A prospective study of stress autonomy versus stress sensitization in adolescents at varied risk for depression.

This longitudinal study investigated the stress autonomy, stress sensitization, and depression vulnerability hypotheses in adolescents across 6 years (i.e., Grades 6 through 12). Participants were 240 children (Time 1 mean age = 11.86, SD = 0.57) who varied in risk for depression on the basis of their mother's history of mood disorders. All analyses were conducted as multilevel models to account for nesting in the data. Results were consistent with the stress sensitization hypothesis. The within-subject relation of stress levels to depressive symptoms strengthened with increasing numbers of prior depressive episodes. In addition, evidence consistent with the vulnerability hypothesis was found. The relation of stress levels to depressive symptoms was stronger for adolescents who were at risk for depression on the basis of maternal depression history and for those who had experienced more depressive episodes through Grade 12. These findings suggest that onsets of depression in adolescents may be predicted by both relatively stable and dynamic transactions between stressful life events and vulnerabilities such as maternal depression and youths' own history of depressive episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major life events and major chronic difficulties are differentially associated with history of major depressive episodes.

Major life events have been found to precede onsets of a 1st lifetime episode of depression more commonly than subsequent recurrences. Despite general empirical support for this finding, few data directly address how the role of major life events may change over successive recurrences. Further, little research has examined major chronic difficulties in relation to a 1st lifetime episode versus a recurrence of depression. The present study tested the associations between major life events and major difficulties in relation to lifetime history of depressive episodes in a sample of 96 individuals diagnosed with major depression. Using investigator-based measures of life stress, the authors found that, whereas major life events were associated with fewer lifetime episodes, major chronic difficulties were related to more prior episodes. These findings are discussed in terms of underlying mechanisms that may account for the changing role of major life stress over successive recurrences of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stress and the long-term treatment course of recurrent depression: III. Nonsevere life events predict recurrence for medicated patients over 3 years.

Research has consistently documented the significance of severe life events for onset of major depression. Theory, however, suggests other forms of stress are relevant for depression's recurrence. Nonsevere life events were tested in relation to depression for 126 patients with recurrent depression in a 3-year randomized maintenance protocol. Life stress was assessed every 12 weeks and rated along dimensions of severity, focus, and independence. A significant interaction between specific types of nonsevere life events and medication was found. For medicated patients, subject-focused independent nonsevere life events predicted recurrence; for unmedicated patients, these events predicted fewer recurrences. Other nonsevere life events did not predict recurrence. The findings underscore the potential importance of specific stressors for triggering recurrences of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cumulative impact of nonsevere life events predicts depression recurrence during maintenance treatment with interpersonal psychotherapy.

Although much research has focused on the role of severe life events as risk factors for depression onset, less is known about the relationship between nonsevere life events and depression recurrence. The current study examined the cumulative effects of nonsevere and positive life events on depression recurrence in an outpatient sample of recurrently depressed women treated to remission with interpersonal psychotherapy (IPT). A Cox proportional hazards model was used to test this relationship in 124 adult women who entered into the maintenance phase of IPT treatment and completed at least 1 Life Events and Difficulties Schedule interview. The cumulative experience of nonsevere life events that were subject- or joint-focused and nonindependent was significantly related to depression recurrence during the maintenance treatment phase. None of the other event categories were significantly related to depression recurrence. These findings may help to clarify the mechanisms by which life events contribute to depression recurrence and to guide the development of more efficacious maintenance treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in life events prior to onset of major depressive disorder: The moderating effect of age.

Theoretical models attempting to explain why approximately twice as many women as men suffer from depression often involve the role of stressful life events. However, detailed empirical evidence regarding gender differences in rates of life events that precede onset of depression is lacking, due in part to the common use of checklist assessments of stress that have been shown to possess poor validity. The present study reports on a combined sample of 375 individuals drawn from 4 studies in which all participants were diagnosed with major depressive disorder and assessed with the Life Events and Difficulties Schedule (Bifulco et al., 1989), a state-of-the-art contextual interview and life stress rating system. Women reported significantly more severe and nonsevere, independent and dependent, and other-focused and subject-focused life events prior to onset of depression than did men. Further, these relations were significantly moderated by age, such that gender differences in rates of most types of events were found primarily in young adulthood. These results are discussed in term of their implications for understanding the etiological role of stressful life events in depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol abuse history and adjustment following spinal cord injury.

Objective: Examined the relation of alcohol abuse history to emotional adjustment and pressure sore occurrence during the 1st 3 years following Spinal Cord Injury (SCI). Study Design: Comparisons were made between varying levels of prior abuse and depression and disability acceptance. A model predicting pressure sore occurrence over 3 years was computed. Participants: One hundred seventy-five persons completed the self-report measures; 105 were available for pressure sore evaluations. Main Outcome Measures: The Inventory to Diagnose Depression, the Acceptance of Disability Scales, and pressure sore occurrence. Results: Alcohol abuse was not associated with depression or disability acceptance. Severe alcohol abuse history was associated with pressure sores over the 3 years. Conclusions: Persons with prior history of severe alcohol abuse may be at increased risk for pressure sore occurrence during the 1st years of SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study.

The current study examined vulnerability to depression during the transition from early to middle adolescence from the perspective of the response styles theory. During an initial assessment, 382 adolescents (ages 11–15 years) completed self-report measures assessing rumination and depressive symptoms as well as a semistructured clinical interview assessing current and past major depressive episodes. Every 3 months for the subsequent 2 years, adolescents completed self-report measures assessing depressive symptoms and negative events. Every 6 months, adolescents completed a semistructured clinical interview assessing the onset of new major depressive episodes. Higher levels of rumination were associated with a greater likelihood of exhibiting a past history of major depressive episodes, a greater likelihood of experiencing the onset of a future major depressive episode, and greater duration of future depressive episodes. Consistent with a vulnerability-stress perspective, rumination moderated the association between the occurrence of negative events and the development of future depressive symptoms and major depressive episodes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relationship between stress and depression in first onsets versus recurrences: A meta-analytic review.

S. M. Monroe and K. L. Harkness (see record 2005-02750-005) reviewed the empirical evidence supporting R. M. Post's (see record 1992-43211-001) kindling model, which suggests the 1st episode of depression is more likely to be preceded by major stressors than are subsequent episodes. Their review highlighted the diverse interpretations of Post's premise in the current literature and the changes in research methods that have contributed to this interpretive shift. The authors conducted a meta-analysis (N=13 studies) to test Post's premise that integrated early and recent research and examined potential moderators. A proportion difference effect size was used. Results indicated that 1st onsets of depression were more likely than recurrences to be preceded by severe life events, supporting Post's premise. The moderator analyses suggested that support may be most evident in patient samples and may vary according to age and gender, with less support for Post's premise evidenced in younger samples and in women. Although these results are preliminary, as the analysis included a small number of studies, they suggest that future research should further examine factors that influence the stress-depression relationship with successive recurrences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of optimism in social network development, coping, and psychological adjustment during a life transition.

The authors investigated the extent to which social support and coping account for the association between greater optimism and better adjustment to stressful life events. College students of both genders completed measures of perceived stress, depression, friendship network size, and perceived social support at the beginning and end of their 1st semester of college. Coping was assessed at the end of the 1st semester. Greater optimism, assessed at the beginning of the 1st semester of college, was prospectively associated with smaller increases in stress and depression and greater increases in perceived social support (but not in friendship network size) over the course of the 1st semester of college. Mediational analyses were consistent with a model in which increases in social support and greater use of positive reinterpretation and growth contributed to the superior adjustment that optimists experienced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overgeneral autobiographical memory and traumatic events: An evaluative review.

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intergenerational Transmission of Depression: Test of an Interpersonal Stress Model in a Community Sample.

An interpersonal stress model of depression transmission was tested in a community sample of nearly 800 depressed and never-depressed women and their 15-year-old children. It was hypothesized that maternal depression (and depression in the maternal grandmother) contributed to chronic interpersonal stress in the mothers, affecting quality of parenting and youths' social competence. In turn, poor social functioning and interpersonal life events caused at least in part by the youths were predicted to be the proximal predictors of current depressive symptoms and diagnoses. Structural equation modeling confirmed the predicted associations among variables and the link between youth chronic and episodic interpersonal stress and depression. Additionally, the association between maternal and child depression was entirely mediated by the predicted family and interpersonal stress effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prediction of major depression in women: toward an integrated etiologic model

OBJECTIVE: The authors develop an exploratory, integrated etiologic model for the prediction of episodes of major depression in an epidemiologic sample of women. METHOD: Both members of 680 female-female twin pairs of known zygosity from a population-based register were assessed three times at greater than 1-year intervals. The last two assessments included a structured interview evaluation for presence of episodes of major depression, defined by DSM-III-R, in the preceding year. The final structural equation model contained nine predictor variables: genetic factors, parental warmth, childhood parental loss, lifetime traumas, neuroticism, social support, past depressive episodes, recent difficulties, and recent stressful life events. RESULTS: The best-fitting model predicted 50.1% of the variance in the liability to major depression. The strongest predictors of this liability were, in descending order, 1) stressful life events, 2) genetic factors, 3) previous history of major depression, and 4) neuroticism. While 60% of the effect of genetic factors on the liability to major depression was direct, the remaining 40% was indirect and mediated largely by a history of prior depressive episodes, stressful life events, lifetime traumas, and neuroticism. The model suggested that at least four major and interacting risk factor domains are needed to understand the etiology of major depression: traumatic experiences, genetic factors, temperament, and interpersonal relations. CONCLUSIONS: Major depression is a multifactorial disorder, and understanding its etiology will require the rigorous integration of genetic, temperamental, and environmental risk factors.     

Significance of prior episodes of depression in two patient populations.

Perhaps the single best predictor of current depression is a prior episode of depression. This study examined the significance of prior depressive episodes in a weighted sample of 425 primary medical care (PC) patients. It also compared the 53 PC patients with major depression with 93 depressed psychiatric patients with respect to percentage of recurrences versus 1st episodes. PC patients with prior depression were over 8 times more likely to be currently depressed than those without such a history. Having at least 1 prior episode of depression was modestly more sensitive, but less specific, than an elevated Center for Epidemiologic Studies—Depression Scale score in predicting current depression. Most currently depressed patients in both PC (85%) and psychiatry (78%) had prior episodes of depression. These findings highlight the importance of assessing history of depression in research and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of defeat and entrapment in depression, anxiety, and suicide.

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality, stressful life events, and treatment response in major depression.

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive–behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-complexity as a cognitive buffer against stress-related illness and depression.

This prospective study tested the self-complexity buffering hypothesis that greater self-complexity moderates the adverse impact of stress on depression and illness. This hypothesis follows from a model that assumes self-knowledge is represented in terms of multiple self-aspects. As defined in this model, greater self-complexity involves representing the self in terms of a greater number of cognitive self-aspects and maintaining greater distinctions among self-aspects. Subjects completed measures of stressful events, self-complexity, depression, and illness in two sessions separated by 2 weeks. A multiple regression analysis used depression and illness at Time 2 as outcomes, stressful life events and self-complexity at Time 1 as predictors, and drepression and illness at Time 1 as control variables. The Stress?×?Self-Complexity interaction provided strong support for the buffering hypothesis. Subjects higher in self-complexity were less prone to depression, perceived stress, physical symptoms, and occurrence of the flu and other illnesses following high levels of stressful events. These results suggest that vulnerability to stress-related depression and illness is due, in part, to differences in cognitive representations of the self. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Growth Curve Analysis of the Course of Dysthymic Disorder: The Effects of Chronic Stress and Moderation by Adverse Parent-Child Relationships and Family History.

Using mixed effects models, the authors examined the effects of chronic stress, adverse parent-child relationships, and family history on the 7.5-year course of dysthymic disorder. Participants included 97 outpatients with early-onset dysthymia who were assessed with semistructured interviews at baseline and 3 additional times at 30-month intervals for 7.5 years. Results indicated that higher levels of chronic stress 6 months prior to each follow-up predicted greater depression severity at follow-up, controlling for depression severity at the start of the chronic stress assessment. In addition, adverse parent-child relationships and family history of dysthymic disorder moderated this association. For patients with poorer parent-child relationships, chronic stress was associated with increased depression severity at follow-up, whereas patients with a higher familial loading for dysthymic disorder were less responsive to chronic stress over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forensic applications of DNA fingerprinting

Although previous research has shown that childhood adversity has long-term effects on adult depression, little is known about the causal pathways involved in these effects. In this report data from a two-wave longitudinal survey of the U.S. household population are used to study these pathways as they affect the association between childhood family violence and adult recurrence of depression. We focus on recurrence of depression because most episodes of clinically significant depression in adulthood occur to persons with a history of depression. We find that chronic interpersonal stress in adulthood mediates the effect of childhood family violence on recurrence of depression, and that childhood family violence modifies the effect of chronic adult interpersonal stress on recurrence of depression. Furthermore, in the absence of chronic adult interpersonal stress there is no association between childhood family violence and adult recurrence of depression.     

Drug-induced reinstatement of heroin- and cocaine-seeking behaviour following long-term extinction is associated with expression of behavioural sensitization

The present study was designed to evaluate the relationship between reinstatement of drug-seeking behaviour following long-term extinction of intravenous (i.v.) drug self-administration (an animal model for craving) and long-term behavioural sensitization. Rats were allowed to self-administer heroin (50 microg/kg per inj., 14 daily sessions), cocaine (500 microg/kg per inj., 10 daily sessions) or saline. Following a 3-week extinction period, reinstatement tests were performed to evaluate priming effects of amphetamine, cocaine and heroin on nonreinforced drug-seeking behaviour. In addition, the occurrence of long-term behavioural sensitization in rats with a history of heroin or cocaine self-administration was determined. Heroin-seeking behaviour was reinstated by heroin (0.25 mg/kg), amphetamine (1.0 mg/kg) and cocaine (10 mg/kg). In addition, animals with a history of heroin self-administration displayed locomotor sensitization to both heroin and amphetamine. Cocaine-seeking behaviour was reinstated by cocaine and amphetamine, but not by heroin. Interestingly, locomotor sensitization to amphetamine, but not heroin, was observed in animals with a history of cocaine self-administration. In other words, the induction of drug-seeking behaviour following a prolonged drug-free period was found to be associated with the expression of long-term behavioural sensitization. These data provide experimental evidence for a role of behavioural sensitization in the incentive motivation underlying drug-seeking behaviour. If drug hyperresponsiveness would indeed be a crucial factor in drug-induced craving in human addicts, pharmacological readjustment of the neuroadaptations underlying drug sensitization may prevent relapse to drug use long after detoxification.     

Depression, hypomania, and dysfunctional sleep-related cognitions as mediators between stress and insomnia: The best advice is not always found on the pillow!

A cognitive mediation model was examined to find out how stress, depression, and hypomania precipitate the occurrence of dysfunctional sleep-related cognitions, which in turn lead to insomnia. A total of 862 participants (639 women, 223 men; M age: 24.67 years, SD = 5.91) completed a series of self-report questionnaires assessing perceived stress, depression, hypomania, dysfunctional sleep-related cognitions, and insomnia. Compared to men, women reported higher levels of stress, depression, and insomnia. Women also suffered from more dysfunctional sleep-related cognitions. All variables were intercorrelated. Structural equation analyses showed that the relationship between stress and insomnia was largely mediated by dysfunctional sleep-related cognitions. Links between depression and insomnia were found to be weak when controlled for stress and dysfunctional sleep-related cognitions. The findings support a cognitive model of insomnia. Stress must be seen as a precipitating factor in the onset and maintenance of insomnia. Consequently, competencies to deal with dysfunctional sleep-related cognitions should be fostered in stress management programs. In turn, stress management should be a primary focus in the treatment of insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)