Transitioning Through Emerging Adulthood and Physical Health Implications

Emerging Adulthood and Health

Several studies have examined the mental health consequences of an unsuccessful transition through the emerging adulthood developmental period in populations ranging from 18 to 29 years of age. For instance, research has found that increased negativity/instability negatively correlates with life satisfaction (Negru, 2012; Reifman et al., 2007). Moreover, Howard, Galambos, and Krahn (2010) longitudinally assessed emerging adults at ages 18, 19, 20, 22, and 25 years and found (a) the negative relationship between life satisfaction and depressive symptoms became stronger as the sample aged and (b) increases in depression over time for women negatively predicted life satisfaction while controlling for having children, obtaining a degree, the number of time employed, and their relationship status (i.e., married or divorced). Finally, Nelson and Barry (2005) showed that depression was significantly higher for participants who identified as emerging adults compared to those who identified as having passed through emerging adulthood. Overall, these studies suggest that, for some, the unsuccessful transition through emerging adulthood is related to negative mental health consequences; however, we are unaware of any published research that examined the physical health consequences of transitioning through emerging adulthood (see Schulenberg & Zarrett, 2006). We hypothesize (Hypothesis 1) that the perception of the unsuccessful transition through emerging adulthood will be related to higher somatic physical health symptoms—analogous to the previously cited work with mental health.

In addition to examining the simple relationships between emerging adulthood dimensions and somatic physical health symptoms, we examined the mediating role of perceived stress. In their theoretical model linking childhood/early adolescent trauma to depressive symptoms in emerging adulthood via stress in late adolescence, Foster, Hagen, and Brooks-Gunn (2008) argued that life transitions in late adolescence (i.e., high school graduation, moving away from parents, etc.) may cause an increase in stress and changes to self-identity that are related to depression in emerging adulthood. In other words, variations in markers of emerging adulthood during late adolescence that causes high stress predict later depressive symptoms. Applying this model to the current study, we posit that the perception of the unsuccessful navigation through emerging adulthood is related to stress that causes changes in subsequent physical health symptoms. Although Foster et al. (2008) studied depression, results from other studies have shown strong links between mental health (depression) and physical health (e.g., Aneshensel, Frerichs, & Huba, 1984). Therefore, if stress and poor physical health and positively correlated (Repetti, Taylor, & Seeman, 2002) and specific emerging adulthood markers predict physical health, such as unemployment (Linn, Sandifer, & Stein, 1985) and being married (Verbrugge, 1983), then we argue that the Foster et al. (2008) model is applicable to the current research and we hypothesize (Hypothesis 2) that stress will mediate the relationship between the perception of emerging adulthood transitional success and somatic physical health symptoms.

Examining Potential Moderators

Our theoretical model (adapted from Foster, Hagen, & Brooks-Gunn, 2008) posits that the perception of the unsuccessful navigation through emerging adulthood will be positively related to somatic physical health symptoms, which will be mediated by perceived stress. Although we are unaware of any research specifically testing this model, past research testing parts of this model have uncovered sex differences, suggesting that the model we are testing may not be ubiquitous. For instance, Barlett and Barlett (2016) showed that emerging adult males scored significantly lower than females on several emerging adulthood transition variables (i.e., experimentation/possibilities, negativity/instability, self-focused, and feeling in-between). Moreover, research has suggested that emerging adult females (aged 18–22) have more headaches, constipation, fainting or dizziness, and bladder or kidney problems than their male peers (Macintyre, Hunt, & Sweeting, 1996). Finally, Denton, Prus, and Walters (2004) found evidence that higher levels of stress in females, compared to males, account for the sex differences in health.

Mean-level sex differences on key variables offer limited empirical support for the plausibility of the moderating role of sex in the relation between emerging adulthood transition perceptions and physical health symptoms. However, additional research sheds light onto such moderated importance. Halfon and Hochstein (2002) proposed a model that delineates the optimal health trajectory from birth to death emphasizing the importance of the how various risk and protective factors can shift health functioning closer to or away from the optimal mark. In other words, various risk and protective factors act as moderators in the relation between age (i.e., development) and physical health outcomes, and we hypothesize that participant sex may act as a risk or protective factor in the relation between emerging adulthood transition perceptions and physical health. Indeed, research has shown that the percentage of individuals transitioning through emerging adulthood who are depressed are higher for females relative to males as the participants’ age (Hankin et al., 1998). Less is known about the physical health consequences for emerging adults; however, preliminary evidence with early adolescents suggests that the positive slope between age and subjective health complains (i.e., headache, back pain, and general complaint) is stronger for females compared to males (Torsheim et al., 2006). Unfortunately, such research does not sample emerging adults. Therefore, we hypothesize (Hypothesis 3) that sex will moderate the mediating role of perceived stress in the relations between emerging adulthood dimensions and physical health symptoms.

Objective of the Current Study

Overall, we sought to determine whether (a) the perception of an (un)successful transition through emerging adulthood was related to physical health, (b) whether perceived stress mediated such relations, and (c) whether participant sex moderated these effects. Consistent with past work and theory, we hypothesized that (a) the perception of emerging adulthood transitions would correlate with somatic health symptoms, (b) perceived stress will mediate such relations, and (c) sex will moderate these mediated effects.

Method

Measures

Somatic physical health symptoms

To assess our primary outcome variable, we modified the Patient Health Questionnaire (Kroenke, Spitzer, & Williams, 2002). This scale was modified by removing 2 items that were only applicable to female participants (i.e., “menstrual cramps or other problems with your periods”) or for ethical reasons (“pain or problems during sexual intercourse”). The remaining 13 items (α = .84) asked participants to indicate how often they have been bothered by several physical health symptoms during the past 4 weeks on a 3-point rating scale from 1 (not bothered at all) to 3 (bothered a lot). A sample item includes “stomach pain.” Scores on these items were averaged, such that higher scores indicate more somatic physical health symptoms.

Stress

Perceived stress was assessed using a modified version of the Global Measure of Perceived Stress (S. Cohen, Kamarck, & Mermelstein, 1983). Due to space constraints, this measure was shortened from 14 original items to 10 (α = .85). Participants were instructed to indicate how often they felt a certain way in the past month on a 5-point rating scale from 1 (never) to 5 (very often). A sample item includes, “In the last month, how often have you been able to control irritations in your life?” Certain items were reverse coded prior to averaged, such that higher scores indicate more perceived stress.

Emerging adulthood

We assessed the perception of the transition through emerging adulthood using the short form of the IDEA (IDEA-8; Baggio, Iglesias, Studer, & Gmel, 2015). This measure asks participants to think about their life during the past few years to answer the questions on a 4-point rating scale from 1 (strongly disagree) to 4 (strongly agree). This scale includes four subscales to assess various dimensions of the transition through emerging adulthood, and each subscale consists of 2 items. The first is identity exploration (r = .39, p < .05) and a sample item includes, “Is this period of your life a time of defining yourself.” The second is experimentation/possibilities (r = .40, p < .05) and a sample item includes, “Is this period of your life a time of many possibilities.” The third is negativity/instability (r = .60, p < .05) and a sample item includes, “Is this period of your life a time of high pressure.” The final subscale assesses feeling in-between (r = .32, p < .05) and a sample item includes, “Is this period of your life a time of gradually becoming an adult.” The scores on the subscales were averaged, such that higher scores represent a higher degree of transition through emerging adulthood specific to each dimension.

Inspection of Table 1 shows varying Cronbach α coefficients for the IDEA scales. In order to gauge the factor structure of the IDEA subscales, we conducted a confirmatory factor analysis in MPLUS (Version 6.1) in which we had the 8 observed IDEA items load onto their four respective latent factors, which we correlated. Results showed that the model fit really well, χ²(df = 14) = 60.78, p < .05, CFI = .98, TLI = .97, RMSEA = .04 (90% confidence interval [CI] = [.03, .05]), SRMR = .02. Although statistically significant, the factor loadings for feeling in-between (βs = .54 and .60, respectively) were the lowest among the other IDEA subscales. Indeed, the factor loadings for experimentation/possibilities (βs = .58 and .69, respectively), negativity/instability (βs = .74 and .81, respectively), and identity exploration (βs = .64 and .61, respectively) were slightly improved.

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Table 1.

Zero-Order Correlations and Descriptive Statistics for Relevant Variables.

Variable	1	2	3	4	5	6
1. Somatic physical health Symptoms	(.84)
2. Perceived stress	.46**	(.85)
3. Experimentation/possibilities	−.05*	−.06**	(.57)
4. Negativity/instability	.23**	.36**	.14**	(.75)
5. Identity exploration	.01	.03	.44**	.22**	(.56)
6. Feeling in-between	−.02	.04	.36**	.27**	.39**	(.49)
Mean	1.62	3.09	3.64	3.56	3.59	3.58
Standard deviation	.39	.65	.48	.58	.51	.51
Skew	0.72	−0.02	−1.40	−1.43	−1.26	−1.46
SE (skew)	.06	.06	.06	.06	.06	.06
Z	12.00**	−0.33	−23.33**	−23.83**	−21.00**	−24.33**

Note. Numbers in parentheses are Cronbach’s α for each measure.

* p < .05. **p < .01.

Demographics

A demographics questionnaire was used to assess sex, educational attainment, race/ethnicity, income, nation of origin, and country of residence.

Results

A plan for analysis of these data was preregistered (https://osf.io/a6uxf/). We retained the correlation and sex differences analyses; however, we omitted the use of the exploratory factor analysis due to the exploratory nature of the analysis itself. Moreover, we altered the use of PROCESS as a tool to test for moderated mediation due to the number of variables. Instead, we opted to use multigroup path modeling to answer the same hypothesis. The preregistered hypotheses remained intact; however, due to a data collection error regarding the omission of age on some demographic questionnaires, we removed the age hypothesis.

Path Model

Our second hypothesis states that perceived stress will mediate the relation between emerging adulthood transition success and somatic physical health symptoms and was tested using path modeling procedures in MPLUS (Version 6.1) that utilized maximum likelihood estimation techniques to address missing data. Our path model had the four emerging adulthood variables (identity exploration, experimentation/possibilities, negativity/instability, and feeling in-between) as correlated exogenous variables that predicted perceived stress and somatic physical health symptoms. Finally, perceived stress predicted somatic physical health symptoms. INDIRECT model statements in MPLUS allowed for the test of mediation. Due to the skewed nature of the data, we examined the direction and strength of the direct and indirect relationships using 5,000 bootstrapped unstandardized regression coefficients with 95% CIs. All paths and relationships were estimated, and thus, the model was fully saturated causing the data to be a perfect fit for the data (i.e., no degrees of freedom to estimate model fit indices).

Results showed that negativity/instability (b = .44, 95% CI [.39, .49]) and experimentation/possibilities (b = −.14, 95% CI [−.20, −.07]) significantly predicted perceived stress, which significantly predicted somatic physical health symptoms (b = .26, 95% CI [.23, .28]). Negativity/instability (b = .06, 95% CI [.03, .10]) and feeling in-between (b = −.04, 95% CI [−.08, −.002]) were the only emerging adulthood variables to directly predict somatic physical health symptoms. Finally, all the emerging adult variables significantly correlated with each other. Examination of the estimated indirect effects (and corresponding 95% CIs) showed that perceived stress significantly mediated the relationship between experimentation/possibilities and somatic physical health symptoms (b = −.04, 95% CI [−.05, −.02]) and the relationship between negativity/instability and somatic physical health symptoms (b = .11, 95% CI [.10, .13]). No other mediated effects were significant. The unstandardized path coefficients with 95% CIs from the path model are displayed in Figure 1.

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Figure 1.

Path model results. Solid lines indicate statistically significant relationships and dashed lines indicate nonsignificant relationships. Single headed arrows are path coefficients and double headed arrows are correlations. Numbers in parentheses are 95% confidence intervals around the unstandardized estimate.

Sex Differences

Several independent t tests were conducted to compare male and female participants on our key variables. Results are displayed in Table 2 and show significant sex differences on all variables, such that female participants reported higher levels of somatic physical health symptoms, perceived stress, and all four emerging adulthood transition variables compared to males. These differences were retained when Mann–Whitney U tests were conducted to address the skewed nature of the data.

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Table 2.

Means and Inferential Statistics for Sex Differences on Relevant Variables.

Variable	Male	Female	t	d	Z (Mann–Whitney U Test)
	M (SD)	M (SD)
Somatic physical health symptoms	1.46 (.37)	1.68 (.39)	−11.36**	−.51	−12.19**
Perceived stress	2.92 (.66)	3.15 (.64)	−6.80**	−.31	−6.63**
Experimentation/possibilities	3.60 (.51)	3.66 (.47)	−2.50*	−.11	−2.66*
Negativity/instability	3.47 (.63)	3.59 (.56)	−3.84**	−.17	−3.73**
Identity exploration	3.49 (.57)	3.63 (.48)	−5.34**	−.24	−4.71**
Feeling in-between	3.51 (.52)	3.61 (.50)	−3.79**	−.17	−4.30**

Note. The sample size for males in these analyses is 504 for all variables except for the 503 who completed the health symptoms questionnaire. The sample size for females is 1,483 for the four emerging adulthood variables, 1,482 for health symptoms, and 1,481 for perceived stress (varying numbers are a function of missing data).

* p < .05. **p < .01.

Discussion

Past research has found that perceived transitional success through emerging adulthood and into young adulthood is related to several mental health variables (e.g., Galambos et al., 2006); however, there is a paucity of research examining the physical health outcomes associated with this important life transition period. In support of our first hypothesis, our correlational analysis showed that somatic physical health symptoms were positively correlated with negativity/instability and negatively correlated with experimentation/possibilities. These findings are consistent with the research showing that negativity/instability is positively correlated with other negatively valenced variables, such as narcissism (Barlett, 2016), psychopathy (Barlett & Barlett, 2015), and poor mental health (Arnett et al., 2014).

Next, we sought to determine why emerging adulthood dimensions correlate with somatic physical health symptoms. Past research has found positive correlations between perceived stress and physical health symptoms (Toussaint, Shields, Dorn, & Slavich, 2016), and moreover, the unsuccessful transition through emerging adulthood has been associated with increased stress (Lisha et al., 2014). Therefore, we predicted and found evidence to suggest that perceived stress mediated the relationships between (a) negativity/instability and somatic physical health symptoms and (b) experimentation/possibilities and somatic physical health symptoms. The path coefficients and direction of these effects suggest that negativity/instability is positively correlated with stress, which may explain why those who have a negative outlook after emerging adulthood will likely have more somatic physical health symptoms. Conversely, those who are optimistic and excited about future possibilities (high scores on experimentation/possibilities) showed a negative correlation with perceived stress and subsequent somatic health symptoms.

The indirect relationship between negativity/instability and somatic physical health through perceived stress is expected. Past work has consistently shown that this emerging adulthood individual difference variable is related to myriad other negative psychological outcomes, such as internalizing mental health symptoms (Goodman et al., 2015), poor life satisfaction (Reifman et al., 2007), aggression (Barlett, 2016), and psychopathy and narcissism (Barlett & Barlett, 2015). Further, the theorizing by Foster and colleagues (2008) posits that various life transitions during emerging adulthood may increase stress and eventual negative functioning, which, when integrated with Arnett’s (2000) and Reifman and colleague’s (2007) theory, suggests that those who score high on their perception of negativity/instability are likely to experience high levels of stress and subsequent negative physical health symptomatology. The mediating effect of perceived stress in the relation between experimentation/possibilities and somatic physical health symptoms can also be explained using similar logic. Albeit less researched, those who score high on experimentation/possibilities are likely to be less stressed while navigating through their emerging adulthood developmental stage. Indeed, Negru (2012) showed that experimentation/possibilities positively correlated with life satisfaction in emerging adults, suggesting that those who score high on this construct are likely navigating through emerging adulthood well. However, we would be remiss if we did not address the low correlation between experimentation/possibilities and health (r = −.05) and stress (r = −.06). Although both statistically significant, the overall strength of these correlations is weak, and a certain degree of caution is warranted.

Our results also suggest that stress did not mediate the relationships between (a) feeling in-between and (b) identity possibilities and somatic physical health symptoms. Indeed, the results from the current study show nonsignificant correlations between these variables. One possible explanation for why perceived stress did not mediate the relationship between feeling in-between and stress is that perceived stress is not the causal variable linking feeling in-between with health outcomes, which precludes that other mediators could be better at explaining these relations. For instance, Barlett and Barlett (2015) showed that feeling in-between was negatively correlated with trait mindfulness, whereas others have shown positive correlations with narcissism (Barlett & Barlett, 2015). Regarding the lack of mediation between identity exploration and somatic physical health symptoms via stress, Marcia (1980) posited that those who are currently exploring possible selves and have committed to an identity report lower levels of stress than those not exploring possible selves. Indeed, examination of the mean scores for the perception of identity exploration (Table 1) showed high levels of this emerging adulthood variable. We did not measure commitment to an identity, and thus, this explanation is speculative; however, it is a possible explanation for the lack of significant relationship with perceived stress.

Finally, past research has shown that females are more likely to report higher levels of stress (Matud, 2004), physical health symptoms (Macintyre et al., 1996), and emerging adulthood dimensions (Barlett & Barlett, 2015) than males, and therefore, we predicted that participant sex would moderate the mediated relationships between emerging adulthood dimensions and somatic physical health symptoms. Our findings from the multigroup path model revealed that sex did not moderate the mediated relations. Indeed, the fully constrained model—where all estimated relationships were set to be equal for male and female participants—showed good model fit and when we freed the equality constraints for all relations in the model, the model fit did not improve. Overall, our findings revealed that even though females report more stress, more somatic physical health symptoms, and emerging adulthood transition perceptions than males, the mediating effect of stress between negativity/instability and experimentation/possibilities on somatic physical health symptoms does not differ between males and females.