Externalizing symptoms moderate associations among interpersonal skills, parenting, and depressive symptoms in adolescents seeking mental health treatment.

Adolescents' interpersonal skills are associated with fewer teen depressive symptoms and more positive parenting, but little is known about how teens' externalizing problems moderate these relationships. This study examines links among teens' interpersonal skills, parenting, and withdrawn-depressed symptoms in adolescents seeking outpatient psychiatric treatment with elevated or non-elevated externalizing problems. Adolescents (N = 346; 42 % female; 61 % African-American) ages 12-19 years old (M = 14.9; SD = 1.8) and parents completed assessments at baseline and 6 months. At baseline parents and teens reported on teen withdrawn-depressed and externalizing symptoms, and were observed interacting to assess teen interpersonal skills. At 6 months adolescents reported on parenting, and parents and teens reported on teen withdrawn-depressed symptoms. Structural equation modeling tested two models (one with teen reported symptoms and one with parent reported symptoms). Model fit was better for youth with elevated externalizing problems regardless of reporter. For youth with elevated externalizing problems, baseline teen positive interpersonal skills were not directly associated with 6-month withdrawn-depressed symptoms, but more positive parenting was associated with fewer withdrawn-depressed symptoms. In the teen report model, more positive teen interpersonal skills were associated with more positive parenting, and there was a trend for parenting to indirectly account for the relationship between interpersonal skills and withdrawn-depressed symptoms. The findings extend research on the role of externalizing problems in teens' depression risk. Interventions for depression that target interpersonal skills may be particularly effective in youth with elevated externalizing problems.