European Child & Adolescent Psychiatry

, Volume 26, Issue 11, pp 1377–1386 | Cite as

Psychopathology and friendship in children and adolescents: disentangling the role of co-occurring symptom domains with serial mediation models

  • Arthur Gus ManfroEmail author
  • Pedro M. Pan
  • Ary Gadelha
  • Marcelo Fleck
  • Maria C. do Rosário
  • Hugo Cogo-Moreira
  • Rodrigo Affonseca-Bressan
  • Jair Mari
  • Euripedes C. Miguel
  • Luis A. Rohde
  • Giovanni A. Salum
Original Contribution


The consolidation of social friendship groups is a vital part of human development. The objective of this study is to understand the direct and indirect influences of three major symptomatic domains—emotional, hyperkinetic, and conduct—on friendship. Specifically, we aim to study if the associations of one domain with friendship may be mediated by co-occurring symptoms from another domain. A total of 2512 subjects aged 6–14 years participated in this study. Friendship was evaluated by the Development and Well-Being Assessment’s friendship section. We evaluated two main constructs as outcomes: (1) social isolation and (2) friendship latent construct. Emotional, hyperkinetic, and conduct symptomatic domains were evaluated with the Strengths and Difficulties Questionnaire (SDQ). All SDQ domains were positively associated with social isolation and negatively associated with friendship latent construct in univariate analysis. However, serial mediation models showed that the association between conduct domains with social isolation was mediated by emotion and hyperkinetic domains. Moreover, the associations between emotional and hyperkinetic domains with friendship latent construct in non-isolated children were mediated by the conduct domain. Emotion and hyperkinetic domains were directly and indirectly associated with social isolation, whereas conduct was directly and indirectly associated with overall friendship in non-isolated children. Results suggest that interventions aimed to improve social life in childhood and adolescence may have stronger effects if directed towards the treatment of emotion and hyperkinetic symptoms in socially isolated children and directed towards the treatment of conduct symptoms in children with fragile social connections.


Friendship Psychopathology Mediation 


Compliance with ethical standards

Conflict of interest

Arthur Manfro, Giovanni Salum, Jair Mari, Rodrigo Bressan, Hugo Cogo, and Euripedes Constantino Miguel declare no potential conflicts of interest. Ary Gadelha and Pedro Pan have received continuous medical education support from Astra Zeneca, Eli-Lilly, and Janssen-Cilag. Luis Augusto Rohde has been a member of the speakers’ bureau/advisory board and/or acted as a consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. He has also received travel awards from Shire for his participation in the 2014 APA and 2015 WFADHD meetings. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Arthur Gus Manfro
    • 1
    • 2
    Email author
  • Pedro M. Pan
    • 2
    • 3
  • Ary Gadelha
    • 2
    • 3
  • Marcelo Fleck
    • 4
  • Maria C. do Rosário
    • 2
    • 3
  • Hugo Cogo-Moreira
    • 2
    • 3
  • Rodrigo Affonseca-Bressan
    • 2
    • 3
  • Jair Mari
    • 2
    • 3
  • Euripedes C. Miguel
    • 2
    • 5
  • Luis A. Rohde
    • 2
    • 4
    • 5
  • Giovanni A. Salum
    • 1
    • 2
    • 4
  1. 1.Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  2. 2.National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq)São PauloBrazil
  3. 3.Department of PsychiatryUniversidade Federal de São PauloSão PauloBrazil
  4. 4.Department of PsychiatryUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  5. 5.Department and Institute of PsychiatryUniversidade de São PauloSão PauloBrazil

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