A mixed methods investigation of multiple risk exposure and early adolescent girls' emotional symptoms: Mechanisms, adaptive processes, and lived experience

Student thesis: Phd


Rationale: Evidence suggests that from early adolescence, girls and women experience greater rates of emotional symptoms and disorders, while recent evidence indicates increased emotional distress among adolescent girls. The current study set out to examine the factors and processes contributing to and mitigating emotional symptoms among early adolescent girls, with an emphasis on multiple risk exposure, and to explore how these phenomena are experienced. Methods: A pragmatic parallel mixed methods design was used. A quantitative strand included 8,327 girls aged 11–12 years, comprising both self-report and demographic data, and was analysed using structural equation modelling. A qualitative strand explored the lived experience of three girls aged 12 years, analysing accounts gathered through semi-structured interviews using interpretative phenomenological analysis. Quantitative Results: Results indicated four risk factors: Low academic attainment, special educational needs, low family income, and caregiving responsibilities. Exposure to a greater number of risk factors was associated with increased symptoms, though a latent risk construct incorporating both the nature and extent of multiple risk exposure showed the greatest predictive utility. Multiple risk effects were found to be associated with emotional symptoms entirely through indirect effects via components of stress appraisal processes. Family adult connection, school peer connection, and active engagement in home and school life were associated with lower levels of emotional symptoms. Family adult connection and school peer connection were found to be protective in relation to the effects of multiple risk exposure upon perceived stress components. Qualitative Findings: Four superordinate themes were developed: The experience of symptoms, which captures the ways participants conceptualised and experienced the thoughts and feelings associated with symptoms; internal grappling, which explores participants’ conflict in understanding these symptoms in relation to themselves as well as the outer world; demands and control, which explores participants’ experiences of persistent demands perceived to be beyond their control; and drawing on others, exploring the ways participants mapped out and drew on an emotional support network. Meta-Inferences: Quantitative and qualitative findings were integrated to develop three meta-inferences: (1) Emotional symptoms are embedded in daily life, (2) demands and stress can be psychologically overwhelming, and (3) close relationships are critical. The theoretical, methodological, and practical implications of findings are explored and directions for future research are discussed.
Date of Award1 Aug 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorMargarita Panayiotou (Supervisor), Neil Humphrey (Supervisor) & Ann Lendrum (Supervisor)


  • Mixed methods research
  • Stress and coping
  • Lived experience
  • Women's health
  • Risk exposure
  • Emotional symptoms
  • Resilience

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