Primary and secondary control among children undergoing medical procedures: Adjustment as a function of coping style.

The literature suggests that optimal adjustment to relatively uncontrollable stressors may require adjusting oneself to the stressors rather than trying to alter them. This possibility was explored for low-controllability stressors (e.g., painful medical procedures) associated with leukemia. Children's reports of coping strategies and goals were classified as primary control coping (attempts to alter objective conditions), secondary control coping (attempts to adjust oneself to objective conditions), or relinquished control (no attempt to cope). Secondary control coping was positively associated with (1) general behavioral adjustment assessed by the Child Behavior Checklist and (2) illness specific adjustment assessed by children's own distress ratings and by behavioral observations during painful procedures. All significant group differences showed better adjustment among secondary control children than among the primary or relinquished groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive attributes of depression in children and adolescents.

This study explores whether cognitive attributes differentiate depressed children from those with other psychiatric disorders. The subjects were 108 children from 7 to 17 years of age. Forty-seven children were diagnosed as currently depressed, 30 as having had an episode of major depression within the last year (depressed-resolved), and 31 with diagnoses other than depression (nondepressed). The subjects completed the Piers-Harris Children's Self-Concept Scale, the Children's Hopelessness Scale, the Nowicki-Strickland Children's Locus of Control Scale, the Children's Attributional Styles Questionnaire, and the Children's Depression Inventory. The depressed children endorsed significantly lower self-esteem, more hopelessness, a more externalized locus of control, and a more depressive attributional style than the depressed-resolved or the nondepressed children. Thus, a depressive cognitive style can be documented in clinically depressed young people. (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)     

A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression

BACKGROUND: Depression is a major cause of morbidity and mortality in children and adolescents. To date, randomized, controlled, double-blind trials of antidepressants (largely tricyclic agents) have yet to reveal that any antidepressant is more effective than placebo. This article is of a randomized, double-blind, placebo-controlled trial of fluoxetine in children and adolescents with depression. METHODS: Ninety-six child and adolescent outpatients (aged 7-17 years) with nonpsychotic major depressive disorder were randomized (stratified for age and sex) to 20 mg of fluoxetine or placebo and seen weekly for 8 consecutive weeks. Randomization was preceded by 3 evaluation visits that included structured diagnostic interviews during 2 weeks, followed 1 week later by a 1-week, single-blind placebo run-in. Primary outcome measurements were the global improvement of the Clinical Global Impressions scale and the Children's Depression Rating Scale--Revised, a measure of the severity depressive symptoms. RESULTS: Of the 96 patients, 48 were randomized to fluoxetine treatment and 48 to placebo. Using the intent to treat sample, 27 (56%) of those receiving fluoxetine and 16 (33%) receiving placebo were rated "much" or "very much" improved on the Clinical Global Impressions scale at study exit (chi 2 = 5.1, df = 1, P = .02). Significant differences were also noted in weekly ratings of the Children's Depression Rating Scale--Revised after 5 weeks of treatment (using last observation carried forward). Equivalent response rates were found for patients aged 12 years and younger (n = 48) and those aged 13 years and older (n = 48). However, complete symptom remission (Children's Depression Rating Scale--Revised < or = 28) occurred in only 31% of the fluoxetine-treated patients and 23% of the placebo patients. CONCLUSION: Fluoxetine was superior to placebo in the acute phase treatment of major depressive disorder in child and adolescent outpatients with severe, persistent depression. Complete remission of symptoms was rare.     

Attributional style and depressive symptoms among children.

The reformulation of helplessness theory proposes that an insidious attributional style accompanies and predisposes depressive symptoms. The present study investigated predictions of the reformulation among 96 8–13 yr olds who completed the Children's Attributional Style Questionnaire (ASQ) and Children's Depression Inventory twice, 6 mo apart. 83 of their parents completed the adult ASQ and the Beck Depression Inventory at their children's 2nd testing. Children who attributed bad events to internal, stable, and global causes were more likely to report depressive symptoms than were children who attributed these events to external, unstable, and specific causes. This depressive attributional style predicted depressive symptoms 6 mo later, suggesting that it may be a risk factor for depression. Children's attributional style for bad events and their depressive symptoms converged with those of their mothers but not their fathers. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood depression: A 6-month follow-up study.

Examined the stability of depressive symptoms in 436 4th and 5th graders as measured by peer, self, and teacher ratings over a 6-mo period. The stability of the contemporaneous relationships between depression and certain variables (e.g., self-esteem, locus of control, and popularity) shown to be concomitants of depression were also examined. Tests administered included a modification of the Children's Depression Inventory, the Children's Nowicki-Strickland Locus of Control Scale, and the Self-Esteem Inventory. The three measures of depression were significantly correlated over 6 mo, and the pattern of contemporaneous relationships was stable over time. Depressive symptoms, as measured by peer nominations, were shown to be quite stable over time. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between conceptual tempo and depression in children.

The Matching Familiar Figures Test performances of 53 5th–6th graders identified as being depressed on the basis of self-report questionnaires (e.g., the Self-Esteem Scale and the Children's Depression Inventory) were compared to the performances of 53 nondepressed children. The depressed group had longer latencies, made more errors, and was less efficient, even when intellectual differences were taken into account. Implications for childhood depression are discussed. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived Partner Critical and Avoidant Behaviors as Predictors of Anxious and Depressive Symptoms Among Mothers of Children Undergoing Hemopaietic Stem Cell Transplantation.

This prospective study examined the role of perceived partner criticism and avoidance in the anxiety and depressive symptoms of 148 mothers of children undergoing hemopaietic stem cell transplantation (HSCT). The roles of indicators of transplantation risk and posttransplantation medical course were also examined. Perceived partner criticism (e.g., criticizing coping efforts) and perceived partner avoidance (e.g., changing the topic), objective indicators of transplantation risk, and anxiety and depressive symptoms were assessed at the time of HSCT and again 3 and 6 months later. Growth curve modeling analyses indicated that perceived partner criticism was associated with higher average depressive symptoms. However, perceived partner criticism did not predict changes in mother's anxiety. Contrary to predictions, perceived partner avoidance was associated with decreases in maternal anxiety. (PsycINFO Database Record (c) 2010 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)     

The validity of the DSM-III posttraumatic stress disorder classification as applied to children.

Tested three groups of children: The first group (n?=?231) presented with posttraumatic stress disorder (PTSD), the second group (n?=?32) presented with simple phobia (i.e., test phobia), and the third group (n?=?35) was made up of nonclinical controls. The subjects marked the Revised Children's Manifest Anxiety Scale (RCMAS), Children's Depression Inventory (CDI) and their conduct was rated against the Conners Teacher Rating Scale (CTRS) criteria. A multivariate analysis of variance (MANOVA) evinced significant group and gender differences. No significant interaction effects were noted. Univariate F tests and Bonferroni posttests revealed that the PTSD cases evinced markedly higher RCMAS, CDI, and CTRS scores than their phobic and nonphobic peers. Analogously, the RCMAS and CDI scores of the phobia cases were appreciably greater than the control groups. On the other hand, the CTRS scores of the test phobia and control groups were not significantly different. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

Cognitive versus behavioral–interpersonal approaches to the group treatment of depressed college students.

Treated matched groups of 38 depressed undergraduates by behavioral–interpersonal (B–I) and cognitive treatments, each under 2 conditions. Both kinds of treatment proved more effective than no treatment, with some evidence of superiority of the B–I approach. The group treated by the B–I method under intensive conditions made the greatest absolute gains on self-report measures of depression (e.g., Zung Self-Rating Depression Scale) and also became the most interpersonally skillful. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learned helplessness in children: A longitudinal study of depression, achievement, and explanatory style.

Assessed the depressive symptoms, life events, and explanatory styles of 168 8–11 yr olds 5 times over a 1-yr period to test the prediction that the maladaptive explanatory style would be associated with higher levels of depression, lower school achievement, and higher incidences of helpless behaviors in the classroom. Ss completed the Children's Depression Inventory, the Children's Attributional Style Questionnaire, and a life events questionnaire. Measures of school achievement (the California Achievement Tests) were obtained once during the year. Depressive symptoms and explanatory styles were found to be stable over the year. As predicted by the reformulated learned helplessness theory, explanatory style both correlated with concurrent levels of depression and school achievement and predicted later changes in depression during the year. Depression also predicted later explanatory styles. Implications for intervention with children with depressive symptoms or school achievement problems are discussed. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use and abuse of the children's depression inventory.

This study investigated current uses of the Children's Depression Inventory (CDI), a frequently cited self-report measure for children's depressive symptomatology. Recently published studies of "childhood depression" were reviewed: Half of them used the CDI. Of these studies, 68% did not use a clinical or structured interview to determine diagnostic status. When the CDI was used alone to assess depressive symptoms, 44% of studies referred to high CDI scorers as "depressed" without providing a clear cautionary statement (i.e., either stating that the CDI cannot be used to diagnose depression or clarifying limitations regarding generalization of findings from a nonclinical to a clinical sample). These results are similar to those previously published regarding the Beck Depression Inventory, and they suggest a need for caution in the administration and interpretation of results from self-report inventories for children's depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications

In this article we summarize our current understanding of depression in older (14-18 years old) adolescents based on our program of research (the Oregon Adolescent Depression Project). Specifically, we address the following factors regarding adolescent depression: (a) phenomenology (e.g., occurrence of specific symptoms, gender and age effects, community versus clinic samples); (b) epidemiology (e.g., prevalence, incidence, duration, onset age); (c) comorbidity with other mental and physical disorders; (d) psychosocial characteristics associated with being, becoming, and having been depressed; (e) recommended methods of assessment and screening; and (f) the efficacy of a treatment intervention developed for adolescent depression, the Adolescent Coping With Depression course. We conclude by providing a set of summary statements and recommendations for clinicians.     

A guide to constructs of control.

An integrative framework, designed to organize the heterogeneous constructs related to "control," is based on 2 fundamental distinctions: (a) objective, subjective, and experiences of control; and (b) agents, means, and ends of control. The framework is used to analyze more than 100 terms, such as sense of control, proxy control, and primary control. It is argued that although many terms reflect aspects of perceived control (both distinct and overlapping), some are more usefully considered aspects of objective control conditions (e.g., contingency), potential antecedents of perceived control (e.g., choice), potential consequences (e.g., secondary control), sources of motivation for control (e.g., mastery), or other sources of motivation (e.g., autonomy). Implications for theory, measurement, research, and intervention are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's Perceived Illness Uncertainty as a Moderator in the Parent-Child Distress Relation in Juvenile Rheumatic Diseases.

Objective: Examine children's perceived illness uncertainty as a potential moderator in the parent-distress/child-depressive-symptom relation in youths with juvenile rheumatic disease (JRD). Participants and Study Design: 50 youths between the ages of 9 and 17 and their parents completed self-report measures. Main Outcome Measures: Parents completed the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983); youths completed the Children's Depression Inventory (M. Kovacs, 1992) and the Children's Uncertainty in Illness Scale (L. L. Mullins & V. L. Hartman, 1995). Results: Children's perceived illness uncertainty moderated the parent-distress/child-depressive-symptom relation. Parent distress was associated with child depressive symptoms only under conditions of high child-perceived uncertainty; under conditions of low illness uncertainty, parent distress was unrelated to child depressive symptoms. Conclusions: Results highlight the role of children's cognitive appraisals in parent-child adjustment relations in JRD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Longitudinal Structure of the Children's Depression Inventory: Testing a Latent Trait-State Model.

In a 6-wave longitudinal study, children (Grades 4-6, n=648), adolescents (Grades 7-9, n=1,489), and their parents completed child-adolescent or parent versions of the Children's Depression Inventory (CDI; M. Kovacs, 1981). Using structural equation modeling, the authors conducted latent trait-state analyses to distinguish between a stable trait dimension of depression (in which individual differences are stable over time) and an autoregressive dimension (in which individual differences are less stable over time). Children's CDIs reflected the autoregressive dimension more than a stable trait dimension, whereas parents' CDIs reflected a stable trait dimension more than an autoregressive dimension. Reports from adolescents and their parents reflected a stable trait dimension more than an autoregressive dimension of depressive symptoms. Results suggest that the longitudinal structure of the CDI varies considerably depending on the age of the target and the type of informant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased incidence of depressive symptoms in men with erectile dysfunction

OBJECTIVES: To investigate the hypothesis that men with erectile dysfunction (ED) have a higher incidence of depressive symptoms compared with age-matched control subjects. We also hypothesized that depressive symptoms impact on the level of libido and on the success of treatment of ED. METHODS: One hundred twenty men with ED or benign prostatic hyperplasia (BPH) were divided into three groups. Group 1 had ED only, group 2 had BPH only, and group 3 had both ED and BPH. Patients were screened for depressive symptoms using the Primary Care Evaluation of Mental Disorders and the Beck Depression Inventory. They were also surveyed for comorbidity, marital status, severity of ED, level of libido, prior ED treatment choice (if any), success of treatment, and others. RESULTS: One hundred patients completed the questionnaires. Depressive symptoms were reported by 26 (54%) of 48 men with ED alone, 10 (56%) of 18 men with ED and BPH, and 7 (21 %) of 34 men with BPH alone. Patients with ED were 2.6 times more likely to report depressive symptoms than men with BPH alone (P < 0.005). Patients with depressive symptoms reported lower libido than other patients (P < 0.0001). Severity of comorbidities did not differ among the three groups. A total of 33 patients with ED had prior treatment for ED using penile injections or vacuum devices. All 15 (100%) patients with ED only continued treatment and were satisfied with its outcome, whereas only 7 (38.9%) of 18 patients with ED and depressive symptoms continued treatment (P < 0.00021). CONCLUSIONS: ED is associated with high incidence of depressive symptoms, regardless of age, marital status, or comorbidities. Patients with ED have a decreased libido compared with control subjects. In addition, patients with depressive symptoms have a lower libido than patients without depressive symptoms. Patients with ED and depressive symptoms are more likely to discontinue treatment for ED than other patients with ED. These data emphasize the importance of a multidisciplinary approach to the treatment of erectile dysfunction.     

The emergence of children's causal explanations and theories: Evidence from everyday conversation.

This research examines the content of explanations that 4 English-speaking children gave or asked for in everyday conversations recorded from 2? to 5 years of age. Analyses of nearly 5,000 codable explanations (identified by markers like why or because) focused on the entity targeted for explanation (e.g., person, animal, object), the explanatory mode of causal reasoning (e.g., psychological, physical), and interrelations between these elements. Children's explanations focused on varied entities (animals, objects, and persons) and incorporated diverse modes (psychological, physical, social-conventional, and even biological reasoning). Children's pairings of entities with explanatory modes suggest appropriately constrained yet flexible causal reasoning. These data are consistent with the hypothesis that young children draw on several complementary causal-explanatory theories to make sense of real-life events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)