A prospective study of the cognitive-stress model of depressive symptoms in adolescents.

This prospective study investigated a cognitive diathesis-stress model of depression in adolescents across the transition from 6th to 7th grade using individual, additive, weakest link, and keystone approaches to operationalizing the cognitive vulnerability. Participants were 240 young adolescents (mean age = 11.87 years, SD = 0.57) who differed in risk for mood disorders based on their mother's history of depression. Results of the hierarchical multiple regression analyses indicated some support for the individual, additive, weakest link, and keystone diatheses. In particular, the weakest link diathesis interacted with stress and gender to predict increases in depressive symptoms in 7th grade; the form of this interaction was consistent with the cognitive diathesis-stress model for boys, whereas for girls the pattern of relations reflected more of a dual-vulnerability model. That is, high levels of depressive symptoms were found for all girls except those with more positive cognitive styles and low stress levels. These findings highlight the utility of examining different approaches to combining measures of cognitive vulnerability in conjunction with stress in predicting depressive symptoms, and the importance of exploring gender differences with regard to the cognitive diathesis-stress model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of the first onset of a major depressive episode and changes in depressive symptoms across adolescence: Stress and negative cognitions.

This 6-year longitudinal study examined stressors (e.g., interpersonal, achievement), negative cognitions (self-worth, attributions), and their interactions in the prediction of (a) the first onset of a major depressive episode (MDE), and (b) changes in depressive symptoms in adolescents who varied in risk for depression. The sample included 240 adolescents who were first evaluated in Grade 6 (M = 11.86 years old; SD = 0.57; 54.2% female) and then again annually through Grade 12. Stressful life events and depressive diagnoses were assessed with interviews; negative cognitions and depressive symptoms were assessed with self-report questionnaires. Discrete time hazard modeling revealed a significant interaction between interpersonal stressors and negative cognitions, indicating that first onset of an MDE was predicted by high negative cognitions in the context of low interpersonal stress, and by high levels of interpersonal stressors at both high and low levels of negative cognitions. Analyses of achievement stressors indicated significant main effects of stress, negative cognitions, and risk in the prediction of an MDE, but no interactions. With regard to the prediction of depressive symptoms, multilevel modeling revealed a significant interaction between interpersonal stressors and negative cognitions such that among adolescents with more negative cognitions, higher levels of interpersonal stress predicted higher levels of depressive symptoms, whereas at low levels of negative cognitions, the relation between interpersonal stressors and depression was not significant. Risk (i.e., maternal depression history) and sex did not further moderate these interactions. Implications for intervention are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Children’s inferential styles, 5-HTTLPR genotype, and maternal expressed emotion-criticism: An integrated model for the intergenerational transmission of depression.

The authors tested a model for the intergenerational transmission of depression integrating specific genetic (5-HTTLPR), cognitive (inferential style), and environmental (mother depressive symptoms and expressed-emotion criticism [EE-Crit]) risk factors. Supporting the hypothesis that maternal depression is associated with elevated levels of stress in children’s lives, mothers with a history of major depressive disorder (MDD) exhibited higher depressive symptoms across a 6-month multiwave follow-up than mothers with no depression history. In addition, partially supporting our hypothesis, levels of maternal criticism during the follow-up were significantly related to mothers’ current depressive symptoms but not to history of MDD. Finally, the authors found support for an integrated Gene × Cognition × Environment model of risk. Specifically, among children with negative inferential styles regarding their self-characteristics, there was a clear dose response of 5-HTTLPR genotype moderating the relation between maternal criticism and children’s depressive symptoms, with the highest depressive symptoms during the follow-up observed among children carrying 2 copies of the 5-HTTLPR lower expressing alleles (short [S] or long [LG]) who also exhibited negative inferential styles for self-characteristics and who experienced high levels of EE-Crit. In contrast, children with positive inferential styles exhibited low depressive symptoms regardless of 5-HTTLPR genotype or level of maternal criticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental trajectories of adolescents' depressive symptoms: Predictors of change.

in a sample of 240 adolescents assessed annually in Grades 6 through 11, the developmental trajectories of their depressive symptoms were examined using latent factor growth modeling. Growth in mother-reported adolest.ent depressive symptoms was quadratic; growth in adolescent-reported symptoms was linear. In the model with gender and maternal depression, girls reported a greater increase in depressive symptoms over time than boys, and adolescents of mothers with histories of mood disorders had higher initial levels of depressive symptoms than offspring of never-depressed mothers. After gender and maternal depression were controlled, initial levels of negative attributions and stressors significantly predicted initial levels of adolescent- and mother-reported depressive symptoms. Attributional styles that were increasingly negative across time were associated with significantly higher initial levels (mother reported) and increasing growth (adolescent reported) of depressive symptoms. Reciprocal models in which development of depressive symptoms predicted the development of attributions and stress also were examined. (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)     

Stress exposure and stress generation in child and adolescent depression: A latent trait-state-error approach to longitudinal analyses.

In 2 longitudinal studies of negative life events and depressive symptoms in adolescents (N = 708) and in children (N = 508), latent trait-state-error structural equation models tested both the stress generation hypothesis and the stress exposure hypothesis. Results strongly suggested that self-reports of depressive symptoms reflect the influence of a perfectly stable trait factor as well as a less stable state factor. Support emerged for both the stress generation model and the stress exposure model. When the state depression factor was modeled as predicting stress, support for the stress generation model appeared to increase with age. When the trait depression factor was modeled as the predictor of stress, support for the stress generation model did not vary with the child's age. In both models, support for the stress exposure remained relatively constant across age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caretaking behaviors by adolescent children of mothers with and without a history of depression.

In a sample of 72 mothers with and without a history of depression and their adolescent children, maternal depression history, current maternal depressive symptoms, intrusive and withdrawn parental behavior, and adolescent caretaking behaviors were examined as predictors of adjustment in these youth. Two types of caretaking behaviors were examined: emotional (e.g., caring for a parent's emotional distress) and instrumental (e.g., looking after younger siblings). Although adolescents of mothers with and without a history of depression were comparable on levels of both types of caretaking, caretaking was associated with adolescents' reports of anxiety–depression and mothers' reports of social competence only for adolescents of mothers with a history of depression. Moreover, regression models showed that among children of mothers with a history of depression, emotional, but not instrumental, caretaking was related to adolescents' anxiety–depression symptoms and social competence after controlling for current parental depressive symptoms and stressful parenting behaviors. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-rumination predicts the onset of depressive disorders during adolescence.

The tendency to co-ruminate, or frequently discuss and rehash problems with peers, may serve as one mechanism in the dramatic rise in depression observed during adolescence, particularly among adolescent girls. In the current study, our goal was (a) to test the hypothesis that adolescents' levels of co-rumination would predict the onset of clinically significant depressive episodes over a 2-year follow-up and (b) to determine whether levels of co-rumination would mediate gender differences in risk for depression onset. Both hypotheses were supported. Results of survival analysis revealed that adolescents with higher levels of co-rumination at the initial assessments exhibited a significantly shorter time to depression onset. Levels of co-rumination also mediated the gender difference in time to depression onset. These results were maintained even when adolescents' baseline levels of depressive symptoms and rumination were covaried statistically. Finally, co-rumination also predicted the course of illness in terms of episode severity and duration. Results suggest that co-rumination contributes a unique risk for the development of depression in adolescents. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Severe and nonsevere events in first onsets versus recurrences of depression: Evidence for stress sensitization.

Overall, research has evidenced support for Post's (1992) model, which asserts that the 1st episode of depression is more likely to be associated with severe life events than are subsequent episodes. In spite of this, there are significant gaps in the understanding of the stress–depression association. This study aimed to address three gaps by (a) identifying the explanatory model underlying the association (stress sensitization vs. stress autonomy), (b) elucidating how the role of stress changes with successive episodes, and (c) examining the role of nonsevere events. The impact and occurrence of severe and nonsevere events in a 5-year longitudinal study of late-adolescent women were examined using Cox regression models. Overall, we found support for the stress sensitization model over the stress autonomy model. Specifically, the impact of nonsevere (but not severe) events was greater in individuals with a history of depression compared with those with no history of depression. In addition, the occurrence of severe (but not nonsevere) events was greater for 1st onsets than recurrences. These effects were modified by event independence. The results were discussed in terms of the underlying mechanisms of the stress–depression association and future directions for research were elaborated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents’ dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children’s Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents’ metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms in mothers and children: Preschool attachment as a moderator of risk.

Drawing from transactional models, the authors examined whether attachment security measured at age 3 (a potential source of differential vulnerability) interacts with the course of maternal depressive symptoms over an 8-year period (a potential source of differential exposure) in predicting children’s self-reported depressive symptoms at age 11. Participants were from the NICHD Study of Early Child Care (N = 938). Results from growth curve modeling and analysis of covariance suggest that preschool attachment quality moderates the influence of subsequent maternal depression on children. In particular, variability in the course of maternal depressive symptoms predicted offspring depressive symptoms only among those children with an insecure attachment history. A potential protective effect of early attachment security was evident among children exposed to the most chronic levels of maternal depression. Of the children with different patterns of insecure attachments, those with behaviors classified as disorganized appeared most vulnerable to also becoming depressed if paired with a mother experiencing ongoing depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender-specific pathways between maternal depressive symptoms, family discord, and adolescent adjustment.

Relations among maternal depressive symptoms, family discord, and adolescent psychological adjustment were examined in a sample of 443 middle adolescents and their mothers. Histories of maternal depressive symptoms, gathered at 3 occasions with 6-month intervals, were related to subsequent adolescent reports of depressive symptoms, conduct problems, and academic difficulties for girls but not for boys. Mediational tests indicated that girls' greater vulnerability to family discord (e.g., marital discord, low family intimacy, parenting impairments) accounted for the impact of maternal depressive symptoms on their social and emotional adjustment. Analyses suggest that family discord is a strong mediator in the development of girls' conduct disturbances and a modest mediator of girls' depressive symptoms. Results are discussed within a framework that integrates interpersonal models of parental depressive symptoms with the gender intensification hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Role of Social Stressors and Interpersonal Orientation in Explaining the Longitudinal Relation Between Externalizing and Depressive Symptoms.

The authors examined the longitudinal association between externalizing and depressive symptoms using a sample of 185 young adolescents whose mothers had histories of depression. The relation between externalizing behaviors in 6th grade and depressive symptoms a year later was partially mediated by dependent social stressors. Moreover, consistent with the personality-event congruence hypothesis, this mediation model was particularly true for children with high levels of interpersonal orientation (Neediness and Connectedness). In contrast, social stressors that were judged to be independent of the children's behavior, as well as both dependent and independent nonsocial stressors, did not mediate the longitudinal relation between externalizing and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for stress in children after parental stroke.

Objectives: To assess risk factors for stress in children 3 years after parental stroke. Participants: Questionnaires were filled in by 44 children aged 7–18 years, parents who suffered a stroke and healthy spouses from 29 families recruited in 9 participating rehabilitation centers across the Netherlands. Method: We measured patient functioning (cognitive disorders, communicative disorders and ADL dependency), parental depression and perceived quality of marital relationship at 4 assessments, from the start of rehabilitation until 3 years post-stroke. Children assessed their stress level 3 years after parental stroke. Results: Girls experienced more stress than boys. Spouses' depressive symptoms during the first year after stroke were positively correlated with stress in children. Patients' depressive symptoms 2 months post-rehabilitation (2 months after discharge from the rehabilitation center), 1 year and 3 years post-stroke were also positively correlated with stress in children. The perceived quality of marital relationship decreased over time and at 2 months postrehabilitation, it was related to stress in children. Stress was not related to patient gender and functioning. Conclusions: Early prediction of long-term stress in children after parental stroke may be most accurate on the basis of children's female gender and depressive symptoms of the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal look at the relation between depression and anxiety in children and adolescents.

Elementary school students (n?=?330) and their parents (n?=?228) participated in a 3-year longitudinal study of the temporal relation between anxiety and depressive symptoms in children. Every 6 months, children and parents completed depression and anxiety questionnaires for a total of 6 waves. Structural equation modeling revealed that individual differences on all measures were remarkably stable over time. Nevertheless, high levels of anxiety symptoms at 1 point in time predicted high levels of depressive symptoms at subsequent points in time even after controlling for prior levels of depression symptoms. These findings were consistent across self- and parent reports. Results support the temporal hypothesis that anxiety leads to depression in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

First onset versus recurrence of depression: Differential processes of psychosocial risk.

Differential risk factors for the onset of depression were prospectively examined in a community-based sample of adolescents (N?=?1,709), some of whom had a history of major depressive disorder (MDD; n?=?286) and some of whom did not (n?=?1,423). From the theories of J. Teasdale (1983, 1988) and R. Post (1992) concerning the etiology of initial versus recurrent episodes of depression, the authors hypothesized that (a) dysphoric mood and dysfunctional thinking styles would be correlated more highly among those with a previous history of MDD than among those without a history of MDD; (b) dysphoric mood or symptoms and dysfunctional thinking would be a stronger predictor of onset of recurrent episodes (n?=?43) than of first onsets (n?=?70); and (c) major life stress would be a stronger predictor of first onsets of MDD than of recurrent episodes. The results provide support for the 3 hypotheses and suggest that distinct processes are involved in the onset of first and recurrent episodes of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Temple-Wisconsin Cognitive Vulnerability to Depression Project: Lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression.

The authors tested the cognitive vulnerability hypotheses of depression with a retrospective behavioral high-risk design. Individuals without current Axis I diagnoses who exhibited either negative or positive cognitive styles were compared on lifetime prevalence of depressive and other disorders and the clinical parameters of depressive episodes. Consistent with predictions, cognitively high-risk participants had higher lifetime prevalence than low-risk participants of major and hopelessness depression and marginally higher prevalence of minor depression. These group differences were specific to depressive disorders. The high-risk group also had more severe depressions than the low-risk group, but not longer duration or earlier onset depressions. The risk group differences in prevalence of depressive disorders were not mediated by current depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder?

OBJECTIVE: The authors' goal was to examine the relationship between subclinical depressive symptoms in adolescence and major depressive episodes in adulthood. METHOD: An epidemiologic sample of 776 young people received psychiatric assessments in 1983, 1985, and 1992. Among adolescents not meeting criteria for major depression, the authors estimated the magnitude of the association between subclinical adolescent depressive symptoms and adult major depression. RESULTS: Symptoms of major depression in adolescence strongly predicted an adult episode of major depression: having depressive symptoms more than two-standard-deviations above the mean in number predicted a two-fold to three-fold greater risk for an adult major depressive episode. CONCLUSIONS: Symptoms of depression in adolescence strongly predict an episode of major depression in adulthood, even among adolescents without major depression.     

Children of depressed mothers: Maternal strain and symptom predictors of dysfunction.

Because of both methodological and theoretical limitations, previous studies of offspring of parents with affective disorders have rarely tested psychosocial models of depressive vulnerability. The current research is part of a longitudinal investigation of psychosocial risk for disorder in 8- to 16-year-old children of unipolar, bipolar, medically ill, and normal mothers. High rates of psychopathology, including depression, were found in children in the high-risk groups. The current study evaluated the separate contributions of maternal depressive history, current self-reported depressive symptoms (Beck Depression Inventory scores), and chronic strains to observe relations between these ordinarily confounded variables and children's psychiatric diagnoses and current functioning. Hierarchical regression analyses indicated that chronic strain added significantly to the prediction of several outcomes and that current depressive symptoms were more predictive of children's scores than was maternal history of affective disorder. Both chronic strains and current Beck Depression Inventory scores are viewed as concomitants of affective disorder but are not specific to it. Therefore studies of the risk to children conferred by parental disorder cannot assume that diagnostic status as such is a single risk factor and must attend to the effects of ongoing stressors and nonspecific symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents.

Objective: Our objective in the present study was to examine the temporal sequencing of posttraumatic and depressive symptoms during prolonged exposure therapy for posttraumatic stress disorder (PTSD) among children and adolescents. Method: Participants were 73 children and adolescents (56.2% female) between the ages of 8 and 18. Participants completed self-report measures of posttraumatic stress and depression prior to every session. Measures included the Child PTSD Symptom Scale, Beck Depression Inventory, and Children's Depression Inventory. Results: Multilevel mediational analyses indicated reciprocal relations during treatment: Changes in posttraumatic symptoms led to changes in depressive symptoms and vice versa. Posttraumatic symptoms accounted for 64.1% of the changes in depression, whereas depressive symptoms accounted for 11.0% of the changes in posttraumatic stress. Conclusions: Prolonged exposure therapy may work primarily by reducing posttraumatic stress, which in turn reduces depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)