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)     

Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder.

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Cross-Cultural Investigation of Cognitions and Depressive Symptoms in Adolescents.

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United Stales. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bidirectional relations of religious orientation and depressive symptoms in adolescents: A short-term longitudinal study.

Religious orientation can be divided into intrinsic and extrinsic: intrinsically oriented individuals “live their religion,” whereas extrinsically oriented individuals practice religion mainly to gain external benefits. In adults, depression has been found to correlate negatively with intrinsic religious orientation and positively with extrinsic orientation. Studies of the relation between religiosity and depression typically have not been longitudinal, conducted with adolescents, controlled for the influence of other factors associated with depression (i.e., negative cognitions), or examined the reverse relation of depression predicting religious orientation. Our 4-month longitudinal study of 273 ninth-grade students addressed these issues. Results showed that higher intrinsic religious orientation measured at baseline significantly predicted lower self-reported depressive symptoms 4 months later, controlling for initial level of depressive symptoms and cognitive style; in contrast, extrinsic orientation and the interaction between religious orientation and life events did not significantly predict later depressive symptoms. Self-reported depressive symptoms, however, did not predict either intrinsic or extrinsic religious orientation 4 months later. Factors contributing to different findings for adolescents versus adults in the relation between extrinsic religious orientation and depression are suggested. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Developmental and symptom specificity of hopelessness, cognitive errors, and attributional bias among clinic-referred youth

The present study examined the unique and interactive relationships between age and indices of psychopathology (i.e., anxiety, aggression, and depression), with three types of maladaptive cognitions: hopelessness, negative cognitive errors, and attributional bias. Some negative cognitions were not unique to depression and were associated with broader psychopathology. Developmental considerations also influenced some negative cognitions or qualified the association between negative cognitions and depression.     

Cognitive vulnerability to depressive symptoms in adolescents in urban and rural Hunan, China: A multiwave longitudinal study.

The current multiwave longitudinal study examined the applicability of two cognitive vulnerability-stress models of depression—Beck's (1967, 1983) cognitive theory and the hopelessness theory (Abramson, Metalsky, & Alloy, 1989)—in two independent samples of adolescents from Hunan Province, China (one rural and one urban). During an initial assessment, participants completed measures assessing dysfunctional attitudes (Beck, 1967, 1983), negative cognitive style (Abramson et al., 1989), neuroticism (Costa & McCrae, 1992), depressive symptoms, and anxiety symptoms. Once a month for the subsequent 6 months, participants completed measures assessing the occurrence of different types of negative events, depressive symptoms, and anxiety symptoms. Results provided support for cognitive vulnerability factors as predictors of increases in depressive symptoms following the occurrence of higher than average levels of negative events in Chinese adolescents. The results also supported the specificity of these two cognitive vulnerability factors as predictors of depressive versus anxiety symptoms following the occurrence of higher than average levels of negative events (i.e., symptom specificity), and the ability of cognitive vulnerability factors to predict prospective change in depressive symptoms above and beyond the effects of trait neuroticism (i.e., etiological specificity). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects.

In this meta-analytic review, the authors summarized the effects of depression prevention programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., selective programs with a shorter duration that include homework). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of the cognitive diathesis-stress model of depression in children: Academic stressors, attributional style, perceived competence, and control.

The cognitive diathesis–stress model of depression was tested in a sample of 439 children in grades 5 and 6. Attributional style and cognitions about academic competence and control over achievement were assessed before the occurrence of a potentially stressful event—receiving unacceptable grades on a report card. Depressive symptoms were assessed 1 week before the event, the morning after, and 5 days later. Replicating G. I. Metalsky, L. J. Halberstadt, and L. Y. Abramson (1987), stressor level and negative cognitions predicted depressive symptoms the morning after the event, controlling for initial symptom levels. Depressive symptoms 5 days later were predicted by the interactions of negative cognitions with stressors, supporting a cognitive diathesis–stress model. Students who reported a negative explanatory style or lack of academic control and competence expressed more distress after receiving unacceptable grades than did students without such cognitions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integration of positive and negative affectivity and cognitive content-specificity: Improved discrimination of anxious and depressive symptoms.

In a sample of 159 psychiatric outpatient adults, negative affectivity (NA) was significantly correlated with a broad range of anxiety and depressive symptoms and was not useful for the differentiation of anxiety from depression. Low positive affectivity (PA) was significantly related only to depressive symptoms. Whereas depressive cognitions demonstrated discriminant capability, anxiety cognitions (in isolation) demonstrated nonspecificity. A combination of NA and anxious cognitions significantly predicted anxiety symptoms, better than did cognitions or affect alone. NA, depressive cognitions, and low PA significantly predicted depressive symptoms. Results support the integration of affective and cognitive models for the discrimination of anxious from depressive symptoms and have implications for measure development. Modifications in the cognitive content-specificity theory of anxiety states are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily Depression and Cognitions About Stress: Evidence for a Traitlike Depressogenic Cognitive Style and the Prediction of Depressive Symptoms in a Prospective Daily Diary Study.

The authors examined the stability and dynamic structure of negative cognitions made to naturalistic stressors and the prediction of depressive symptoms in a daily diary study. Young adults reported on dispositional depression vulnerabilities at baseline, including a depressogenic cognitive style, dysfunctional attitudes, rumination, neuroticism, and initial depression, and then completed short diaries recording the inferences they made to the most negative event of the day along with their experience of depressive symptoms every day for 35 consecutive days. Daily cognitions about stressors exhibited moderate stability across time. A traitlike model, rather than a contextual one, explained this pattern of stability best. Hierarchical linear modeling analyses showed that individuals' dispositional depressogenic cognitive style, neuroticism, and their daily negative cognitions about stressors predicted fluctuations in daily depressive symptoms. Dispositional neuroticism and negative cognitive style interacted with daily negative cognitions in different ways to predict daily depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disentangling the prospective relations between maladaptive cognitions and depressive symptoms.

In a four-wave, cohort-longitudinal design with a community sample of 515 children and adolescents (grades 2 through 9), this study examined the longitudinal structure of and prospective interrelations between maladaptive cognitions and depressive symptoms. Multigroup structural equation modeling generated four major findings. First, the longitudinal structures of maladaptive cognitions and depressive symptoms consist of a single time-invariant factor and a series of time-varying factors. Second, evidence supported a model in which depressive symptoms predicted negative cognitions but not the reverse. Third, the time-invariant components of cognition and depression were highly correlated. Fourth, the strength of the depression-to-cognition relation increased with age. Implications regarding the mechanisms underlying clinical interventions with depressed children are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predicting response to depression treatment: The role of negative cognition.

Repeated experiences with major depressive disorder (MDD) may strengthen associations between negative thinking and dysphoria, rendering negative cognition more accessible and pronounced with each episode. According to cognitive theory, greater negative cognition should lead to a more protracted episode of depression. In this study of 121 adults with MDD, number of previous episodes was associated with slower change in depression across inpatient and outpatient treatment. Further, although pretreatment negative cognition and pretreatment family impairment both uniquely predicted slower change in depressive symptoms, only negative cognition mediated the association between depression history and depression change. Findings suggest that repeated MDD episodes are specifically associated with increased negative cognition, which in turn contributes to a more pernicious course of symptom change during treatment for depression. (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)     

Depressive thinking: Shifts in construct accessibility or in schematic mental models?

Alternative explanations for depression-related changes in thinking were examined. Forty-one depressed patients and 40 controls completed sentence stems involving social approval or personal achievement such as "If I could always be right then others would me." The view that depressive thinking primarily reflects a generalized increase in accessibility of negative constructs predicts patients will give more negative completions (e.g., "dislike"). Alternatively, depression could affect the interrelationships between constructs: Use in depression of schematic mental models implying closer dependence of personal worth-acceptance on success-approval predicts patients may give more positive completions (e.g., "like"). Results supported the latter prediction and suggest that depressive thinking reflects changes in high-level mental models used to interpret experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It takes three: Selection, influence, and de-selection processes of depression in adolescent friendship networks.

The authors of this study tested a selection–influence–de-selection model of depression. This model explains friendship influence processes (i.e., friends' depressive symptoms increase adolescents' depressive symptoms) while controlling for two processes: friendship selection (i.e., selection of friends with similar levels of depressive symptoms) and friendship de-selection (i.e., de-selection of friends with dissimilar levels of depressive symptoms). Further, this study is unique in that these processes were studied both inside and outside the school context. The authors used a social network approach to examine 5 annual measurements of data in a large (N =847) community-based network of adolescents and their friends (M = 14.3 years old at first measurement). Results supported the proposed model: adolescents tend to select friends with similar levels of depression, and friends may increase each other's depressive symptoms as relationships endure. These two processes were most salient outside the school context. At the same time, friendships seemed to be ended more frequently if adolescents' level of depressive symptoms was dissimilar to that of their friends. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive change and the therapeutic alliance: The role of technical and nontechnical factors in cognitive therapy.

Tests whether there are reciprocal interactions between the technical and nontechnical aspects of cognitive therapy (CT). 47 outpatients (mean age 36.8 yrs) with a depressive and/or anxiety disorder were treated with a 20-week, manualized CT intervention. Measures included the Beck Depression Inventory, the Dysfunctional Attitude Scale, and the Working Alliance Inventory. Results indicate that pretreatment depressogenic cognitions impact on the ability to form an early therapeutic alliance, whereas pretreatment depression severity is unrelated to alliance formation. Second, the degree to which patients were in agreement with the goals and tasks of therapy was predictive of subsequent change in depressogenic cognitions. Third, the 2-way interaction between the therapeutic bond and cognitive-change scores was found to predict depression outcomes: patients who reported a better therapeutic bond and who experienced greater reduction in their depressogenic cognitions, experienced the most favorable clinical outcomes. Certain aspects of the therapeutic alliance (i.e., goals and tasks) may facilitate the implementation of the technical factors of CT, while other aspects of the alliance (i.e., bond) act in concert with technical factors to produce direct effects on depressed symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive predictors of symptom return following depression treatment.

This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N=121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n=53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of three depression prevention programs.

Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive–behavioral (CB) intervention, group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition. Results: The group CB intervention reduced depressive symptoms and negative cognitions and increased pleasant activities. Change in these mediators predicted change in depression, and intervention effects became weaker controlling for change in the mediators; yet, change in depression appeared typically to occur before change in the mediators. The supportive expressive intervention reduced depressive symptoms but affected only 1 of 2 mediators (emotional expression but not loneliness). Change in emotional expression did not correlate with change in depression, and change in depression usually occurred before change in the mediators. Bibliotherapy did not significantly affect depressive symptoms or the ostensive mediators (negative cognitions and pleasant activities), and change in depression usually occurred before change in the mediators. Conclusion: Results imply that this procedure provides a sensitive test of mediation but yielded limited support for the hypothesized mediators, suggesting that nonspecific factors may play an important mediational role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional congruence in older couples coping with wives' osteoarthritis: Exacerbating effects of pain behavior.

The authors examined congruence in the negative emotions (depression, anger) of 101 female osteoarthritis patients (M age=69 years) and their caregiving husbands (M age=71 years) and the extent to which patients' pain behavior (e.g., limping, rubbing joints) exacerbated linkages between partners' negative emotions. Associations between patients' and husbands' emotions were examined within domains (e.g., depression-depression) and across domains (e.g., depression-anger) over a 6-month interval. Regression analyses revealed that patients' initial levels of depressive symptoms and anger were related to increases in their husbands' anger over time. The associations between patients' depressive symptoms and their husbands' depressive symptoms and anger were conditioned by pain behaviors. Patients who were more depressed and who engaged in high levels of pain behavior had husbands who became more depressed and angry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive correlates of teacher stress and depressive symptoms: Implications for attributional models of depression.

Conducted a test of the reformulated learned helplessness (attributional) model of depression (L. Y. Abramson et al, see record 1979-00305-001). Ss were 75 urban high school teachers who were experiencing high levels of teaching-related stress. Ss were administered Bruno's Teacher Stress Inventory, the Center for Epidemiological Studies—Depression scale, and a specially developed attribution and cognition questionnaire. Results indicate that the teachers experienced a high degree of stress-related depressive symptomatology. The depressive behavior was significantly related to cognitions regarding the consequences of the stressful circumstances, but contrary to the reformulation of learned helplessness, depression was not related to causal attributions regarding these situations. Results suggest the need both for refinements in cognitive theories of depression to distinguish between enduring mood states and transient depressive symptoms arising universally in certain situations, and for the study of depression-related cognitions in naturalistic settings. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)