Longitudinal relationships between sub-clinical depression, sub-clinical eating disorders and health-related quality of life in early adolescence

Objective: A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate how all three variables interact over time. This study sought to explore the bi-directional relationships between depressive symptoms, ED symptoms and HRQOL in a large community sample of young adolescents. Method: Adolescents (N = 1393) aged between 11 and 14 years (M = 12.50, SD = 0.38) completed an online survey measuring depressive symptoms, ED symptoms and HRQOL. Two-level autoregressive cross-lagged models with three variables (i.e., depressive symptoms, HRQOL and ED) assessed across two time points (T1 and T2) were created to address the study aims. Results: HRQOL was found to predict depressive symptoms and depressive symptoms were found to predict ED symptoms. Components of HRQOL (i.e., social relationships and ability to cope) were found to share a differential relationship with depressive symptoms. Inability to cope predicted depressive symptoms and depressive symptoms predicted negative social relationships. EDs were found to predict reduced HRQOL and negative social relationships. Discussion: Findings suggest prevention and early intervention programs designed to address adolescent depression should focus on improving HRQOL. Future research should assess the relationship between HRQOL and individual ED symptoms (e.g., body-related ED symptoms, restrictive symptoms) as a means of exploring relationships that may have been masked by assessing ED symptoms using a total score. Public Significance: This study sought to explore how eating disorders, depressive symptoms, and health-related quality of life (HRQOL) relate over time in a sample of young adolescents. Findings indicate adolescents who self-reported lower levels of HRQOL, including a reduced ability to cope, are at risk of experiencing depressive symptoms. Adolescents should be provided with the tools to develop problem-focused coping strategies as a means of reducing depressive symptoms.