physical activity, resilience, and depressive symptoms in adolescence

Accepted Manuscript

Physical activity, resilience, and depressive symptoms in adolescence

Inger E. O Moljord , MSc Unni K. Moksnes , PhD Geir A. Espnes , PhD OdinHjemdal , Lasse Eriksen , PhD

PII: S1755-2966(14)00026-X

DOI: 10.1016/j.mhpa.2014.04.001

Reference: MHPA 136

To appear in: Mental Health and Physical Activity

Received Date: 3 September 2013

Revised Date: 10 April 2014

Accepted Date: 22 April 2014

Please cite this article as: Moljord, I.E.O., Moksnes, U.K., Espnes, G.A., Hjemdal, O., Eriksen, L.,Physical activity, resilience, and depressive symptoms in adolescence, Mental Health and PhysicalActivity (2014), doi: 10.1016/j.mhpa.2014.04.001.

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http://dx.doi.org/10.1016/j.mhpa.2014.04.001

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ACCEPTED MANUSCRIPTPhysical activity, resilience, and depressive symptoms

TITLE PAGE

Title: “Physical activity, resilience, and depressive symptoms in adolescence”

Authors: Inger E. O. Moljord MSc a, Unni K. Moksnes PhD b,c, Geir A. Espnes PhD c,e,, Odin

Hjemdal f,, Lasse Eriksen PhD a,d

a St. Olavs University Hospital, Division of Psychiatry, Nidaros Community Mental Health

Centre, Trondheim, Norway.

b Sør-Trøndelag University College, Faculty of Nursing, Trondheim, Norway.

c Research Centre for Health Promotion and Resources HiST/NTNU, Trondheim, Norway.

d Norwegian University of Science and Technology, Faculty of Medicine, Department of

Neuroscience, Trondheim, Norway.

e Norwegian University of Science and Technology, Department of Social Work and Health

Science, Trondheim, Norway.

f Norwegian University of Science and Technology, Department of Psychology, Trondheim,

Norway.

Corresponding author: Inger Elise Opheim Moljord, St. Olavs University Hospital, Division

of Psychiatry, Nidaros Community Mental Health Centre, Østmarkveien 21, Postboks 1893

Lade, N-7440 Trondheim. Norway. Phone: +4773865400/ +4747336900.

E-mail address: [email protected]

Running title: Physical activity, resilience, and depressive symptoms

Source of support: St. Olavs University Hospital, Division of Psychiatry, Nidaros

Community Mental Health Centre

Abstract/text: 192 words/ 5843 words inclusive references

Tables/figures: 3 tables

Keywords: Physical exercise, protective factors (resilience), mental health, adolescents

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Abstract 1

Promoting mental health by facilitation of physical activity and resilience are of great 2

importance in adolescence. This cross-sectional study investigated the association between 3

physical activity and resilience, in relation to depressive symptoms among adolescents. 4

Resilience is based on five factors: personal competence, social competence, structured style 5

(planning, structure, and daily routines), social resources, and family cohesion. 6

Norwegian adolescents 13-18 years old (N = 1100; 51% girls and 49% boys) participated in 7

the study. Girls scored lower in physical activity, and higher in social resources and 8

depressive symptoms than boys, while boys scored higher in personal competence and 9

structured style. For both genders the hierarchical multiple regression analysis showed a 10

negative association between the resilience factors and depressive symptoms. Higher levels 11

of physical activity were associated with lower levels of depressive symptoms for girls. There 12

was no significant association between physical activity and depressive symptoms among 13

boys. There was, however, an interaction effect for boys indicating that the association 14

between structured style, and depressive symptoms depends on the frequency of physical 15

activity. 16

Acknowledging the association between physical activity, resilience, and the outcome of 17

depressive symptoms may be important in developing health promotion programs for young 18

people, especially girls. 19

20

1. Introduction 21

The role of personal resources as protective factors and their contribution to the 22

development of health during adolescence has been given attention (Hjemdal, Aune, 23

Reinfjell, Stiles, & Friborg, 2007; von Soest, Mossige, Stefansen, & Hjemdal, 2009). It is 24

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important to identify and understand protective factors contributing to preventive strategies 25

(von Soest et al., 2009) especially among adolescents, as potential changes may have a long-26

lasting impact compared to the general population (Sawyer et al., 2012). Resilience is often 27

defined as a process of normal and healthy functioning, moderating the negative effects of 28

adverse life conditions or trauma (Masten, 2001). Three main groups of protective factors 29

related to resilience have been identified: family cohesion (parental support, monitoring, 30

communication skills), social resources (community support, environment, and social 31

structures) and personal dispositions (individual characteristics, self-regulation, self-esteem) 32

(Hjemdal, Vogel, Solem, Hagen, & Stiles, 2011; Luthar, Cicchetti, & Becker, 2000; Zolkoski 33

& Bullock, 2011). Interesting gender differences in resilience are found in some studies, 34

where boys report higher intrapersonal dispositions, whereas girls report more social and 35

interpersonal resources (Hjemdal, Friborg, Stiles, Martinussen, & Rosenvinge, 2006a; 36

Hjemdal, Friborg, Stiles, Rosenvinge, & Martinussen, 2006b; Hjemdal et al., 2011). 37

Adolescents who report negative life events score lower in resilience than adolescents with 38

few or no such experiences (Hjemdal et al., 2006a). Resilience has become a conceptual 39

umbrella that encompasses virtually all protective factors. 40

One specific protective factor, physical activity, has also gained a more important role 41

in the understanding of health behaviour (Gerber & Pühse, 2008; Haskell et al., 2007; Strong 42

et al., 2005). Life events seem to affect physical activity both positively and negatively 43

(Engberg et al., 2012). Transition to university and having a child are life events that seem to 44

decrease physical activity, while retirement and new relationship are life events that could 45

increase physical activity (Engberg et al., 2012). Experiences of stress seem to decrease 46

physical activity (Moljord, Moksnes, Eriksen, & Espnes, 2011; Stults-Kolehmainen & Sinha, 47

2014). 48

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Physical activity seems to lead to positive psychosocial outcomes (Andreassen, 2009; 49

Biddle & Asare, 2011; Pickett, Yardley, & Kendrick, 2012), and adolescents who are 50

engaged in frequent physical activity report higher scores for protective factors related to 51

resilience than others (Hjemdal et al., 2006a; Strohle, 2009). It has been reported that 52

adolescents who participate in activities that require social interaction and cooperation score 53

higher in resilience than others (Hjemdal et al., 2006a). One study (Gerber et al., 2012) 54

reported that individuals who engaged in the recommended level of physical activity had 55

stronger mental toughness than those who did not. 56

The recommended level of physical activity is moderate activity ≥ 5 days/week (≥30 57

minutes) or ≥ 3 days/week of vigorous activity (≥ 20 minutes) (Gerber et al., 2012). The 58

relationship between physical activity and mental health among adolescents is generally 59

found to be weak or moderate (Biddle & Asare, 2011; Larun, Nordheim, Ekeland, Hagen, & 60

Heian, 2006). Some studies have reported that higher levels of physical activity and sport 61

participation are associated with lower levels of depressive symptoms (Hallal, Victora, 62

Azevedo, & Wells, 2006; Kirkcaldy, Shephard, & Siefen, 2002; Motl, Birnbaum, Kubik, & 63

Dishman, 2004; Sagatun, Sogaard, Bjertness, Selmer, & Heyerdahl, 2007; Sund, Larsson, & 64

Wichstrom, 2011). Meanwhile, other studies have reported no association between depressive 65

symptoms and physical activity (De Moor, Boomsma, Stubbe, Willemsen, & de Geus, 2008; 66

Rothon et al., 2010). Girls report more depressive symptoms than boys (Dishman et al., 2006; 67

Hjemdal et al., 2011; Moksnes, Moljord, Espnes, & Byrne, 2010), and depressive symptoms 68

and disorders seem to increase, especially among girls, during middle adolescence (Dishman 69

et al., 2006; Hjemdal et al., 2011; Moksnes et al., 2010; Motl et al., 2004). Interestingly, the 70

frequency of leisure time physical activity and physical exercise is reported to decrease 71

during adolescence, when girls’ general participation is lower than that of boys (Duncan, 72

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Duncan, Strycker, & Chaumeton, 2007; Nesheim & Haugland, 2003; Sagatun et al., 2007; 73

Trost et al., 2002). A more recent study has reported no gender differences in the frequency 74

of physical activity (Moljord et al., 2011). 75

The Resilience Scale for Adolescents (READ) (Hjemdal et al., 2006a) is a measure of 76

protective factors associated with resilience. It measures resilience factors across the three 77

main groups of protective factors, but it does not measure the protective factor of physical 78

activity. Therefore, the relationship between depressive symptoms, physical activity, and 79

READ is worth investigating. There are to the authors’ knowledge few studies investigating 80

the association and possible interaction effects between resilience and physical activity 81

related to levels of depressive symptoms in adolescence. One study (Skrove, Romundstad, & 82

Indredavik, 2012) used two resilience factors, family cohesion and social competence, in 83

association with depressive symptoms and healthy/unhealthy lifestyle behaviors (physical 84

activity among others). They found a substantial effect of resilience on the association 85

between unhealthy lifestyle behaviors and depressive symptoms. The present study includes 86

all the READ factors both intra and inter personal. The aim of the present study was to 87

explore the association between the variables of resilience and physical activity and the 88

outcome of depressive symptoms for girls and boys. 89

90

2. Method 91

2.1. Participants 92

Adolescents (N = 1229) in junior and senior high schools from the urban areas of two 93

counties in mid-Norway were asked to participate in the survey during autumn 2008. Overall, 94

1,209 respondents (619 from senior high school and 564 from junior high school) from six 95

different schools returned the questionnaires. A total of 1,183 of the 1,209 respondents (98%) 96

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were between the ages of 13 and 18. However, only those with complete data (N = 1100) 97

were included in the present study (51% girls and 49% boys). Mean age of the sample was 98

15.64 (SD = 1.74). The mean age for girls was 15.66 (SD = 1.75) and for boys 15.63 (SD = 99

1.74). 100

101

2.2. Design and procedure 102

The present cross-sectional study is part of a research project, “Children and 103

adolescents daily life, health, and well-being”, which was approved by the Regional 104

Committee for Medical Research Ethics (REK) and the Norwegian Social Science Data 105

Service (NSD). 106

The adolescents and their parents received an information letter describing the 107

purpose of the study and explaining that participation was voluntary, anonymous, and 108

confidential. Demographic measures (age, sex, and school year) were collected and 109

questionnaires were distributed directly to schools. The researcher gave information to the 110

teachers on how the questionnaires should be filled out, and the teachers distributed the 111

questionnaire to the students during classes lasting 45 minutes. The teachers were available to 112

answer questions from students, who spent the session responding to the questionnaires. This 113

procedure may explain the high response rate. Permission to carry out the study was given by 114

the municipalities and the schools. 115

116

2.3. Instruments 117

Physical activity was measured using one item: “During the last four weeks, how 118

many days per week have you participated in sports or physical activity so hard that you had 119

high respiratory frequency, sweated, or had an increased heart rate for at least 20 minutes?” 120

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The response categories were: (1) Never, (2) Less than one day a week, (3) One day a week, 121

(4) Two or three days a week, and (5) Mostly every day during the week. The question was 122

adapted from Kurtze, Gundersen, and Holmen (2003) and used by Gerber and Pühse (2008) 123

and Moksnes et al., (2010) for measuring leisure time physical activity. Test-retest reliability 124

(8-12 days) is r = .73 (Rangul, Holmen, Kurtze, Cuypers, & Midthjell, 2008). 125

Depressive symptoms were measured using a 15-item scale appropriate for measuring 126

adolescents’ non-clinical depressive attributes experienced during the previous week (Byrne, 127

Davenport, & Mazanov, 2007). The scale was developed and used by Byrne et al. (2007), and 128

the items refer to commonly experienced depressive features outlined in the Diagnostic and 129

Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) 130

(American Psychiatric Association, 2000) and the Zung Self-Rating Depression Scale (Zung, 131

1965). Some items from the scale include: (1) I have felt sad or unhappy; (4) I have lost 132

interest for things that were important for me before; (15) I have felt tired or have had low 133

energy. The respondents are requested to rate the items on a five-point Likert scale ranging 134

from 0 = never to 4 = always, where higher scores indicate more depressive symptoms. The 135

sum scores ranged from 0-60; Cronbach’s alpha (α) for the scale in the present study was .92. 136

Resilience was measured using the 28-item, self-reported Resilience Scale for 137

Adolescents (READ) (Hjemdal et al., 2006a). The respondents are requested to mark their 138

response to each item on a five-point Likert scale ranging from 1 = strongly disagree to 5 = 139

strongly agree, where higher scores indicate a higher degree of resilience. The READ 140

consists of five factors, reflecting: (1) personal competence (measuring self-esteem, self-141

efficacy, self-liking, hope, determination, realistic orientation to life and, maintain daily-142

routines); (2) social competence (measuring extraversion, social skills, positive mood, initiate 143

activities, good communication skills, and flexibilities in social matters); (3) structured style 144

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(measuring the level of which a person plans and structures her or his own routines); (4) 145

social resources (measuring external support from friends and relatives); and (5) family 146

cohesion (measuring shared values and support in the family and the family’s ability to keep 147

an optimistic view even with adversity) (Hjemdal et al., 2006a; Hjemdal et al., 2011). Some 148

examples include: Personal Competence: (1) I reach my goal if I work hard; Social 149

Competence: (6) I easily make others to feel comfortable around me; Structured Style: (2) I 150

am at my best when I have clear aims and objectives; Social Resource: (3) I have some 151

friends/family members that usually encourage me; Family Cohesion: (5) In my family we 152

share views of what is important in life. 153

The READ is based on the Resilience Scale for Adults (RSA) (Friborg, Hjemdal, 154

Rosenvinge, & Martinussen, 2003), and the READ shows adequate psychometric qualities 155

(Hjemdal et al., 2006a). Cronbach’s α of the total scale was .94, and for each factor: (1) 156

personal competence .83; (2) social competence .81; (3) structured style .69; (4) social 157

resources .80; and (5) family cohesion .89. Each factor exists of 4 to 8 items. A low 158

Cronbach's α is quite common in scales with few items (Cortina, 1993). 159

160

2.4. Statistics 161

All statistical analyses were carried out using SPSS, version 18.0 (2009). Descriptive 162

statistics of frequencies, means, and standard deviation were calculated for all instruments, 163

and independent samples t-tests were used to compare gender mean scores on the scales. To 164

evaluate the strength of gender differences on the continuous variables, effect sizes were 165

calculated. Some guidelines are presented for the strength of effects: small (≥.20), medium 166

(≥.50), and large (≥.80) (Cohen, 1988). The Pearson product-moment correlation was used to 167

test bivariate associations separately for each gender between the variables in the study. 168

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Multiple hierarchical linear regression analyses were used to evaluate the association 169

between the resilience total score, each of the resilience factors, and physical activity in 170

association with depressive symptoms, adjusting for age. Separate analyses were conducted 171

for gender. The continuous variables in the interaction term were centered before being 172

entered in the regression analysis. This was done by calculating the mean score for each scale 173

and subtracting the mean on each scale. There were no indications of multicollinearity in the 174

present study, the standard variance inflation factor (VIF) was close to 1 and the tolerance of 175

correlation was above .80 -1.0 (Bowerman & O'Connell, 1990; Tabachnick & Fidell, 2007). 176

The predictor variables were included in four steps: (1) age (2) resilience factors (3) physical 177

activity and (4) interaction terms of each resilience factor x physical activity. The total READ 178

scores and the five READ factors were entered in the second step in six separate analyses, 179

and separate analyses were run for girls and boys. The interactions between physical activity 180

and resilience, both total READ and each READ factor, were entered in the fourth step, and 181

also in separate analyses as in step two. 182

A multiple hierarchical linear regression analysis was undertaken to investigate the 183

association between physical activity and depressive symptoms without entering READ into 184

the model. The predictor variables were included in two steps: (1) age and (2) physical 185

activity. 186

187

3. Results 188

3.1 Descriptive statistics 189

The results from the independent samples t-tests in Table 1 show that boys scored 190

significantly higher than girls on physical activity t (1069.10) = -3.80, p < .001, personal 191

competence t (1094) = -6.10, p < .001, and structured style t (1094) = -2.93, p < .003, 192

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whereas girls scored higher on social resources t (1070.80) = 3.11, p < .002 and depressive 193

symptoms t (1092.24) = 9.49, p < .001. The strongest gender differences were in personal 194

competence, depressive symptoms, and physical activity, all with p <.001. 195

______ 196

Table 1 197

_______ 198

199

3.2 Correlations between physical activity, resilience, and depressive symptoms 200

The results of the correlation analyses of the scales in the study are presented 201

separately for gender in Table 2. When looking at the correlations for both girls and boys, 202

there were significant, strong, and positive correlations between all the resilience factors, and 203

all the factors showed significant and negative correlations with depressive symptoms. 204

Furthermore, physical activity was significantly and positively associated with social 205

competence and structured style. 206

Girls showed a significant positive correlation between physical activity and personal 207

competence, and a significant negative correlation between physical activity and depression. 208

There were significant negative associations between age and personal competence, 209

structured style, social resource, and family cohesion, and a significant positive association 210

with depressive symptoms. 211

Boys showed a significant and positive correlation between physical activity and 212

social resources and between physical activity and age. 213

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Table 2 215

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3.3 Regression analyses for variables predicting depressive symptoms 217

The results from separate multiple hierarchical linear regression analyses investigating 218

the association between the resilience factors, physical activity, and the outcome of 219

depressive symptoms are presented separately for gender in Table 3. Age was a significant 220

predictor of depressive symptoms for girls (t = 3.071, p = .002), but not for boys (t = .264, 221

p = .792). Higher scores on personal competence, social competence, structured style, social 222

resource, and family cohesion predicted significantly lower levels of depressive symptoms 223

for both genders. Higher levels of physical activity were a significant predictor of lower 224

levels of depressive symptoms for girls. There was no significant association between 225

physical activity and depressive symptoms for boys. 226

________ 227

Table 3 228

________ 229

For the interaction terms between physical activity and resilience factors, none were 230

significant for girl, but there was an interaction effect between physical activity and 231

structured style for boys. The strength of the association seems to depend of the frequency of 232

physical activity. The impact of structured style on depressive symptoms is different for 233

various levels of physical activity; as higher level of physical activity as lower level of 234

depressive symptoms (Figure 1). The multiple hierarchical regression analysis investigating 235

the association between physical activity and depressive symptoms without taking READ 236

into the model was significant for girls, (p = .001) but not for boys (p = .562). 237

___________ 238

Figure 1 239

____________ 240

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241

4. Discussion 242

The present study of 1,100 adolescents revealed interesting findings in regards to the 243

associations between age, physical activity, resilience, and depressive symptoms. The main 244

findings were that physical activity seemed to be negatively related to depressive symptoms 245

for girls but not for boys. However, for boys there was a significant interaction effect of 246

structured style by physical activity, indicating that the combination of being well-organized 247

and physically active is associated with fewer depressive symptoms. In addition, higher 248

scores on all of the resilience factors (personal competence, social competence, structured 249

style, social resources and family cohesion) were significantly associated with predictors of 250

lower levels of depressive symptoms for both genders, which support previous findings 251

(Hjemdal et al., 2007; Hjemdal et al., 2011). 252

The aim of the study was to explore the association among the variables physical 253

activity, resilience, and depressive symptoms for girls and boys. For both genders, READ 254

total scores and each of the resilience factors showed a significant negative association with 255

depressive symptoms. This is confirmed in the previous study of Hjemdal et al. (2007) and 256

partly by Skrove et al. (2012). READ total score explained 15% of the variance in depressive 257

symptoms for boys, and 24% of the variance in depressive symptoms for girls. Personal 258

competence, which has the highest score among all the resilience factors, explained 19% of 259

the variance in depressive symptoms for boys and 28% of the variance for girls. 260

Physical activity showed a negative association with depressive symptoms for girls, 261

without including READ in the model, but explained little variance (2%) in depression 262

(Cohen, 1988; Tabachnick & Fidell, 2007). The results are supported by the study of Motl et 263

al. (2004), which showed that higher levels of physical activity were associated with lower 264

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levels of depressive symptoms, and that increases in physical activity over time are related 265

with a decrease in levels of depressive symptoms. The effect size in this study was also small 266

(Motl et al., 2004). Skrove et al. (2012) found that girls and boys who reported low levels of 267

physical activity reported higher levels of depressive symptoms than those who reported 268

higher levels of physical activity. Physical activity in the present study was negatively 269

associated with symptoms of depression for girls, also after the READ factors were included 270

in the model, but with further smaller variance (1%) in depression (Cohen, 1988; Tabachnick 271

& Fidell, 2007). The factors measured by READ thus seem to be important protectors in 272

relation to depressive symptoms in addition to physical activity although physical activity did 273

not seem to be as important as the resilience factors; these results are supported by the study 274

of Skrove et al. (2012). There was no significant association for boys between physical 275

activity and depressive symptoms, neither when READ was included in the model nor when 276

it was excluded. This result is partly in contrast to the study by Skrove et al. (2012). Levels of 277

protection are positively associated with higher levels of physical activity (Hjemdal et al., 278

2006a), which may indicate that physical activity is a protective factor that ultimately can 279

contribute to increased levels of resilience; however, the associations in the present study 280

were weak (Cohen, 1988; Tabachnick & Fidell, 2007). It is reported that boys receive more 281

support from family and friends in reference to physical activity than girls (Cardon et al., 282

2005; Cardon et al., 2012), but not when measuring family cohesion as in the present study. 283

There was a significant interaction effect of structured style by physical activity for 284

boys, which shows that the strength of the association between structured style and 285

depressive symptoms depends on the frequency of physical activity. This result can be 286

understood such that boys who are structured and well-organized, despite possible 287

adversities, may have an extra buffer against depressive symptoms if they are physically 288

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active. It could be that adolescents who are not well-organized in daily life have a more 289

chaotic situation that may contribute to more depressive symptoms. Physical activity might 290

contribute to protection against depressive symptoms and thus contribute to resilience 291

(Strohle, 2009) through stimulation of social competence, structured style, autonomy, social 292

support, self-esteem, and optimism, which are all important for the development of individual 293

resources (Martinek & Hellison, 1997). As such, physical activity is one of many protective 294

factors. There were no significant interactions between other resilience factors and physical 295

activity for depressive symptoms. 296

297

4.1. Gender differences in the study population 298

The study showed that girls compared to boys, scored significantly lower on physical 299

activity, although the effect size was small (Cohen, 1988; Tabachnick & Fidell, 2007). These 300

small, but still significant, gender differences could partly be explained by a large sample 301

size. However, gender differences in physical activity are supported by several studies 302

(Duncan et al., 2007; Nesheim & Haugland, 2003; Sagatun et al., 2007; Trost et al., 2002), 303

although Moljord et al. (2011) found no support for gender differences in physical activity. In 304

the latter study the adolescents were from rural areas, in contrast to the other studies and the 305

present study where samples are from urban areas. There may be differences across samples, 306

such as samples from rural or urban areas, for example. Girls scored significantly higher on 307

depressive symptoms than boys, as supported by previous studies (Moksnes et al., 2010; Motl 308

et al., 2004; Sagatun et al., 2007; Teunissen et al., 2010). The effect size in the present study 309

was moderate (Cohen, 1988; Tabachnick & Fidell, 2007). Girls scored significantly higher 310

than boys on social resources and boys scored higher on personal competence, which is in 311

line with Hjemdal et al. (2006a; 2011). Boys scored higher on structured style, which 312

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contradicts previous findings of Hjemdal et al. (2006a; 2011). In the present study, age 313

seemed not to be relevant in association with the variables for boys, but for girls depressive 314

symptoms seemed to increase with age. This is not in line with the study of Hjemdal et al. 315

(2011), who found that age and gender were not related to mental health symptoms. One 316

possible explanation is that their sample had a higher mean age and less variation with regard 317

to age. Interestingly, a nationwide sample of 12,000 Norwegian adolescents, Wichstrom 318

(1999) found an increase in depressive symptoms between 13 and 14 years of age. The 319

increase was gender-specific for girls. Boys showed no such increase in depressive symptoms 320

between the ages of 13 and 15. 321

322

4.2. Methodological considerations 323

The strengths of the present study include a large sample size, a high response rate 324

and very few missing responses. The fact that the adolescents came from six different schools 325

increases the general validity of the observations. In spite of significant correlations some of 326

them were very small. Small but significant correlations are explained by the large sample 327

size. 328

The present study has some limitations. Physical activity was measured by using one 329

single item. Such measures are disputed (Kurtze, Gundersen, & Holmen, 2003) and the use of 330

more complex and accurate measures might have led to increased validity. However, a 331

number of studies (Gerber & Pühse, 2008; Haugland, Wold, & Torsheim, 2003; Moksnes et 332

al., 2010) have measured physical activity by using a single item, leading us to conclude this 333

can be a viable way to make accurate and valid measures of activity. Other researchers have 334

concluded, however, that the ideal self-reported measure of physical activity should include 335

frequency, intensity, and duration (Shephard, 2003). The respondents were asked to assess 336

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physical activity and resilience within the last four weeks, whereas depressive symptoms 337

were assessed during the last week. These differences might have been reflected in the 338

results. 339

It is widely accepted that adolescents can evaluate and give reliable information with 340

use of self-reporting, and it seems to give a fairly good indication of physical activity, 341

depressive symptoms, and resilience (Gerber & Pühse, 2008; Haugland et al., 2003). The 342

present exploratory study applied a cross-sectional design that cannot determine a causal 343

relation among the variables. Further, this is the first exploration of the relation between these 344

variables and no causal relation between the variables was indicated. 345

The associations could possibly represent reciprocal relationships (Bauman, Sallis, 346

Dzewaltowski, & Owen, 2002). Resilience could interact with depressive symptoms to affect 347

physical activity in this present study. The weakness of the present study is the lack of 348

information about adverse life events in relation to resilience and physical activity (Engberg 349

et al., 2012; Stults-Kolehmainen & Sinha, 2014). Such information could give a better 350

understanding about this construct. 351

352

5. Conclusion 353

The result of the study showed that girls, compared to boys, were less frequently 354

physically active, scored higher in social resources, and had more depressive symptoms. 355

Additional gender differences were indicated by boys scoring higher than girls on personal 356

competence and structured style. READ factors predicted lower levels of depressive 357

symptoms, while physical activity did not. There was an interaction effect of physical activity 358

and structured style for boys. The higher level of physical activity the bigger impact has 359

structured style on depressive symptoms. Boys with higher levels of structured style and that 360

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are physically active report lower levels of depressive symptoms, than boys with higher 361

levels of structured style who are less physically active. Collectively these two factors may be 362

particularly relevant as protective factors against depressive symptoms among boys. 363

Recommendations for further research could be longitudinal and experimental studies that 364

illuminate some of the issues raised in the present study. 365

366

Acknowledgement 367

St. Olav's University Hospital, Division of Psychiatry, Nidaros Community Mental Health 368

Centre has funded the study. They had no role in the study's design, data collection, analysis, 369

or writing, or in the decision to submit the article for publication. 370

Thanks to the schools and pupils that volunteered to take part and to Kyrre Svarva, NTNU, 371

for valuable help with the data file and the interaction graph in SPSS. 372

373

Authors’ contributions 374

All authors gave substantial contributions to conceptions and design of the present study, 375

revised it critically for important intellectual content, and gave their final approval of the 376

version to be published. IEOM designed the study, collected and analyzed the data, wrote and 377

completed the manuscript. UKM developed the survey, collected some of the data, and 378

participated in reviewing some of the analysis. 379

380

Competing interests 381

No competing interests have been declared. 382

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Table 1 Independent t-test (two-tailed) between genders in READ, PC, SC, SS, SR FC, PA and DS Girls

N = 560

Boys

N = 536

CI 95 %

mean SD mean SD t df p d Lower Upper

READ 3.70 .63 3.77 .70 -1.77 1074.28 .077 .11 -.15022 .00778

PC 3.53 .69 3.79 .72 -6.10 1094 <.000 .37 -.34232 -.17568

SC 3.79 .74 3.71 .82 1.65 1071.25 .098 .10 -.01463 .17162

SS 3.30 .77 3.44 .82 -2.93 1094 .003 .18 -.23448 -.04644

SR 4.17 .75 4.03 .83 3.11 1070.80 .002 .19 .05495 .24230

FC 3.72 .96 3.80 .85 -1.50 1087.96 .133 .09 -.18899 .02508

PA 3.26 1.07 3.52 1.19 -3.80 1069.10 <.000 .23 -.394 -.126

DS 2.48 .78 2.05 .72 9.49 1092.24 <.000 .57 .34003 .51729

Note: Resilience (READ), personal competence (PC), social competence (SC), structured style (SS), social resources (SR), family cohesion (FC), physical activity (PA) and depressive symptoms (DS). d: Cohens’s d (effect size)

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Table 2 Correlation between READ, PC, SC, SS, SR, FC, PA, DS and AGE READ PC SC SS SR FC PA DS Age READ (total) - .916** .857** .771** .874** .892** .115** -.385** -.087*

Personal Competence .867** - .784** .684** .727** .711** .084 -.438** -.048

Social competence .759** .627** - .543** .696** .671** .149** -.276** .004

Structured Style .757** .668** .455** - .551** .653** .118** -.291** -.142**

Social Resource .808** .575** .551** .519** - .798** .097* -.322** -.077

Family cohesion .844** .590** .501** .538** .669** - .070 -.308** -.134**

Physical activity .122** .122** .094* .164** .064 .070 - -.023 .011

Depressive symptoms -.497** -.539** -.277** -.351** -.380** -.408** -.138** - .186**

Age -.127 ** -.134** -.032 -.107* -.113** -.110** .129** -.010 -

Note: The correlations for girls are below and for boys above the diagonal. Personal competence (PC), social competence (SC), structured style (SS), social resources (SR), family cohesion (FC), physical activity (PA),depressive symptoms (DS) and age.

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Physical activity, resilience, and depressive symptoms

Table 3. Summary of the separate hierarchical linear multiple regression analyses with READ, READ factors, physical activity and the interaction between the two as predictors of levels of depressive symptoms.

Depressive symptoms

Girls = 560 Boys = 536

Step β F change R2 Change β F change R2 Change

1 Age .13** 9.43 .02 .01 .07 .00

2 Total resilience (READ) -.49*** 175.02 .24 -.39*** 93.16 .15

2 Personal competence (PC) -.53*** 218.09 .28 -.44*** 126.61 .19

2 Social competence (SC) -.27*** 45.73 .08 -.28*** 44.08 .07

2 Structured style (SS) -.34*** 73.57 .12 -.30*** 49.96 .09

2 Social Resource (SR) -.37*** 88.59 .14 -.32*** 61.76 .10

2 Family Cohesion (FC) -.40*** 105.61 .16 -.31*** 56.24 .10

3 PA (total resilience) -.08* 4.57 .01 .03 .45 .001

3 PA (PC) -.07* 4.23 .01 .02 .18 <.001

3 PA (SC) -.11** 7.69 .01 .02 .16 <.001

3 PA (SS) -.08* 4.33 .01 .02 .20 <.001

3 PA (SR) -.11** 8.53 .01 .01 .08 <.001

3 PA (FC) -.11** 8.12 .01 .01 .01 <.001

4 PA x Total resilience -.02 .17 <.001 -.01 .04 <.001

4 PA x PC -.02 .34 <.001 <.001 <.001 <.001

4 PA x SC -.01 .06 <.001 -.004 .01 <.001

4 PA x SS .02 .20 <.001 -.10* 5.38 .01

4 PA x SR -.01 .04 <.001 .01 .02 <.001

4 PA x FC .03 .71 .001 - .01 .09 <.001

Note. * p ≤ .05; ** p ≤ .01; *** p ≤ .001. PA = Physical activity

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High physical activity

Moderate physical activity

Low physical activity

Figure 1: Presentation of the interaction effect between structured style and physical activity, with depressive symptoms as dependent variable, boys only. Physical activity was divided into three groups including low: 1 day or less per week; moderate: 2 - 3 days per week; and high: most days per week.

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ACCEPTED MANUSCRIPTHighlights

• Girls are less physically active and have more depressive symptoms compared to boys

• Higher physical activity were associated with lower depressive symptoms for girls

• High resilience scores is a good predictor of the level of depressive symptoms

• Higher physical activity the higher impact on structured style on boys’ depression

physical activity, resilience, and depressive symptoms in adolescence

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