Depression is a common and debilitating mental health problem among youth worldwide (Patel et al., 2007). In the United States, it is estimated that one in four adolescents will experience a depressive disorder by the age of 18 (Merikangas & Knight, 2009). In Canada, an estimated 3.2 million youth between the ages of 12-19 are at risk for developing depression, with 5% of male and 12% of female adolescents having experienced one major depressive episode (MHCC, 2013). Adolescence also represents a high-risk period for the first onset of suicidal behavior, as the rate of suicidal ideation (i.e., thinking about, considering, or planning suicide) jumps from less than 1% at age 10 to a staggering 17% by age 18 in the United States (Nock et al., 2013). Moreover, as many as 8% of adolescents diagnosed with major depressive disorder have completed suicide by early adulthood (NIMH, 2019), making suicide the second leading cause of death in youth aged 15 to 24 in both the United States (Drapeau & McIntosh, 2018) and Canada (Statistics Canada, 2018).
Additionally, Canadian youth aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group (Pearson et al., 2013). For instance, problematic alcohol use (i.e., heavy drinking, or drinking that is accompanied by adverse consequences) for depressed adolescents has become increasingly prevalent and debilitating (Windle & Davies, 1999). Although the causal mechanism underlying the relationship between adolescent depression and alcohol problems is not thoroughly understood, the extant research indicates that depression and alcohol problems act as risk factors for each other (see Swendsen & Merikangas, 2000 for a review). For instance, longitudinal research demonstrated that depression in early adolescence is predictive of an increased risk of early alcohol use and alcohol-related problems (i.e., negative consequences associated with alcohol use such as impaired driving, school problems, and reckless sexual behaviors (White & Labouvie, 1989)) in mid to late adolescence, with major depressive disorder doubling the odds of first-time alcohol use by age 14 (King et al., 2004). Additionally, comorbid depression and alcohol problems yield higher risk of suicide and greater social and personal impairment as well as other psychiatric conditions (Davis et al., 2008). Given the high rate of comorbidities between depression, alcohol problems, and suicidality in adolescence, it is imperative that researchers and clinicians develop a better understanding of the various risk and protective factors for these serious mental health challenges.
The Role of Family Functioning in Adolescent Psychopathology
A review of the extant literature suggests family functioning has an important role in the onset and trajectory of emotional and behavioral problems in adolescents, including depression, suicide behaviors, and alcohol use problems (Chan et al., 2013; Davies & Windle, 1997; Sheeber et al., 1997). According to the family systems theory (Bowen, 1974), healthy family functioning or dysfunction is attributed to the ongoing complex interplays between family members, relationships and family system. These transactional patterns of the family system are important in shaping the behavior of individual family members (Bowen, 1974; Epstein et al., 1983). Through the lens of family systems theory, adolescent psychopathology can be interpreted as an indicator of impaired functioning within the larger family system as a whole (Bowen, 1974). For instance, one of the most distinctive risk factors associated with comorbid adolescent depression and alcohol problems is the perceived lack of family support (Chan et al., 2013; Davis et al., 2008; Sheeber et al., 1997; Windle & Davies, 1999). Compared to adolescents with either depression or alcohol-related problems, adolescents with comorbid depression and alcohol-related problems reported the lowest levels of family social support (Windle & Davies, 1999). Similarly, there is compelling evidence that family discord during adolescence significantly increases the risk of depression among adolescent girls, who are then more likely to turn to alcohol or other substances to alleviate depressive symptoms (Chan et al., 2013; Ohannessian et al., 2016). Prior research has also established prospective associations between adolescents’ reports of family relationships (e.g., affective responsiveness, cohesion, and conflict) and subsequent adolescent alcohol and drug problems (Chan et al., 2013; McKay et al., 1991; Ohannessian et al., 2016).
Research also suggests that adolescent-reported family functioning in affective responsiveness is particularly relevant to adverse psychological consequences in adolescents, such as depression and alcohol use problems (e.g., McKay et al., 1991; Tamplin & Goodyer, 2001). Familial affective responsiveness refers to the degree to which interactions between family members are characterized by warmth, affection, and emotional expressivity (Epstein et al., 1983). Affectively responsive parenting, whereby parents appropriately respond to children’s expressions of feelings and needs, is critical in fostering a positive family emotional climate and setting up an early foundation for healthy development (Eisenberg et al., 2004). When children live in a consistent, responsive environment in which they feel nurtured and accepted, they feel emotionally secure and free to express their feelings because they are certain their emotional needs will be met. Indeed, children’s perceptions of familial affective responsiveness are associated with greater use of active, support-seeking emotional regulatory strategies and fewer internalizing and externalizing problems (Eisenberg et al., 2004). In contrast, children whose parents minimize or discourage their emotion expression or punish them for expressing negative emotions are more emotionally reactive, more intense in emotional expression, and more likely to engage in avoidant emotion regulation strategies and escape tactics (e.g., problem drinking) to cope with distress (Eisenberg et al., 2004). For instance, adolescents from families low in affective responsiveness exhibit greater emotional distress and more drug- and alcohol-related problems (e.g., Chan et al., 2013; McKay et al., 1991; Tamplin & Goodyer, 2001). Therefore, given the critical role of parental and familial responsiveness in adolescents’ healthy social and emotional development, parent factors and characteristics that are closely related to familial affective responsiveness may be particularly relevant to a better understanding of adolescent psychological maladjustment.
Parental Perfectionism and Adolescent Psychological Outcomes
Over the past two decades, parental perfectionism and its associations with psychological wellbeing in children and adolescents have gained increasing empirical attention (e.g., Affrunti & Woodruff-Borden, 2015; Mitchell et al., 2013; Soenens et al., 2005; 2006). During parent-child interaction tasks (e.g., solving difficult puzzles, preparing a speech), parents high in perfectionistic concerns (e.g., socially prescribed perfectionism, concern over mistakes, and doubts about actions) were more preoccupied with the negative consequences of the child’s mistakes. In addition, these parents also displayed more controlling behaviors toward the child (e.g., giving explicit directives/commands, choice making, and behavior regulation), and used more negative emotion words during the tasks. Furthermore, the relationship between parental perfectionistic concerns and child anxiety was mediated by parents’ controlling behaviors and/or their use of negative emotion words during the interaction tasks (Affrunti & Woodruff-Borden, 2015; Mitchell et al., 2013). In a study of high school students and their parents, Soenens et al. (2006) demonstrated that parental psychological control mediated the relationships between parental perfectionistic concerns and adolescent emotional wellbeing as assessed by measures of depression, loneliness, and low self-esteem.
In a recent meta-analytic review that included 14 studies on parents’ trait perfectionism (i.e., perfectionistic strivings and perfectionistic concerns) and child/adolescent psychological outcomes, Lilley et al. (2020) found small but significant (positive) associations between parental perfectionistic concerns and child/adolescent psychological outcomes such as depression and anxiety, while controlling for parental perfectionistic strivings (e.g., self-oriented perfectionism). Perfectionistic concerns (e.g., socially prescribed perfectionism) also significantly increases the risk of parental burnout (Sorkkila & Aunola, 2020). Additionally, the relationship between parental perfectionistic concerns and burnout is at least partly explained by parents’ tendency to suppress or hide their emotions from their children (Lin & Szczygiel, 2022).
In sum, the extant research provides support for the notion that parents with elevated trait perfectionism engage in behaviors (e.g., psychological control, conditional approval) with the underlying message that the child must be perfect or appear perfect, and that mistakes and failures are distressing and intolerable (Affrunti & Woodruff-Borden, 2015; Mitchell et al., 2013; Soenens et al., 2005; 2006). These authors concluded that parental perfectionistic concerns may be a core vulnerability factor for poor child/adolescent psychological outcomes (Lilley et al., 2020). Taken together, these findings highlight the role of trait perfectionism in parents as a potential vulnerability factor in child and adolescent psychopathology.
Perfectionistic Self-Presentation and the Perfectionism Social Disconnection Model
Despite the well-documented links between parental perfectionistic concerns (e.g., socially prescribed perfectionism) and adolescent psychological distress (see Lilley et al., 2020 for a review), no study has examined the role of parental perfectionistic self-presentation in adolescent psychological functioning. Perfectionistic self-presentation, as conceptualized by Hewitt and colleagues (2003), reflects the interpersonal expressions of perfectionism and consists of three distinct components: 1) perfectionistic self-promotion is driven by the need to appear perfect or to project an image of perfection to others, 2) nondisplay of imperfection is propelled by the need to avoid appearing as imperfect or flawed via avoidance of situations in which mistakes or flaws may be exposed or scrutinized, and 3) nondisclosure of imperfection is driven by the need to avoid verbally expressing or admitting to distress, mistakes, and any perceived imperfections due to fear of negative evaluation (Hewitt et al., 2003). The Perfectionism Social Disconnection Model (PSDM; Hewitt et al., 2017) offers a useful theoretical framework by suggesting that interpersonal components of perfectionism (e.g., perfectionistic self-presentation) leads to psychological problems by engendering interpersonal problems and social disconnection. Specifically, the PSDM asserted that individuals high in perfectionistic self-presentation engage in behaviors (e.g., hyper-criticalness, psychological control, and a lack of emotional sensitivity) that can give rise to problems with social or emotional connectedness (e.g., loneliness, social isolation, and interpersonal problems). This heightened sense of disconnectedness in turn increases the risk of negative psychological outcomes such as depression and suicide (Hewitt et al., 2017).
In support of the PSDM (Hewitt et al., 2017), perfectionistic self-presentation has been positively linked with indicators of social disconnection (e.g., loneliness, social anxiety, and interpersonal hopelessness), which in turn, predicted increased depressive symptoms and suicidal ideation in studies involving community adults (Rnic et al., 2021; Robinson et al., 2021) and adolescents (Goya Arce & Polo, 2017). However, the extant research has focused exclusively on perfectionistic self-presentation in relation to the individual’s own psychological or interpersonal functioning. To our knowledge, no study to date has tested the PSDM in the context of dyadic (e.g., parent-adolescent) or family relationships. Moreover, there is a lack of research on the role of family relationships in the context of parental perfectionism and adolescent psychopathology.
The Current Study
The general aim of this study was therefore to address these important gaps in the literature by exploring the associations between parental perfectionistic self-presentation, perceived family functioning in affective responsiveness, and adolescent psychological outcomes (i.e., depressive symptoms, suicide ideation, and alcohol-related problems) in a group of psychiatric adolescents and their parents. By examining family functioning in affective responsiveness, as a measure of social connectedness between family members, we aimed to shed more light on the mechanism by which parental perfectionistic self-presentation is associated with adolescent maladjustment. Notably, we included both adolescents’ and parents’ reports of familial affective responsiveness to provide multi-informant assessments of family functioning. This is crucial because of well-documented discrepancies between adolescent and parent reports about family relationships (see De Los Reyes et al., 2019 for a review). Additionally, parents high in perfectionistic self-presentation may underestimate or minimize the extent of family dysfunction due to their tendency to downplay or hide personal problems and distress (Hewitt et al., 2003). Assessing both adolescents’ and parents’ perceptions of family functioning can therefore add valuable insight into the dynamics of the parent-adolescent relationships.
Drawing on the PSDM (Hewitt et al., 2017) and prior research on parental perfectionism and adolescent psychopathology (Lilley et al., 2020), we hypothesized that parental perfectionistic self-presentation would be associated with 1) greater perceptions of family dysfunction in affective responsiveness, and 2) more severe adolescent psychological maladjustment as indicated by measures assessing depression, suicide ideation, and alcohol-related problems, and that 3) the positive associations between parental perfectionistic self-presentation and measures of adolescent psychopathology (i.e., depressive symptoms, suicide ideation, and alcohol-related problems) would be accounted for by greater perceived family dysfunction in affective responsiveness.