title: Decrease in self-esteem mediates the association between symptoms of social phobia and depression in middle adolescence in a sex-specific manner: a 2-year follow-up of a prospective population cohort study.
abstract: BACKGROUND
  Social phobia and depression are common, highly comorbid disorders in middle adolescence. The mechanism underlying this comorbidity, however, is unclear. Decrease in self-esteem caused by the initial disorder might play a decisive role in the development of the subsequent disorder. The present study aimed to determine whether the association between symptoms of social phobia and depression is mediated by decrease in self-esteem in mid-adolescent girls and boys.
  
  
  METHODS
  As a part of the prospective Adolescent Mental Health Cohort (AMCH), subjects of this study were 9th grade pupils (mean age, 15.5) responding to a survey conducted in 2002-2003 (T1) and to a 2-year follow-up survey in 2004-2005 (T2) (N = 2070, mean age 17.6 years, 54.5% girls).
  
  
  RESULTS
  Symptoms of social phobia without symptoms of depression at age 15 and symptoms of depression at age 17 were associated only among boys, and this association was mediated by decrease in self-esteem. Symptoms of depression without symptoms of social phobia at age 15 and symptoms of social phobia at age 17 were associated only among girls, and this association was partially mediated by decrease in self-esteem.
  
  
  CONCLUSIONS
  Decrease in self-esteem plays a decisive role in the association between social phobia and depression. Self-esteem should be a key focus in interventions for adolescents suffering from social phobia or depression. Efficient intervention for the first disorder might help to prevent the decline in self-esteem and thus the incidence of the subsequent disorder. These findings are based on a sample of Finnish adolescents and should be confirmed in other jurisdictions or in more ethnically diverse samples.
authors.affiliation: Department of Adolescent Psychiatry, Tampere University Hospital, Box 2000, Tampere 33521, Finland. juha.vaananen@pshp.fi.
authors.forename: Juha-Matti
authors.initials: JM
authors.lastname: Väänänen
authors.forename: Rasmus
authors.initials: R
authors.lastname: Isomaa
authors.forename: Riittakerttu
authors.initials: R
authors.lastname: Kaltiala-Heino
authors.forename: Sari
authors.initials: S
authors.lastname: Fröjd
authors.forename: Mika
authors.initials: M
authors.lastname: Helminen
authors.forename: Mauri
authors.initials: M
authors.lastname: Marttunen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D054526:Men's Health / Q000706:statistics & numerical data; D010698:Phobic Disorders / Q000453:epidemiology / Q000523:psychology*; D011446:Prospective Studies; D012649:Self Concept; D017678:Sex Distribution; D012737:Sex Factors; D012920:Social Behavior Disorders / Q000453:epidemiology / Q000523:psychology*