Background and hypotheses Sexual minority youth are at increased risk for psychotic experiences, potentially due to identity-related difficulties. We hypothesized that sexual minority youth would report greater identity difficulties, and that these difficulties would be associated with heightened suspiciousness in daily life. Finally, we examined whether these associations differ between sexual minority and heterosexual adolescents.Study design Experience Sampling Method (ESM) and questionnaire data were collected from 1913 Flemish adolescents (aged 11-20). Identity functioning was assessed using a validated questionnaire (Erikson Psychosocial Stage Inventory, EPSI) and momentary assessments via ESM. Suspiciousness was also measured through ESM. Multilevel linear regression models tested within- and between-person associations between identity functioning and suspiciousness, and explored moderation by sexual minority status.Study results Sexual minority participants reported significantly lower identity synthesis, higher identity confusion, and greater momentary identity difficulties. At the within-person level, lower momentary identity functioning predicted higher suspiciousness both concurrently and at subsequent time points. Suspiciousness also predicted later identity difficulties, indicating a bidirectional relationship. Sexual minority status moderated these effects: Identity confusion was more strongly associated with suspiciousness in sexual minority youth, while identity synthesis appeared protective only in heterosexual youth.Conclusions Identity difficulties are closely linked to suspiciousness in adolescents, particularly among sexual minority youth. The bidirectional relationship suggests a reinforcing cycle that may increase vulnerability to psychotic experiences. These findings stress the need for preventive interventions that address identity integration during adolescence, especially for sexual minority adolescents navigating identity development in a heteronormative context.

Key symptoms of anxiety include experiencing unpleasant emotions and hyperarousal. Growing evidence suggests that delayed affective recovery (DAR) from daily stressors plays a role in their maintenance and development on a day-to-day basis. We examined whether DAR is linked to current and future anxiety symptoms, independently of depressive symptoms. Self-reported anxiety and depressive symptoms were assessed at Wave 1 (N = 1,031) and approximately 2.5 years later at Wave 2 (N = 171) in a community sample of Flemish adolescents. Additionally, at Wave 1, the experience sampling method was used to obtain assessments of momentary affect and to infer stressful occurrences, with data collected 10 times a day, for 6 days. Using affective experience sampling method data, we constructed two variables, that is, affective valence and arousal, reflecting the (un)pleasantness and (hyper)arousal associated with emotions. The time interval for recovery was estimated using parametric survival analysis. Prospective associations were tested with multiple regression. Slower valence recovery was associated with higher concurrent anxiety symptoms. A similar association was present for the arousal recovery, however only when depressive symptoms were added to the model. We found no prospective association between the speed of valence nor arousal recovery at Wave 1 and anxiety symptoms at Wave 2. The results suggest that DAR is linked to current anxiety symptoms but does not predict their development 2.5 years later. Our findings provide insights into possible processes underlying the key features of anxiety and help identify the moments of vulnerability in the daily lives of youth.

The COVID-19 pandemic is believed to have strongly impacted adolescents' mental health through limiting their day-to-day social lives. However, little is known about the role of (social) risk/protective factors and adolescent mental health. Subclinical psychopathology, and risk and protective factors of n = 173 adolescents (T1 mean age = 16.0; 89% girls) were assessed prepandemic and early-pandemic (T1: 2018/2019; T2: May 2020). Daily-life social interactions were assessed in 6-day experience sampling periods. Correcting for age, multilevel analyses revealed declines in general psychopathology and anxiety symptoms; fewer face-to-face social interactions, more online social interactions; and higher-quality face-to-face interactions during the pandemic than before. Negative associations between psychopathology and the quality of face-to-face peer and family interactions were stronger during the pandemic than prepandemic. The results reflect that, early in the pandemic, the mental health impact on adolescents may have been limited. High-quality face-to-face interactions with family and peers seemed particularly powerful in keeping adolescents resilient.

Childhood adversity is known to predispose to a wide array of psychopathology in adolescence and early adulthood. Identity development, being a crucial developmental task during adolescence, has been suggested to affect this association. Nonetheless, research on the role of identity processes is scarce. The current study aims to investigate how identity processes of exploration and commitment may impact the association between childhood adversity and psychopathology. We cross-sectionally investigated the association between childhood adversity, identity processes (i.e., exploration in breadth and depth, commitment making, identification with commitment and ruminative exploration) and depressive, anxiety and psychosis symptoms in 869 Flemish adolescents between 14 and 20 years old (mean = 15.52, SD = 1.28). Childhood adversity was associated with increased ruminative exploration, which itself was associated with increased psychopathology. On the other hand, commitment making, identification with commitment and exploration in breadth were associated with decreased psychopathology. Processes of exploration in breadth and commitment making attenuated the association between childhood adversity and psychopathology. Moreover, identification with commitment and ruminative exploration potentially mediated this association. These findings underscore the importance of healthy identity processes in adolescents, with and without exposure to childhood adversity. Measures of identity structure and identity processes should be combined to fully capture identity.

The Experience Sampling Method (ESM) is increasingly used by researchers from various disciplines to answer novel questions about individuals’ daily lives. Measurement best practices have long been overlooked in ESM research, and recent reviews show that item quality is often not reported in ESM studies. The absence of information about item quality may partly be explained by the lack of consensus on how ESM item quality should be evaluated. As part of the ESM Item Repository project (esmitemrepository.com) — an international open science initiative that collects ESM items in an open item bank and evaluates their quality — we brought together 42 international ESM experts to develop an ESM item quality assessment tool. In four Delphi phases, experts suggested 57 item quality criteria, rated the criteria, provided arguments for and against the criteria, and rated the criteria again, considering reflections from other experts. The result of the Delphi process is ESM-Q: A quality assessment tool consisting of 10 core criteria, as well as an additional 15 supplementary criteria, to be used depending on the type of items being rated and the availability of supplementary information. The criteria cover topics ranging from construct validity to the optimal wording of items. ESM-Q can aid ESM researchers in selecting existing ESM items, developing new high-quality ESM items, and evaluating the quality of ESM items in systematic reviews. Expert reflections also highlight open research questions surrounding ESM item design that form a research agenda for ESM measurement.

Background Previous research suggests that sexual minorities are at higher risk for psychotic experiences, possibly due to repeated social defeat experiences. However, empirical research investigating this hypothesis is largely lacking. This study examined how experiences of "feeling excluded" and "not belonging" impact the prospective development of psychotic experiences in an adolescent sexual minority group, defined here as non-heterosexual attraction to others.Methods Experience sampling method (ESM) data from 1913 Flemish adolescents (aged 11-20) in the SIGMA study were analyzed. They reported their momentary feelings of exclusion when alone, belonging when in the company of others (both operationalizations of social defeat), and suspiciousness. Multilevel linear regression models tested the bidirectional, within- and between-person associations between social defeat and suspiciousness, and the effects of sexual minority status.Results Lower feelings of belonging when in company significantly predicted higher suspiciousness at the next beep [95% CI: -0.03, -0.01], whereas increased feelings of exclusion when alone did not. Moreover, suspiciousness did not significantly predict feelings of exclusion and belonging at the next beep, confirming the direction of effect. Sexual minority participants reported generally lower belonging in social settings [95% CI: -0.68, -0.29] and higher suspiciousness [95% CI: 0.16, 0.57], but not higher feelings of exclusion. The interaction between social defeat and sexual minority status was not significant, indicating no differential sensitivity to social defeat experiences.Conclusions The experience of "not fitting in" when in company may be the most poignant social factor increasing risk for psychotic experiences in sexual minority youth. The findings highlight the need for inclusive environments where sexual minority individuals feel supported and integrated.

BACKGROUND:The COVID-19 pandemic is assumed to have had a large impact on the mental health of adolescents. Finding out for which youth the mental health impact was largest is imperative for strengthening future crisis responses. In this study, we aimed to assess the impact of the pandemic on the mental health of different sociodemographic groups of general population adolescents in Flanders, Belgium. METHODS:Adolescents were tested for the SIGMA study, at W1 (n=1913; mean age=13.8; 63.1% female; 2018/2019); W2 (n=272; mean age=16.5; 74.0% female; 2020); and W3 (n=227; mean age=18.0; 78.4% female; 2022/2023). Subclinical anxiety, depression, psychoticism, and general psychopathology were measured with the Brief Symptom Inventory-53. Multilevel linear regression models with imputed data sets were used to test cross-wave differences in each psychopathology outcome (controlling for age-related increases), effects of time since the beginning of the pandemic and stringency of pandemic-related measures, and effects of several sociodemographic predictors on levels and changes in psychopathology (from W1 to W2, and from W1 to W3). RESULTS:Results indicated limited overall early increases in psychopathology (only for depression from W1 to W2), and some decreases in psychopathology levels from W1 to W3 (for anxiety and general psychopathology). Girls and those reporting same-gender attraction reported higher levels of nearly all symptoms. CONCLUSION:Although most youth in this sample were resilient during the COVID-19 pandemic, some groups consistently showed high psychopathology levels. Attention is still needed for groups that were at risk before the pandemic, notably, LGTBQIA+ youth.

Introduction: Childhood adversity may result in a negative expectation of future interactions with others, also referred to as ‘threat anticipation’. It may also negatively impact on identity development, which subsequently may influence how individuals deal with their environment. Here, we examine the hypotheses that 1) identity development is associated with threat anticipation, and 2) that identity confusion, in the presence of childhood adversity, has a synergistic effect on the development of threat anticipation. Methods: 1913 adolescents from the general population (mean age = 13.8 years, SD = 1.86, range = 11-20) completed self-report questionnaires assessing exposure to childhood adversity, identity development and threat anticipation. Results: Identity development was significantly associated with threat anticipation in the expected direction: identity synthesis was associated with reduced anticipation of threat (β = -.0013, p < .001), whereas identity confusion was association with increased threat anticipation (β = .0017, p < .001). Furthermore, childhood adversity was positively associated with threat anticipation (β = .0018, p < .001). However, no evidence for an interaction effect of identity on the association between childhood adversity and threat anticipation was found.Conclusion: The current study illustrates the importance of exposure to childhood adversity and identity development for the anticipation of threat. Identity development however did not moderate the association between childhood adversity and threat anticipation, suggesting childhood adversity and identity development have an additive rather than synergistic effect on threat anticipation. Further research is needed to clarify how both factors influence each other within a developmental framework.

BACKGROUND:Research suggests that most mental health conditions have their onset in the critically social period of adolescence. Yet, we lack understanding of the potential social processes underlying early psychopathological development. We propose a conceptual model where daily-life social interactions and social skills form an intermediate link between known risk and protective factors (adverse childhood experiences, bullying, social support, maladaptive parenting) and psychopathology in adolescents - that is explored using cross-sectional data. METHODS:N = 1913 Flemish adolescent participants (Mean age = 13.8; 63% girls) were assessed as part of the SIGMA study, a large-scale, accelerated longitudinal study of adolescent mental health and development. Self-report questionnaires (on risk/protective factors, social skills, and psychopathology) were completed during class time; daily-life social interactions were measured during a subsequent six-day experience-sampling period. RESULTS:Registered uncorrected multilevel linear regression results revealed significant associations between all risk/protective factors and psychopathology, between all risk/protective factors and social processes, and between all social processes and psychopathology. Social processes (social skills, quantity/quality of daily social interactions) were uniquely predicted by each risk/protective factor and were uniquely associated with both general and specific types of psychopathology. For older participants, some relationships between social processes and psychopathology were stronger. CONCLUSIONS:Unique associations between risk/protective factors and psychopathology signify the distinct relevance of these factors for youth mental health, whereas the broad associations with social processes support these processes as broad correlates. Results align with the idea of a social pathway toward early psychopathology, although follow-up longitudinal research is required to verify any mediation effect.

Purpose: The COVID-19 pandemic is assumed to have had a large impact on the mental health of adolescents. Finding out for which youth the mental health impact was largest is imperative for strengthening future crisis responses. In this study, we aimed to assess the impact of the pandemic on the mental health of different sociodemographic groups of general population adolescents in Flanders, Belgium. Methods: Adolescents were tested for the SIGMA study, at W1 (n=1913; mean age=13.8; 63.1% female; 2018/2019); W2 (n=272; mean age=16.5; 74.0% female; 2020); and W3 (n=227; mean age=18.0; 78.4% female; 2022/2023). Subclinical anxiety, depression, psychoticism, and general psychopathology were measured with the Brief Symptom Inventory-53. Multilevel linear regression models with imputed data sets were used to test cross-wave differences in each psychopathology outcome (controlling for age-related increases), effects of time since the beginning of the pandemic and stringency of pandemic-related measures, and effects of several sociodemographic predictors on levels and changes in psychopathology (from W1 to W2, and from W1 to W3). Results: Results indicated limited overall early increases in psychopathology (only for depression from W1 to W2), and some decreases in psychopathology levels from W1 to W3 (for anxiety and general psychopathology). Girls and those reporting same-gender attraction reported higher levels of nearly all symptoms. Conclusion: Although most youth in this sample were resilient during the COVID-19 pandemic, some groups consistently showed high psychopathology levels. Attention is still needed for groups that were at risk before the pandemic, notably, LGTBQIA+ youth.

Background and Hypothesis Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations. Study Design Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12-20, 67% female). Study Results Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs. Conclusions Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.

Background: Adolescent solitude was drastically impacted by the COVID-19 pandemic. As solitude is crucial for adolescent development through its association with both positive and negative developmental outcomes, it is critical to understand how adolescents’ daily-life solitary experiences changed as a result of the pandemic.Methods: Using three waves of Experience Sampling Method data from a longitudinal study, we compared adolescents’ daily-life solitary experiences in the early (nT1=100; MAge=16.1; SDAge=1.9; 93% girls) and mid-pandemic (nT2=204; MAge=16.5; SDAge=2.0; 79% girls) to their pre-pandemic experiences.Results: We found that adolescents with lower levels of pre-pandemic social support and social skills reported wanting to be alone less and feeling like an outsider more at both time points during the pandemic. In the mid-pandemic wave, adolescents with higher levels of pre-pandemic social support and social skills reported decreases in positive affect compared to the pre-pandemic wave.Conclusion: This study shows that adolescents’ daily-life solitary experiences worsened throughout the COVID-19 pandemic. There should be continued concern for the wellbeing of all adolescents, not only those already at risk, as effects of the pandemic on mental health might only manifest later.

Background While evidence shows that people with early psychosis are flexible in using different emotion regulation (ER) strategies to manage the varying contextual demands, no studies have examined the effectiveness of such regulatory flexibility in this population. We addressed this issue by investigating whether and how ER flexibility relate to different dynamic aspects (variability, instability, inertia, and recovery) of negative affect (NA) in a combined early psychosis sample, consisting of both individuals at high clinical risk for psychosis and those diagnosed with first-episode psychosis. Methods Participants were 148 individuals from the INTERACT project, a multi-center randomized controlled trial on the efficacy of acceptance and commitment therapy in early psychosis. We utilized data from the baseline assessment, during which all participants completed six days of experience sampling assessment of momentary NA, as well as end-of-day assessments of ER strategy use. Results Multilevel models of within-person associations showed that greater ER flexibility was associated with more stable NA, and quicker recovery of NA from stressors during the day. Linear regression analyses of between-person associations showed that people who had more variable and unstable NA reported greater ER flexibility generally. No evidence was found for associations with NA inertia. Conclusions The current study identified unique within-person and between-person links between ER flexibility and dynamics of NA in early psychosis. These findings further provide evidence for ER flexibility in early psychosis, emphasizing the adaptive nature of regulatory flexibility in relation to reduced instability in NA and faster recovery from NA in everyday life.

The Perceptual Crossing Experiment (PCE) captures the capacity for social contingency detection using real-time social interaction dynamics but has not been externally validated. We tested ecological and convergent validity of the PCE in a sample of 208 adolescents from the general population, aged 11 to 19 years. We expected associations between PCE performance and (a) quantity and quality of social interaction in daily life, using Experience Sampling Methodology (ESM; ecological validity) and (b) self-reported social skills using a questionnaire (convergent validity). We also expected PCE performance to better explain variance in ESM social measures than self-reported social skills. Multilevel analyses showed that only self-reported social skills were positively associated with social experience of company in daily life. These initial results do not support ecological and convergent validity of the PCE. However, fueled by novel insights regarding the complexity of capturing social dynamics, we identified promising methodological advances for future validation efforts.

Background: Little is known about whether and how contextual appraisals relate to emotion regulation (ER) strategy use across the ultra-high risk and first episode stages of psychosis. The present study extends previous research by investigating the extent to which different appraisal dimensions of the most negative and positive events of the day are associated with ER strategy use in individuals with ultra-high risk (UHR) and first-episode psychosis (FEP).Method: Sixty-eight UHR individuals and fifty-five FEP individuals filled out an experience sampling evening questionnaire for six consecutive days, in which their appraisal of intensity, importance and perceived control concerning the most negative or positive event of the day, and the ER strategies they deploy in response to these events were measured.Results: Multilevel mixed effect models showed that intensity appraisal was most closely associated with ER strategy use, as opposed to importance and controllability appraisals. Higher intense negative events were associated with more rumination and social sharing, while less intense negative events were associated with more reappraisal. Higher intense positive events were associated with a greater number of deployed strategies and more efforts in using savoring, expression and social sharing. The UHR and FEP individuals did not significantly differ regarding effects of above-mentioned appraisal dimensions on ER.Conclusions: These results provide evidence supporting ER flexibility in early psychosis, and event intensity emerged as the dimension most strongly associated with ER. Future research should better account for other situational factors (such as social context) that might affect ER use in psychosis.

Background: Self-harm is a leading cause of death and injury worldwide and is especially common amongst adolescents. Adverse childhood experiences (ACEs) are characterized as a risk factor for self-harm within the Integrated-Motivational Volitional (IMV) model. However, it remains unclear whether ACEs are associated with self-harm thoughts, behaviours, or both. Moreover, research that investigates potential protective factors in the association between ACEs and self-harm is scarce. Here, we investigated whether ACEs were associated with lifetime and current self-harm thoughts and behaviours, and whether parent-child or peer attachment relationship quality influenced this association. Additionally, we explored whether specific types of ACEs were differentially associated with self-harm. Methods: N=1014 adolescents (Age, Mean (SD) = 14.05 years (1.91), 66.66% female) were recruited from the general population via schools across Flanders (Belgium). Retrospective questionnaires were used to assess ACEs, lifetime self-harm thoughts and behaviours, and paternal, maternal, and peer attachment relationship quality. Experience Sampling Methodology (ESM) was used to assess current self-harm thoughts and behaviours, 10x/day for 6 days. Results: Multilevel analyses demonstrated associations between ACEs and lifetime and current self-harm thoughts and behaviours, that were attenuated by a high-quality maternal attachment relationship. Specific types of ACEs (e.g., sexual victimization) were more strongly associated with lifetime and current self-harm thoughts and behaviours.Conclusions: The study provides evidence for ACEs as a pre-motivational phase variable within the IMV model. Clinicians are encouraged to consider exposure to ACEs and the potential of maternal relationships to buffer their impact in the prevention and management of adolescent self-harm.

Key symptoms of anxiety include experiencing unpleasant emotions and hyperarousal. Growing evidence suggests the role of delayed affective recovery from stress (DAR) in their maintenance and development on a day-to-day basis. We aimed to investigate whether DAR is linked to current and future anxiety symptoms, independently of depressive symptoms. Self-reported anxiety and depressive symptoms were assessed twice: at Wave 1 (N=1031) and approximately 2.5 years later at Wave 2 (N=171) in a community sample of adolescents. Additionally, at Wave 1, Experience Sampling Method (ESM) was used. Participants reported their momentary affect and stressful occurrences 10 times a day, for six days. Using ESM data and a subtraction method, we construed two variables, i.e., affective valence and arousal reflecting the (un)pleasantness and (hyper)arousal associated with emotions. The time interval for affective recovery was estimated using parametric survival analysis. Prospective associations were tested with multiple regression. Slower valence recovery was associated with higher concurrent anxiety symptoms (p&lt;.05) and this association remained present when controlling for depressive symptoms (p&lt;.05). The same association was present for the arousal recovery, however only when depressive symptoms were added to the model (p&lt;.05). We found no prospective association between the speed of valence nor arousal recovery at Wave 1 and anxiety symptoms at Wave 2. Our results suggest that DAR may be a concomitant process contributing to the maintenance of key anxiety symptoms, but not to their development. Our findings help identify the moments in the daily lives of youth, where potential interventions could be implemented.

IntroductionChildhood adversity is a major risk factor for psychiatric disorders and has especially been associated with an admixture of depressive, anxiety and psychosis symptoms. Identity formation, a main developmental task during adolescence, may be impacted by these adverse experiences and act as an important process in the association between childhood adversity and psychopathology.MethodsWe investigated the association between childhood adversity, identity formation, and depressive, anxiety and psychosis symptoms cross-sectionally in 1913 Flemish adolescents between 11 and 20 years old (mean = 13.76, SD = 1.86). Adolescents completed questionnaires during the first wave of the SIGMA study between January 2018 and May 2019.ResultsChildhood interpersonal adversity was associated with increased identity confusion and decreased identity synthesis. Additionally, identity confusion was associated with increased self-reported levels of psychopathology and potentially mediated the association between childhood adversity and psychopathology. ConclusionThis study highlights the importance of promoting healthy identity formation in adolescents with and without exposure to adverse childhood experiences.

Emotion regulation in daily life can serve as a risk or resilience factor during times of crisis. Using the experience sampling method, the current study investigated rumination, savoring, and sharing with others in response to positive and negative events during the early COVID-19 pandemic lockdown measures among adolescents (N = 110, aged 13-20, 89% female). For six days, adolescents reported the intensity and valence of events throughout the day and how much they ruminated and shared about negative events and savored and shared about positive events. We aimed to conceptually replicate pre-pandemic findings and found that relationships between emotion regulation and event intensity were largely replicated: During the pandemic, higher intensity of negative events was associated with ruminating more and higher intensity of positive events was associated with savoring more and sharing more about them. Symptoms of psychopathology (anxiety, depression, and psychoticism) were not associated with ruminating about negative events, contrary to pre-pandemic observations, or sharing about negative events. However, psychopathology symptoms were positively associated with savoring positive events. The current results highlight the importance of context in daily life emotion regulation and suggest that adaptive emotion regulation may look different for adolescents during a major disruption to daily life.

Background: Previous research suggests attachment is a vulnerability factor for self-harm thoughts and behaviors in adults. Yet, few studies have investigated this relationship during adolescence, although adolescence is a critical period for changes in attachment relationships and self-harm onset. Whether and how attachment relates to self-harm thoughts and behaviors as measured in daily life is also unknown. Aims: To investigate whether and how paternal, maternal, and peer attachment are associated with lifetime and current adolescent self-harm thoughts and behaviors. Additionally, to examine how different attachment bonds interact in relation to lifetime and current adolescent self-harm thoughts and behaviors. Method: Pre-existing data from N = 1,913 adolescents of the SIGMA study were used. Attachment and lifetime history of self-harm thoughts and behaviors were measured via retrospective questionnaires. Current self-harm thoughts and behaviors were assessed 10 times per day for 6 days using the experience sampling method (ESM). Results: Paternal and maternal attachments were associated with lifetime self-harm thoughts and behaviors and current self-harm thoughts. No significant associations were found between peer attachment and self-harm outcomes. Limitations: Some analyses were underpowered. Conclusion: Our results highlight the importance of parent-child attachment relationships, which may be intervention targets for prevention and treatment of adolescent self-harm.