Stress reactivity following brief treatment for depression: Differential effects of psychotherapy and medication.

Psychotherapy and medication treatments are both effective in reducing depressive symptoms. However, only psychotherapy provides an enduring effect by reducing depressive vulnerability following treatment termination. This differential efficacy may reflect mode-specific effects on the longitudinal relationship between depression and stress. The current study examined posttreatment data from 153 outpatients enrolled in the Treatment of Depression Collaborative Research Program. Longitudinal analyses using the latent difference score (LDS) framework (a structural modeling technique that combines features of latent growth curve and cross-lagged regression models) evaluated the temporal relationship between severity of depression and frequency of stressful life events, assessed by interviewers at treatment termination and at 6, 12, and 18 months following treatment. Results supported a stress reactivity model in that stressful events led to elevations in the rate of depression change. Furthermore, multigroup LDS analysis indicated that this longitudinal stress reactivity occurred only for outpatients in the medication conditions. Results demonstrate that the enduring impact of psychotherapy involves the development of enhanced resiliency to stressful life events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerable self-esteem and depressive symptoms: Prospective findings comparing three alternative conceptualizations.

Across diverse theoretical orientations, vulnerable self-esteem (SE) is thought to act as a diathesis for depression after life stress. In the present study, the roles of trait-level SE, low SE primed by depressed mood, and labile SE in prospectively predicting changes in depressive symptoms in a nonclinical sample (n?=?192) were examined. Results indicate that labile SE predicted increases in symptoms. Furthermore, a 3-way interaction (Labile SE?×?Academic Stress?×?Initial Depression) suggested that in Ss who were initially asymptomatic, lability made Ss differentially vulnerable to increases in depressive symptoms after stress. In contrast to labile SE, trait-level SE and priming of low SE were relatively weak predictors of changes in depressive symptoms and did not interact with stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The direct and interactive effects of neuroticism and life stress on the severity and longitudinal course of depressive symptoms.

The direct and interactive effects of neuroticism and stressful life events (chronic and episodic stressors) on the severity and temporal course of depression symptoms were examined in 826 outpatients with mood and anxiety disorders, assessed on 3 occasions over a 1-year period (intake and 6- and 12-month follow-ups). Neuroticism, chronic stress, and episodic stress were uniquely associated with intake depression symptom severity. A significant interaction effect indicated that the strength of the effect of neuroticism on initial depression severity increased as chronic stress increased. Although neuroticism did not have a significant direct effect on the temporal course of depression symptoms, chronic stress significantly moderated this relationship such that neuroticism had an increasingly deleterious effect on depression symptom improvement as the level of chronic stress over follow-up increased. In addition, chronic stress (but not episodic stress) over follow-up was uniquely predictive of less depression symptom improvement. Consistent with a stress generation framework, however, initial depression symptom severity was positively associated with chronic stress during follow-up. The results are discussed in regard to diathesis–stress conceptual models of emotional disorders and the various roles of stressful life events in the onset, severity, and maintenance of depressive psychopathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychiatric history and stress: Predictors of severity of unipolar depression.

Unipolar depression is frequently a recurrent or chronic disorder. In studies on predicting its course, outcomes are typically linked to either psychiatric features or stressful life events. In order to integrate the 2 approaches, 51 unipolar patients were assessed periodically over at least 1 yr for symptoms, stressful events, and chronic stressors. It was hypothesized that adverse family history and early age of onset impair role functioning and coping capabilities, thereby contributing to stressful circumstances that predict severity of depressive reactions. Results of causal modeling analyses supported a model in which background factors were associated with severity of depressive outcomes as mediated by their effects on stress variables. Such a model implicates the self-perpetuating nature of clinical depression, both for the individual and across generations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressful life events and adolescent substance use and depression: conditional and gender differentiated effects

Stressful life circumstances have myriad influences on human health and behavior. Early research focused on the variable distribution of stress and its effects by socioeconomic status, race, and gender. More recent research indicates that variation by age is also an important consideration. For example, adolescent reactions to stressful life events are often inconsistent with adult reactions to similar life situations and transitions. Moreover, since most studies assess only a single outcome--usually depression--they risk classification bias since analyses exclude other potential stress-related outcomes. This paper assesses the gender distinct effects of stressful life events on two outcomes among adolescents, substance use and depressive symptoms. The results of a second-order regression model indicate that life events affect female, but not male, depressive symptoms, especially when self-esteem is low or mastery is high. Furthermore, life events affect substance use when peer drug use is high, or when parental support is low, but this latter effect is limited to female adolescents.     

Sex differences and adolescent depression.

This study investigates the role of certain psychosocial variables—sex, age, body image/self-esteem, self-consciousness, stressful life events, and the degree to which an individual identifies with the cultural stereotype of masculinity—as correlates and antecedents to depression in adolescents and explores possible intraindividual mediators of the stress–depression relationship in adolescents. A battery of self-report measures was administered to public high school students in Grades 9–12 in their classrooms at two different times 1 month apart. Female adolescents reported more depressive symptoms, self-consciousness, stressful recent events, feminine attributes, and negative body image and self-esteem; no age effects were obtained. Results suggest a model of adolescent depression in which body image/self-esteem and stressful recent events are significant contributors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life events can trigger depressive exacerbation in the early course of schizophrenia.

Previous studies have linked life events with depression in chronic schizophrenia, but those studies had methodological limitations. Using a prospective research design and examining events that were clearly independent of the patients' illnesses, the authors sought to determine whether stressful life events could trigger depressive symptoms in the early course of schizophrenia. Schizophrenia patients (n?=?99) were followed for 1 year from a point of outpatient stabilization. Life event interviews were conducted every 4 weeks and symptom assessments every 2 weeks. Survival analyses showed a significantly increased risk for an exacerbation of significant depressive symptoms following an independent life event. Of interest is that an analysis of competing risk showed that the odds of psychotic exacerbation following a major independent life event were not significantly greater than the odds of depressive exacerbation. The risk of depression and of psychosis after experiencing a stressful life event is significantly increased for the first month, but the risk period can extend to 3 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Seeing the silver lining: Cognitive reappraisal ability moderates the relationship between stress and depressive symptoms.

Individuals differ in their adjustment to stressful life events, with some exhibiting impaired functioning, including depression, while others exhibit impressive resilience. The present study examined the hypothesis that the ability to deploy a particularly adaptive type of emotion regulation—cognitive reappraisal—may be a protective factor. It expands upon existing research in three ways. First, participants' ability to use reappraisal (cognitive reappraisal ability: CRA) was measured by using a behavioral challenge that assessed changes in experiential and physiological domains, rather than questionnaires. Second, all participants had been exposed to one or more recent stressful life events, a context in which emotion regulation may be particularly important. Third, a community sample of 78 women aged 20 to 60 was recruited, as opposed to undergraduates. Results indicate that, at low levels of stress, participants' CRA was not associated with depressive symptoms. However, at high levels of stress, women with high CRA exhibited less depressive symptoms than those with low CRA, suggesting that CRA may be an important moderator of the link between stress and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Applicability of Cognitive Mediational and Moderational Models to Explain Children's Depression Inventory Factor Scores in Urban Youth.

This investigation examined whether cognition serves as a direct factor, mediates, or moderates the relationship between stressful life events and Children's Depression Inventory (CDI; Kovacs, 1992) factor scores in urban, ethnic minority youth. Ninety-eight middle school students completed measures of stressful life events, cognition (cognitive triad and locus of control), and depressive symptoms. Results provided support for both mediating and moderating models of depression. Specifically, the cognitive triad mediated the relationship between stressful life events and depressive symptom categories of negative mood, ineffectiveness, and anhedonia, while it interacted with stressful life events to predict negative self-esteem. In addition, locus of control was found to interact with stressful life events to predict anhedonia. Finally, the diathesis-stress model was not supported when predicting the CDI Interpersonal Problems factor score, which taps externalizing behaviors. Implications for school psychology research and practice include the importance of including measures of stressful life events and cognitive styles in assessment of children's social-emotional functioning. In addition, results highlight the need to target children's perceptions for intervention since they appear to play a significant role in psychological reactions to stressors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trajectories of stressful life events and depressive symptoms during adolescence.

This 4-yr longitudinal study of 191 girls and 185 boys living in intact families in the rural Midwest examines the trajectories of life events and depressive symptoms in adolescence. The trajectories of depressive symptoms differ between boys and girls. Compared with boys, girls experienced a greater number of depressive symptoms after age 13. Changes in uncontrollable events are associated with the increases in girls' but not boys' depressive symptoms. Latent growth curve analyses show that, over 4 yrs, (1) depressive symptoms for girls changed according to a curvilinear pattern that is associated with changes in stressful events; (2) the level of depressive symptoms is related to the level of life events for both boys and girls; and (3) change in depressive symptoms is significantly related to change in stressful events only for girls. Girls living with less supportive mothers are more vulnerable to negative life changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Cognitive styles and life events interact to predict bipolar and unipolar symptomatology.

This study examined the interaction of cognitive style (as assessed self-report and information-processing battery) and stressful life events in predicting the clinician-rated depressive and manic symptomatology of participants with Research Diagnostic Criteria lifetime diagnoses of bipolar disorder (n?=?49), unipolar depression (n?=?97), or no lifetime diagnosis (n?=?23). Bipolar and unipolar participants' attributional styles, dysfunctional attitudes, and negative self-referent information processing as assessed at Time 1 interacted significantly with the number of negative life events that occurred between Times 1 and 2 to predict increases in depressive symptoms from Time 1 to Time 2. Within the bipolar group, participants' Time 1 attributional styles and dysfunctional attitudes interacted significantly, and their self-referent information processing interacted marginally, with intervening life events to predict increases in manic symptoms from Time 1 to Time 2. These findings provide support for the applicability of cognitive vulnerability–stress theories of depression to bipolar spectrum disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving as a moderator of stress-related depressive symptoms: A prospective analysis.

Previous research has suggested that problem-solving skills serve to moderate the likelihood that individuals will experience depressive symptoms as a function of negative stressful life events. The present study attempted both to replicate this finding and to provide for a more rigorous test of this hypothesis by (a) using a prospective design, (b) controlling for prior level of depression, (c) incorporating two measures of problem solving, and (d) including several methodological controls to increase the validity of the assessment of stressful life events. Results from both the cross-sectional and prospective analyses involving data collected from 150 university students provided support for the hypothesis that problem solving moderates stress-related depressive symptoms. More specifically, for both measures of problem solving, results indicated that effective problem solvers under high levels of stress reported significantly lower depression scores than ineffective problem solvers under similar levels of stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life events as predictors of mania and depression in bipolar I disorder.

[Correction Notice: An erratum for this article was reported in Vol 117(3) of Journal of Abnormal Psychology (see record 2008-11014-022). In the aforementioned article, Amy K. Cuellar's last name was misspelled. The corrected list of author names is: Sheri L. Johnson, Amy K. Cuellar, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White, and Ivan Miller.] To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder. (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)     

A longitudinal study of the effects of pessimism, trait anxiety, and life stress on depressive symptoms in middle-aged women.

The relative contributions of life stress, menopausal status, and pessimism and trait anxiety during the presence and absence of stress on increases in depressive symptoms across 3 years were examined in a sample of 460 premenopausal women, aged 42-50, who had few depressive symptoms at study entry. Multivariate analyses showed that after statistical adjustments for initial depressive symptoms and education, depressive symptoms at follow-up were higher among women (a) who reported stressful events, especially of a chronic nature, (b) who scored highly on trait anxiety, and (c) who were pessimistic and subsequently experienced a stressful ongoing problem. Change in menopausal status was not related to symptoms. The study confirms that midlife stress and both optimism and trait anxiety are important predictors of depressive symptoms during midlife. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring abuse stress and negative cognitive appraisals in child sexual abuse: validity data on two new scales

The validity of two measures assessing degree of stress associated with sexual abuse was examined in a sample of 48 girls who had been sexually abused. The Checklist of Sexual Abuse and Related Stressors (C-SARS) assessed negative life events that were part of or were related to the abuse, and the Negative Appraisals of Sexual Abuse Scale (NASAS) assessed negative cognitive appraisals of threat, harm, or loss associated with the abuse. Total scores for victim reports of both stressful events and negative appraisals were positively and significantly related to two other measures of abuse severity: therapist ratings of abuse stress and the number of types of sexual abuse reported. Stressful event scores were also related to aggressive behavior problems, sexual concerns, and total symptom scores on the Child Behavior Checklist. Negative cognitive appraisal scores were related to victims' self-reports of depression, anxiety, and posttraumatic stress symptoms, and to parents reports of child depression and total symptoms. Regression analyses indicated that there were significant effects of negative appraisals on internalizing symptoms when controlling for the level of stressful events experienced. The results suggest that negative life events and negative appraisals associated with sexual abuse are valid constructs that help account for variability in mental health outcomes among child victims. The implications of these results and future research directions in examining variable outcomes among sexual abuse victims are discussed.     

Stress, social support and pregnancy outcome: a reassessment based on recent research

We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth retardation. Included in the review are all reports on the direct effects of stressors or psychological distress; the indirect effects of stressors or distress through health behaviours such as smoking; and the direct and buffering effects of social support. Although an important stimulus for recent stress research has been the attempt to explain racial and social class differences in birth outcome, the recent data show that stressful life events during pregnancy, though more common in disadvantaged groups, do not increase the risk of preterm birth. In contrast, intimate social support from a partner or family member appears to improve fetal growth, even for women with little life stress. Questions unanswered by the research to date are whether elevated levels of depressive symptoms affect pregnancy outcome, either directly or by encouraging negative health behaviours, and whether chronic (vs. acute) stressors are harmful. Additional research is also needed to determine whether psychosocial factors interact with specific clinical conditions to promote adverse pregnancy outcomes. Focusing on intimate support and how it benefits pregnancy outcome could lead to the design of more effective interventions.     

Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents.

Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study.

We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50–68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)