da e: 20 Sep embe 2016, A : 00:01 Heal h Psychology and Beha io al Medicine ISSN: (P in ) 2164-2850 (Online) Jou nal homepage: h p://www. and online.com/loi/ hpb20 Low pe cei ed social suppo p edic s la e dep ession bu no social phobia in middle adolescence Juha-Ma i Väänänen, Mau i Ma unen, Mika Helminen & Rii ake u Kal iala-Heino To ci e his a icle: Juha-Ma i Väänänen, Mau i Ma unen, Mika Helminen & Rii ake u Kal iala-Heino (2014) Low pe cei ed social suppo p edic s la e dep ession bu no social phobia in middle adolescence, Heal h Psychology and Beha io al Medicine, 2:1, 1023-1037, DOI: 10.1080/21642850.2014.966716 To link o his a icle: h p://dx.doi.o g/10.1080/21642850.2014.966716 © 2014 The Au ho (s). Published by Taylo & F ancis. Published online: 28 Oc 2014. Submi you a icle o his jou nal A icle iews: 542 View ela ed a icles View C ossma k da a Low pe cei ed social suppo p edic s la e dep ession bu no social phobia in middle adolescence Juha-Ma i Väänänen a *, Mau i Ma unen b,c,d , Mika Helminen e, and Rii ake u Kal iala-Heino g,a a Depa men o Adolescen Psychia y, Tampe e Uni e si y Hospi al, Tampe e, Finland; b Depa men o Psychia y, Uni e si y o Helsinki, Helsinki, Finland; c Depa men o Adolescen Psychia y, Helsinki Uni e si y Cen al Hospi al, Helsinki, Finland; d Depa men o Men al Heal h and Subs ance Use Se ices, Na ional Ins i u e o Heal h and Wel a e, Helsinki, Finland; e Science Cen e , Pi kanmaa Hospi al Dis ic , Tampe e, Finland; Tampe e School o Public Heal h, Uni e si y o Tampe e, Tampe e, Finland; g Medical School, Uni e si y o Tampe e, Tampe e, Finland (Recei ed 20 No embe 2013; accep ed 4 Sep embe 2014) Social phobia and dep ession a e common and highly como bid diso de s in adolescence. The e is a lack o s udies on possible psychosocial sha ed isk ac o s o hese diso de s. The cu en s udy examined i low social suppo is a sha ed isk ac o o bo h diso de s among adolescen gi ls and boys. This s udy is a pa o he Adolescen Men al Heal h Coho S udy’s wo-yea ollow-up. We s udied c oss-sec ional and longi udinal associa ions o pe cei ed social suppo wi h social phobia, dep ession, and como bid social phobia and dep ession among gi ls and boys. The s udy sample consis ed o 2070 15-yea -old adolescen s a baseline. Dep ession was measu ed by he 13-i em Beck Dep ession In en o y, social phobia by he Social Phobia In en o y (SPIN), and pe cei ed social suppo by he Pe cei ed Social Suppo Scale-Re ised (PSSS-R). Gi ls epo ed highe sco es on he PSSS-R han boys in o al sco es and in iend and significan o he subscales. C oss-sec ional PSSS-R sco es we e lowe among adolescen s wi h social phobia, dep ession, and como bid diso de han among hose wi hou hese diso de s. Low PSSS-R o al sco e and significan o he subscale we e isk ac o s o dep ession among bo h gende s, and low suppo om iends among gi ls only. Low pe cei ed social suppo om any sou ce was no a isk ac o o social phobia o como bid social phobia and dep ession. As conclusion o he s udy, low pe cei ed social suppo was a isk ac o o dep ession, bu no a sha ed isk ac o o dep ession and social phobia. In e en ions enhancing pe cei ed social suppo should be an impo an issue in ea men o dep ession. Keywo ds: social anxie y; phobia; dep ession; social suppo ; adolescen s; gende di e ences; amily suppo ; pee suppo In oduc ion Social phobia and dep ession a e common diso de s among adolescen s. The poin p e alence es ima es o social phobia in adolescence ange om 1.6% o 6%, and li e ime p e alence es i- ma es om 7% o 14% (Essau, Con ad , & Pe e mann, 1999; G en-Landell e al., 2009; Ran a, Kal iala-Heino, Ran anen, & Ma unen, 2009; Shields, 2004; Väänänen e al., 2011; Wi chen, S ein, & Kessle , 1999). P e alence es ima es o dep ession in adolescence ange om 3% o © 2014 The Au ho (s). Published by Taylo & F ancis. *Co esponding au ho . Email: juha. aananen@pshp.fi This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License h p://c ea i ecommons.o g/ licenses/by/3.0/, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. The mo al igh s o he named au ho (s) ha e been asse ed. Heal h Psychology & Beha iou al Medicine, 2014 Vol. 2, No. 1, 1023–1037, h p://dx.doi.o g/10.1080/21642850.2014.966716 10% (Kessle , A ene oli, & Me ikangas, 2001; Lewinsohn, Hops, Robe s, Seeley, & And ews, 1993; Lewinsohn, Rohde, & Seeley, 1998; Robe s, Lewinsohn, & Seeley, 1995) and om 15% o 25% (Kessle & Wal e s, 1998; Lewinsohn e al., 1993), espec i ely. Como bidi y be ween social phobia and dep ession is common, and hese wo diso de s ha e been a ocus o qui e many como bidi y s udies (Beesdo e al., 2007; Bi ne , Goodwin, & Wi chen, 2004; Lewinsohn, Zinba g, Seeley, Lewinsohn, & Sack, 1997; Väänänen e al., 2011; Wi chen e al., 1999). Based on se e al s udies on he como bidi y o social phobia and dep ession, i has been hypo hesized ha social phobia may cause psychological and unc ional de e io a ion leading o dep ession (Kessle , S ang, Wi chen, S ein, & Wal e s, 1999; Me ikangas e al., 1996)o he e may be sha ed isk ac o s o bo h diso de s leading o di e en pheno ypes, which may a y o e ime (Angold, Cos ello, Fa me , Bu ns, & E kanli, 1999). Among adolescen s who su e om social phobia, isk ac o s o subsequen dep ession ha e been ound o be a numbe o ea ed si ua ions, and pe asi eness, se e i y, and ea lie onse o social phobia (Beesdo e al., 2007; Bi ne e al., 2004; Cha i a, S ein, Bailey, & S ein, 2004). Low social suppo has been epo ed as a isk ac o o adolescen psychia ic p oblems (Asel ine, Go e, & Col en, 1994; Ezzell, Swenson, & B ondino, 2000; Ri akallio, Luukkala, Ma unen, Pelkonen, & Kal iala-Heino, 2010; Sheebe , Hops, Alpe , Da is, & And ews, 1997). Blumen hal e al. (1987) epo ed in hei o iginal s udy using Pe cei ed Social Suppo Scale (PSSS) ha among adul s p obabili y o co ona y a e y disease was in e sely ela ed o he le el o social suppo and ha social suppo mode a ed he long- e m heal h consequences o ype As beha iou al pa e n (Blumen hal e al., 1987). Pa en al suppo has ound o be a p e- dic o o iden i y achie emen in adolescen de elopmen (Sa o & Youniss, 2002). The in e - ac ion wi h social ne wo k may di ec ly p oduce posi i e o nega i e psychological s a es being suppo i e o dep i a ing (Kawachi & Be gman, 2001). Low social suppo has shown o be associa ed wi h adolescen dep ession in many s udies (Be ge e al., 2008; Kal iala-Heino, Rimpelä, Ran anen, & Laippala, 2001; Lewinsohn, Go lib, & Seeley, 1997; Newman, Newman, G i en, O’Conno , & Spas, 2007; Sch aedley, Go lib, & Haywa d, 1999) and high social suppo has been ound o ha e a bu e ing e ec agains he eme gence o adolescen dep ession (Denny, Cla k, Fleming, & Wall, 2004; Piko, Ko acs, & Fi z- pa ick, 2009). S udies conce ning he associa ion be ween social suppo and social phobia a e much less common. Theo e ically, low pe cei ed social suppo may lead an adolescen o inse- cu i y in social si ua ion and, hus, o social phobia. Pe cei ing high social suppo om amily and low social suppo om iends may also lead an adolescen o u n mo e o home om social si ua ions possibly leading o social phobia. Adolescen s wi h social anxie y ha e shown o expe ience lowe suppo om iends and classma es in a s udy abou pe cei ed suppo om iends, classma es, and amily (La G eca & Lopez, 1998), and less suppo om iends in a s udy abou pe cei ed suppo om mo he , a he , and iends (McDonald, Bowke , Rubin, Lau sen, & Duchene, 2010). Du ing adolescen de elopmen adolescen s u n o seek suppo om pee s ins ead o hei amily. In childhood, amilies a e he s onges sou ce o suppo ollowed by pee s and eache s (Ezzell e al., 2000). Among child en in p ospec i e s udy om 1s g ade o 10 h g ade, mos common suppo p o ide was biological a he ollowed by g andpa en s (Appleya d, England, & S ou e, 2007). Du ing adolescence, he pe cep ion o sou ce o suppo has epo ed o u n om amily o pee s (Ga ne ski, 2000). The sou ces o social suppo ha e been ound o ha e di e en impac s on isk o social phobia and dep ession. Bo h low amily and low pee suppo ha e been linked o dep ession in middle and la e adolescence in mos s udies (Denny e al., 2004; Lewinsohn, Go lib, e al., 1997; McDonald e al., 2010), while school- ela ed suppo has played only a modes ole in ela ion o dep ession (Piko e al., 2009). High social suppo om iends bu no om amily 1024 J.-M. Väänänen e al. o eache s has been ound o p o ec agains social phobia (La G eca & Lopez, 1998; McDonald e al., 2010). P e ious esea ch has epo ed gende di e ences in social phobia, dep ession, and social suppo . In epidemiological s udies, he p e alence o social phobia has ound o be highe among gi ls han boys (G en-Landell e al., 2009; Shields, 2004; Wi chen e al., 1999). The p e alence o dep ession is highe among gi ls om adolescence onwa ds, and isk ac o s o dep ession di e by gende . Conflic s wi h amily, nega i e cogni i e s yle, and umina ion ha e been ound o be isk ac o s among emales only (Hankin, 2009; Hankin & Ab amson, 2001; Lewinsohn, Rohde, Seeley, Klein, & Go lib, 2000). Females ha e a highe isk o ecu - ence o dep ession (Lewinsohn e al., 2000). Among emales wi h ea lie social phobia he onse o subsequen como bid dep ession akes place in a sho e in e al han among males (Beesdo e al., 2007). Females epo highe le els o pe cei ed social suppo han males (Be ge e al., 2008), especially ecei ed om ou side he amily (Ka ainen, Räikkönen, & Kel inkangas- Jä inen, 1999; La G eca & Lopez, 1998). S ess and social suppo ha e been mo e s ongly associa ed wi h dep ession among gi ls han boys in some s udies (Be ge e al., 2008; Kal- iala-Heino e al., 2001), bu no in all (Denny e al., 2004). Low social suppo has been shown o ha e a mo e dele e ious e ec on social unc ioning among gi ls han among boys (La G eca & Lopez, 1998). Social phobia and dep ession a e highly como bid wi h each o he , bu he e is a lack o p o- spec i e popula ion-based s udies among adolescen s abou possible psychosocial sha ed isk ac o s o hese diso de s. To be e unde s and he de elopmen o social phobia and dep ession and hus o imp o e p e en i e in e en ions and ea men o hese unde - ecognized and unde - ea ed diso de s (Kessle e al., 2001; Lewinsohn e al., 1998; Shields, 2004; Wi chen e al., 1999), p ospec i e popula ion s udies on he psychosocial isk ac o s o hese diso de s and hei como bidi y a e needed. Fu he , mo e esea ch on gende -specific pa e ns o isk ac o s is needed o de elop ea lie and mo e p ecise iden ifica ion o social phobia, dep ession, and como bid social phobia and dep ession, and o de elop specific in e en ions o hese diso de s o gi ls and boys. The aims o ou s udy we e (1) o explo e i low pe cei ed social suppo om di e en sou ces is a isk ac o o social phobia, dep ession, and como bid social phobia and dep ession in wo-yea ollow-up sepa a ely among boys and gi ls; (2) o iden i y c oss-sec ional associa ions be ween dep ession and social phobia and pe cei ed social suppo among gi ls and boys aged 15 and 17 yea s; and (3) o analyse gende di e ences in pe cei ed social suppo , and i s associa ions wi h social phobia and dep ession in middle adolescence. Based on p e ious li e a u e we expec ed ha (1) low pe cei ed social suppo –pa icula ly om pee s –is a isk ac o o bo h dep ession and social phobia; (2) low pe cei ed social suppo om amily is an addi ional isk ac o o dep ession; (3) low pe cei ed social suppo is associa ed wi h cu en social phobia and dep ession, being mos e iden among hose wi h como bid diso de s; and (4) he abo e men ioned e ec s a e mo e p ominen among gi ls han boys. Ma e ials and me hods S udy samples and p ocedu es This s udy is pa o an ongoing p ospec i e coho s udy, he Adolescen Men al Heal h Coho (AMHC) S udy, conduc ed in wo Finnish ci ies, Tampe e (200,000 inhabi an s) and Van aa (180,000 inhabi an s). These ci ies we e chosen because hey ep esen well Finnish u ban popu- la ion. Tampe e is he la ges p o incial cen e ou side he capi al ci y a ea, and Van aa is abou he same sized si e in he capi al ci y a ea o Finland. Da a collec ion, p ocedu es, and measu es o he Heal h Psychology & Beha iou al Medicine 1025 s udy ha e been epo ed in de ail elsewhe e (F öjd, Ma unen, Pelkonen, on de Pahlen, & Kal- iala-Heino, 2006,2007). B iefly, a baseline su ey 2002–2003 (T1), da a we e collec ed om all nin h g ade s (age 15) in all Finnish-speaking seconda y schools in he wo ci ies. Subjec s com- ple ed a pe son-iden ifiable su ey du ing a school lesson unde he supe ision o a eache . Ano he oppo uni y o pa icipa e was o e ed in he school wi hin a couple o weeks o s uden s absen om school on he o iginal su ey day. Fo s uden s no p esen on ei he occasion he ques ionnai es we e sen by pos wice, and i no eply was ecei ed, i was concluded ha he s uden was no willing o pa icipa e. Thus, he pa icipa ion a e o T1 da a collec ion was excel- len (94.4%), consis ing 3278 adolescen s (mean age = 15.5 yea s, SD = 0.39; 1609 gi ls, 1669 boys, 69% li ing in wo-pa en amilies). Follow-up da a collec ion was conduc ed in 2004– 2005 (T2). Eligible pa icipan s a T2 we e s uden s who had pa icipa ed a T1. We o ganized school-based su eys as T1 in uppe seconda y schools and oca ional schools. Su eys we e sen by pos o adolescen s no eached h ough schools and o hose who did no espond e en by pos , he same su ey was o e ed by In e ne (F öjd e al., 2006). A o al o 2070 adolescen s comple ed he su ey a bo h T1 and T2. The esponse a e o he final sample was 63.1% (2070/3278). O he esponden s 56.6% we e gi ls. The mean age a T2 was 17.6 yea s (SD 0.4). A T2 o e 80% o he adolescen s we e ull- ime s uden s (gi ls 89.6%, boys 82.0%, p< .001). Cases we e excluded i mo e han h ee i ems o ou measu es we e unan- swe ed. I only h ee o less i ems we e unanswe ed, missing alues we e eplaced wi h he mean alue o he subjec ’s esponses o he o he i ems o he scale. Because o oo many unanswe ed i ems, 32 subjec s we e excluded om he analyses, and he final sample consis ed o 2038 sub- jec s, 1154 gi ls and 884 boys. In he analyses, we always used all da a a ailable on he issues o in e es , and he e o e, he numbe o subjec s a ies sligh ly be ween sepa a e analyses. Measu es Dep ession (DEP). A Finnish modifica ion o he 13-i em Beck Dep ession In en o y (R-BDI) (Rai asalo, 2007) was used o assess dep ession (Beck & Beck, 1972; Beck, Rial, & Rickels, 1974). The R-BDI is a widely used sel - epo scale measu ing he se e i y o dep essi e symp- oms, and i s eliabili y and alidi y a e good (Benne e al., 1997). The R-BDI has been shown o be app op ia e o measu ing dep ession in Finnish adolescen s in popula ion s udies (Kal iala- Heino, Rimpelä, Ran anen, & Laippala, 1999; Rai asalo, 2007). Each i em is sco ed 0–3 acco d- ing o he se e i y o he symp om. Sum sco es o 13 i ems ( ange 0–39) we e dicho omized o non/mild dep ession (sco es 0–7), and mode a e/se e e dep ession (sco es 8–39) (Beck & Beck, 1972). A cu -o sco e o 8 p edic s a diagnosis o dep ession by s uc u ed in e iew Sche- dules o Clinical Assessmen in Neu opsychia y wi h good sensi i i y (0.93) and specifici y (0.88) (Foun oulakis e al., 2003). Social phobia (SP). To measu e social phobia we used he Social Phobia In en o y (SPIN) (Conno e al., 2000). SPIN is a 17-i em sel - epo ques ionnai e o measu ing symp oms o social phobia. I is cons uc ed on a fi e-poin Like - ype scale which has p e iously shown good eliabili y and cons uc alidi y (Johnson, Inde bi zen-Nolan, & Ande son, 2006; Ran a, Kal iala-Heino, Ran anen, Tuomis o, & Ma unen, 2007) o use among English-speaking and Finnish adolescen s. Fo he Finnish ansla ion o SPIN, a cu -o o 24 poin s has esul ed in 81.8% sensi i i y and 85.1% specifici y in ela ion o a diagnosis o social phobia based on he Schedules o A ec i e Diso de s and Schizoph enia o school-aged child en –P esen and Li e ime e sion (Kiddie-SADS-PL) diagnos ic in e iew (Ran a e al., 2007). Social suppo .The Pe cei ed Social Suppo Scale-Re ised (PSSS-R) was used o measu e pe cei ed social suppo om mul iple sou ces. The PSSS-R was fi s p esen ed by Blumen hal e al. (1987) in hei s udy on he impac o social suppo o mode a e he associa ion be ween 1026 J.-M. Väänänen e al. beha iou ype and co ona y a e y disease. The PSSS-R measu es people’s subjec i e pe cep- ions o social suppo and emo ional closeness (Blumen hal e al., 1987). I con ains 12 i ems on a 5-poin Like - ype scale. Fac o -analy ically de i ed sum sco es we e used o add essing pe cei ed suppo om amily, iends, and significan o he s (each anging 4–20). High sum sco es indica e high pe cei ed social suppo . PSSS-R sum sco es we e used as a con inuous a i- able. The PSSS-R has been shown o be a use ul me hod o assessing pe cei ed social suppo among Finnish adolescen s (Ka ainen e al., 1999). Reliabili ies o he subscales we e o gi ls and boys, espec i ely, α= 0.91 and α= 0.82 o amily suppo ; α= 0.93 and α= 0.91 o signifi- can o he suppo ; and α= 0.89 and α= 0.84 o suppo om iends (F öjd e al., 2006). Co a ia es In he s a is ical analyses, he con olled co a ia es we e age (calcula ed om he da e o su ey and da e o bi h), amily s uc u e (asked o selec om i ems in ques ionnai e on ques ion ‘do you amily include?’: mo he and a he ; mo he and s ep a he ; a he and s ep mo he ; only mo he ; only a he ; someone else ca e ake ; who. Fo p esen s udy we dicho omized he answe s o li ing wi h bo h biological pa en s, i he fi s i em was selec ed/li ing in some o he amily s uc u e, i some o he o he i ems was selec ed), bo h pa en s’highes educa ional qualifica ion (asked o selec om i ems in ques ionnai e on ques ion: wha is he highes edu- ca ional le el you a he has comple ed/‘wha is he highes educa ional le el you mo he has comple ed?’I ems o selec we e comp ehensi e school only, comp ehensi e school and oca- ional school, college and oca ional school, and uni e si y examine. Fo he p esen s udy we dicho omized he answe s o comp ehensi e school only, i he fi s i em was selec ed/highe edu- ca ion, i some o he o he i ems we e selec ed), and ex e nalizing symp oms, measu ed by Finnish e sion o he You h Sel Repo (YSR) (Achenbach, 1991), a T1. We used ex e nalizing scale o YSR as con inuous sum sco es. These co a ia es we e chosen since p e ious s udies ha e sugges ed ha hey ha e an impac on he main a iables o in e es in he p esen s udy (Cos ello, Swendsen, Rose, & Die ke , 2008; DeWi e al., 2005; Hankin, 2009; Hankin & Ab amson, 2001; Kendle , Ga dne , & P esco , 2002,2006; Wi chen & Fehm, 2001). A i ion Compa ed o esponde s a bo h su eys, he e we e mo e boys (63.4% s. gi ls 36.6%; p< .001) and subjec s wi h dep ession a T1 (11.7% (d opou s) s. 9.1% ( esponde s), p= .020) among d opou s. The e we e no di e ences in esponse a e a T2 among hose wi h o wi hou social phobia a T1 (65.1% s. 63.1%, p= .523). D opou boys’pe cei ed suppo om amily a T1 was significan ly lowe han ha pe cei ed by boys also esponding a T2 (Mann–Whi ney es , p= .015). Social suppo om amily among gi ls, and social suppo om iends and om significan o he among bo h gende s did no di e significan ly be ween esponde s and d opou s. Fa he ’s o mo he ’s highes educa ional s a us was mo e o en comp ehensi e school only o lowe among d opou s a T2 ( a he 18.9% s. 15.1, p= .005%; mo he 16.1% s. 12.2%, p= .002). S a is ical analysis We o med ou g oups o ou sample acco ding o diso de s a us: adolescen s wi hou social phobia o dep ession (no SP/DEP) (SPIN sco e < 24, R-BDI sco e < 8), wi h social phobia and wi hou dep ession (SP) (SPIN ≥24, R-BDI < 8), wi h dep ession and wi hou social phobia Heal h Psychology & Beha iou al Medicine 1027 (DEP) (SPIN < 24, R-BDI ≥8), and wi h bo h social phobia and dep ession (como bid SP/DEP) (SPIN ≥24, R-BDI ≥8). To explo e cu en social suppo acco ding o diso de s a us, because he dis ibu ion o sco es o he PSSS-R was non-Gaussian, he K uskal–Wallis es a a significance le el o p= .05 was used. To analyse one- o-one di e ences be ween diso de g oups, we used he Bon- e oni-co ec ed Mann–Whi ney es . Because we had 4 g oups, we had 6 pai ed compa isons, meaning ha s a is ical significance o p-le el 0.05/6 = 0.008333 was used. The s a is ical significance o gende di e ences was es ed by he Mann–Whi ney es a p= .05 le el. We used medians ins ead o means as he pa ame e , because o he non-Gaussian dis ibu ion o PSSS-R sco es. In analyses o longi udinal associa ions be ween social suppo a T1 and diso de s a us a T2, we selec ed he sub-samples ee o bo h diso de s a T1 o con ol he possible con ounding e ec o baseline SP and DEP o he esul s. Fo analyses we used he K uskal–Wallis es . To con ol o he e ec s o co a ia es –age, amily s uc u e, bo h pa en s’highes educa ional qualifica ion, and ex e nal symp oms –we used binomial logis ic eg ession analysis. S a is ical significance was es ed wo- ailed. Da a analyses we e made using SPSS, e sion 16.0 (SPSS Inc., Chicago, Illinois, USA). Resul s C oss-sec ional associa ions be ween cu en SP, DEP, o como bid SP/DEP and pe cei ed social suppo a age 15 and 17 yea s In he K uskal–Wallis es , low sco es o all subscales o PSSS-R, amily, iends, and significan o he s, as well as o al sco es on he PSSS-R we e associa ed wi h ha ing DEP, SP, o como bid SP/DEP a bo h T1 and T2 among bo h gende s (p< .001) (Tables 1 and 2). In he Bon e oni-co ec ed Mann–Whi ney es among gi ls a ages 15 and 17 yea s, pe - cei ed social suppo sco es, bo h o al sco e and all subscale sco es, we e highes in he no SP/DEP g oup, and lowes in he como bid SP/DEP g oup. Pe cei ed social suppo om amily a bo h T1 and T2 su eys, and o al sco e and significan o he subscale o he PSSS-R a T2 we e lowe in he DEP g oup han in he SP g oup (Tables 1 and 2). Simila ly, in he Bon e oni-co ec ed Mann–Whi ney es among boys a bo h ages, pe - cei ed social suppo was highes in he no SP/DEP g oup and lowes in he como bid SP/ DEP g oup. Among boys pe cei ed suppo om amily was lowe in he DEP g oup han in he SP g oup a T1 and T2, bu pe cei ed social suppo om significan o he a T2 was lowe in he SP g oup han in he DEP g oup (Tables 1 and 2). Longi udinal associa ions be ween pe cei ed social suppo a age 15 yea s and incidence o SP, DEP, o como bid SP/DEP du ing ollow-up In analyses made by he K uskal–Wallis es among adolescen s in no SP/DEP g oup a T1, low pe cei ed social suppo a T1 p edic ed DEP a T2 bu no SP o como bid SP/DEP a T2. Among gi ls a s a is ically significan associa ion was ound be ween low o al sco e (p= .004), amily subscale (p= .008), and iend subscale (p= .008) o PSSS-R and subsequen DEP. Among boys he same associa ion was ound be ween low o al sco e (p= .005), amily subscale (p= .008), and significan o he subscale (p= .001) and subsequen DEP. In logis ic eg ession a e con olling o co a ia es (age, amily s uc u e, bo h pa en s’ highes educa ional qualifica ion, and ex e nal symp oms), low o al sco e o PSSS-R (odds a io (OR) = 0.944, 95% confidence in e al (C.I.) 0.906–0.984, p= .006), low pe cei ed 1028 J.-M. Väänänen e al. Table 1. Cu en PSSS-R sco es acco ding o diso de s a age 15 yea s among gi ls and boys. Gi ls Boys po gende di e ence (1) (2) (3) (4) (1) (2) (3) (4) No SP/ DEP SP DEP Como bid SP/DEP No SP/ DEP SP DEP Como bid SP/DEP n= 945 n=56 n=73 n=60 n= 759 n=49 n=35 n=18 PSSS-R sco es To al sco e M= 55.00 M= 53.00 M= 47.00 M= 42.23 M= 48.00 M= 41.00 M= 40.00 M= 25.00 (1) <.001 SD = 7.00 SD = 8.70* SD = 10.04** SD = 11.81** ,++,¤ SD = 10.72 SD = 11.90** SD = 14.45** SD = 12.18** ,++ (2) <.001 (3) =.002 (4) <.001 Family subscale M= 18.00 M= 16.50 M= 13.00 M= 12.50 M= 18.00 M= 16.00 M= 12.00 M= 11.36 (1) n.s. SD = 3.29 SD = 3.91 SD = 4.60** ,++ SD = 4.65** ,++ SD = 3.57 SD = 4.14* SD = 5.03** ,+ SD = 5.18** ,++ (2) n.s. (3) n.s. (4) n.s. F iend subscale M= 19.00 M= 18.00 M= 17.00 M= 14.05 M= 16.00 M= 13.00 M= 13.00 M= 7.50 (1) <.001 SD = 2.95 SD = 3.37* SD = 4.27 SD = 4.86** ,+,¤¤ SD = 4.17 SD = 4.62* SD = 5.76** SD = 4.65** ,+ (2) <.001 (3) =.001 (4) =.001 Significan o he subscale M= 20.00 M= 18.50 M= 19.00 M= 16.00 M= 16.00 M= 13.00 M= 10.64 M= 6.50 (1) <.001 SD = 2.70 SD = 3.48* SD = 4.50 SD = 4.96** ,¤¤ SD = 4.48 SD = 4.74* SD = 6.22 SD = 4.31** ,+ (2) <.001 (3) <.001 (4) <.001 No e: SP = Social phobia (SPIN ≥24, R-BDI < 8), DEP = dep ession (SPIN < 24, R-BDI ≥8), and como bid SP/DEP (SPIN ≥24, R-BDI ≥8). M= median, SD = s anda d de ia ion. S a is ical significance by he Bon e oni-co ec ed Mann–Whi ney es : diso de g oups s. no SP/DEP g oup: **p< .001, *p< .00833; DEP o como bid SP/DEP g oups s. SP g oup: ++ p< .001, + p< .00833; como bid SP/DEP g oup s. DEP g oup: ¤¤ p< .001, ¤ p<.00833. po gende di e ence: (1), in no SP/DEP; (2), in SP; (3), in DEP; and (4), in como bid SP/DEP g oups. Heal h Psychology & Beha iou al Medicine 1029 Table 2. Cu en PSSS-R sco es acco ding o diso de s a age 17 yea s among gi ls and boys. Gi ls Boys po gende di e ence (1) (2) (3) (4) (1) (2) (3) (4) No SP/ DEP SP DEP Como bid SP/DEP No SP/ DEP SP DEP Como bid SP/DEP n= 940 n=79 n=57 n=62 n= 755 n=48 n=22 n=34 PSSS-R sco es To al sco e M= 57.00 M= 52.00 M= 42.00 M= 44.50 M= 51.00 M= 46.00 M= 43.50 M= 37.00 (1) <0.001 SD = 6.61 SD = 7.85** SD = 11.74** ,++ SD = 10.61** ,++ SD = 9.51 SD = 8.01* SD = 11.94* SD = 12.90** ,++ (2) = 0.006 (3) n.s. (4) = 0.001 Family subscale M= 18.00 M= 16.00 M= 12.00 M= 14.00 M= 18.00 M= 17.00 M= 12.50 M= 12.00 (1) =0.015 SD = 3.42 SD = 3.07** SD = 4.97** ,++ SD = 3.98** ,++ SD = 3.53 SD = 2.85 SD = 5.31** ,++ SD = 4.59** ,++ (2) =0.036 (3) n.s. (4) n.s. F iend subscale M= 20.00 M= 17.00 M= 15.00 M= 15.00 M= 17.00 M= 15.00 M= 16.00 M= 12.00 (1) <0.001 SD = 2.74 SD = 3.53** SD = 5.12** SD = 4.72** ,+ SD = 3.72 SD = 3.47** SD = 4.22** SD = 5.41** (2) =0.001 (3) n.s. (4) =0.014 Significan o he subscale M= 20.00 M= 19.00 M= 16.00 M= 17.00 M= 18.00 M= 15.50 M= 17.50 M= 12.00 (1) <0.001 SD = 2.30 SD = 3.23* SD = 4.60** ,++ SD = 4.35** ,+ SD = 3.90 SD = 3.80* SD = 5.33** ,++ SD = 5.39** ,+,¤ (2) <0.001 (3) n.s. (4) <0.001 No e: SP = Social phobia (SPIN ≥24, R-BDI < 8), DEP = dep ession (SPIN < 24, R-BDI ≥8), and como bid SP/DEP (SPIN ≥24, R-BDI ≥8). M= median, SD = s anda d de ia ion. S a is ical significance by he Bon e oni-co ec ed Mann–Whi ney es : diso de g oups s. no SP/DEP g oup: ** = p< .001, * = p< .00833; DEP o como bid SP/DEP g oups s. SP g oup: ++ p< .001, + p< .00833; Como bid SP/DEP g oup s. 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