Depression and Axis II symptomatology in an adolescent community sample: concurrent and longitudinal associations

The relationship between personality pathology and depression has been the focus of increasing attention, but few investigators have examined this issue prospectively or in adolescent community samples. The present study used both self report and interviewer assessments of personality disorder symptomatology and depression in a sample of 155 late adolescent women followed over three years. Personality pathology cluster and total scores demonstrated moderate to fairly high degrees of stability, indicating endurance of these traits in late adolescence. As predicted, Axis II symptoms were associated with concurrent depressive symptomatology. Overall, self-reported personality disorder symptoms, as well as those specifically in Clusters A and B, predicted interviewer-rated depression over two years beyond the contribution of initial depression, indicating that subclinical Axis II symptoms are a risk factor for subsequent depressive symptomatology.

The context of depression in clinic-referred youth: neglected areas in treatment

OBJECTIVE

To review the empirical, methodological, and conceptual limitations of psychotherapy and pharmacotherapy for childhood and adolescent depression and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment.

METHOD

Interview-based assessment of psychiatric features and psychosocial functioning, family psychopathology and marital adjustment, and child and parent stressful life events was performed in a sample of 43 depressed youngsters seeking outpatient treatment.

RESULTS

The empirical and conceptual review indicated that treatments based on downward extensions of adult procedures are limited in number and success. Also, the treatments generally neglect the following characteristics revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe stressors.

CONCLUSIONS

Treatments need to be informed by and address the actual characteristics of depressed youngsters and their environments, which are highly dysfunctional.

Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood

This study examined 2 models of the relationship between personality disorder symptomatology and depression, incorporating life stress as an intervening variable. In a community sample of late adolescent women, symptoms of Cluster B disorders predicted interpersonal chronic stress and self-generated episodic stress over 2 years, controlling for initial depression. Cluster A symptoms also predicted subsequent chronic interpersonal stress, over initial depression. Cluster C pathology did not predict subsequent stress. Personality disorder symptomatology was also associated with partner-reported relationship dissatisfaction. Support was found for a mediation model whereby women with higher levels of initial personality disturbance in Clusters A and B generated excessive amounts of episodic stress and interpersonal chronic stress in the next 2 years, which, in turn, increased vulnerability for depressive symptoms. A moderation model, whereby the presence of greater personality disorder symptoms would increase the likelihood of depression in response to stress, was not supported.

Nursing physical assessment skills: implications for UK practice

The physical assessment skills of inspection, palpation, percussion and auscultation currently have only minimal recognition in UK nursing practice. Authors attest to perceived benefits in terms of continuity of care, holistic care delivery, rapidity of emergency intervention and reduction in junior doctors' hours and workload. However, the use of such skills by nurses has been subject to little in the way of formal outcome-based evaluation, and there is a clear need for such research to be carried out within the UK. Important guidelines exist within the literature to underpin educational programmes in physical assessment; these are reviewed and their implications for UK practice are considered. It is concluded that while generation of a UK evidence base is required, there is a persuasive argument to underpin continued development of physical assessment skills within UK nursing practice.

Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood

This study examined 2 models of the relationship between personality disorder symptomatology and depression, incorporating life stress as an intervening variable. In a community sample of late adolescent women, symptoms of Cluster B disorders predicted interpersonal chronic stress and self-generated episodic stress over 2 years, controlling for initial depression. Cluster A symptoms also predicted subsequent chronic interpersonal stress, over initial depression. Cluster C pathology did not predict subsequent stress. Personality disorder symptomatology was also associated with partner-reported relationship dissatisfaction. Support was found for a mediation model whereby women with higher levels of initial personality disturbance in Clusters A and B generated excessive amounts of episodic stress and interpersonal chronic stress in the next 2 years, which, in turn, increased vulnerability for depressive symptoms. A moderation model, whereby the presence of greater personality disorder symptoms would increase the likelihood of depression in response to stress, was not supported.

Characterization for imperfect polarizers under imperfect conditions

The principles for measuring the extinction ratio and transmittance of a polarizer are formulated by use of the principal Mueller matrix, which includes both polarization and depolarization. The extinction ratio is about half of the depolarization, and the contrast is the inverse of the extinction ratio. Errors in the extinction ratio caused by partially polarized incident light and the misalignment of polarizers can be corrected by the devised zone average method and the null method. Used with a laser source, the null method can measure contrasts for very good polarizers. Correct algorithms are established to deduce the depolarization for three comparable polarizers calibrated mutually. These methods are tested with wire-grid polarizers used in the 3-5-microm wavelength region with a laser source and also a lamp source. The contrasts obtained from both methods agree.

Why does attachment style change?

Adult attachment research has proceeded on the assumption that attachment style is relatively stable and affects future functioning. However, researchers have become interested in attachment instability and predictors of attachment style change. In this article, 2 conceptualizations of attachment style change were examined: Attachment style change is a reaction to current circumstances, and attachment style change is an individual difference in susceptibility to change that is associated with stable vulnerability factors. A total of 155 women were assessed after high school graduation, and 6 months and 2 years later. Results primarily supported the conceptualization of attachment style change as an individual difference. Specifically, some women may be prone to attachment fluctuations because of adverse earlier experiences, and women who show attachment fluctuations are similar to women with stably insecure attachments.

Predictors of the generation of episodic stress: a longitudinal study of late adolescent women

The effects of depression and Axis I comorbidity on subsequent self-generated life stress were examined in a longitudinal sample of 134 late adolescent women. The results indicated that specific forms of psychopathology constitute a risk factor for future self-generated episodic stress, even when controlling for prior chronic stress. Comorbid depression had a particularly salient effect in the prediction of stress related to interpersonal conflicts. The effects of family psychopathology and sociotropy were mediated through participant psychiatric status, whereas autonomy made an independent contribution to the prediction of episodic stress. These results support C. Hammen's (1991b) stress generation model in a community sample, demonstrating how individuals with depression play a role in the creation of stress, and also refine prior work by showing that only the comorbid form of depression is associated with subsequent conflict-related stress.

Predictors of the generation of episodic stress: a longitudinal study of late adolescent women

The effects of depression and Axis I comorbidity on subsequent self-generated life stress were examined in a longitudinal sample of 134 late adolescent women. The results indicated that specific forms of psychopathology constitute a risk factor for future self-generated episodic stress, even when controlling for prior chronic stress. Comorbid depression had a particularly salient effect in the prediction of stress related to interpersonal conflicts. The effects of family psychopathology and sociotropy were mediated through participant psychiatric status, whereas autonomy made an independent contribution to the prediction of episodic stress. These results support C. Hammen's (1991b) stress generation model in a community sample, demonstrating how individuals with depression play a role in the creation of stress, and also refine prior work by showing that only the comorbid form of depression is associated with subsequent conflict-related stress.

A cognitive-interpersonal approach to depressive symptoms in preadolescent children

Cognitive and interpersonal aspects of depressive symptoms were investigated in a community sample of children. Eighty-one 8- to 12-year-olds completed scales assessing cognitive representations of social relationships and symptoms of depression and anxiety. Teachers provided ratings of peer rejection. Children with elevated levels of depressive symptoms displayed increased negativity in their beliefs about self, family, and peers, as well as distinct patterns of interpersonal information processing. Anxiety symptoms did not make a unique contribution beyond depression to negative representations of family and peers; in contrast, symptom-specific profiles of self-representations were found. Structural equation analysis supported a model linking negative interpersonal representations, peer rejection, and depressive symptoms. The findings suggest that future studies may benefit from approaches that incorporate both cognitive and interpersonal variables as predictors of child depression.

The relationship between attachment cognitions and psychological adjustment in late adolescent women

This longitudinal study of 137 female high school seniors investigated the relationship of attachment cognitions, current psychological functioning, and psychological functioning 12 months later. Attachment cognitions, assessed with the Revised Adult Attachment Scale and the Inventory of Parent and Peer Attachment, were significantly associated with current symptomatology. The Revised Adult Attachment Scale, in interaction with initial symptomatology, predicted depression, substance abuse, eating disorders, and personality disorders 12 months later. The Inventory of Parent and Peer Attachment parent subscales predicted eating disorder and personality disorder symptomatology, whereas the peer subscales predicted substance abuse, eating disorder, and personality disorder symptomatology.

Poor interpersonal problem solving as a mechanism of stress generation in depression among adolescent women

The authors examined C. Hammen's (1991) model of stress generation in depression and the role of interpersonal problem-solving strategies (IPS) in the stress generation process in a longitudinal sample of 140 young women who entered the study at ages 17-18. Structural equation modeling was used to test a model in which IPS and subsequent interpersonal stress mediated the relationship between initial and later depressive symptoms. Results supported the main prediction of the stress generation model: Interpersonal stress mediated the relationship between initial and later depressive symptoms. In addition, IPS predicted interpersonal stress. However, no association was found between depressive symptoms and IPS. An alternative model in which IPS moderated the relationship between stress and depressive symptoms was tested; it was not supported.

Cognitive representations of self, family, and peers in school-age children: links with social competence and sociometric status

Attachment and social-cognitive theories of interpersonal relations have underscored the integral role that internalized cognitive representations may play as mediators of the link between family and peer relationships. 3 predictions consistent with this conceptualization received support in the present study of 161 7-12-year-old school children. In Part 1 of the study, significant connections were found among different components of cognitive representations, including social perceptions, interpersonal expectancies, and schematic organization and processing of social information. Moreover, generalization was found among children's representations across 3 interpersonal domains--that is, family, peer, and self. In Part 2, negative representations of self and others were found to be associated with increased social impairment, including dysfunctional social behavior and less positive status in the peer group. Implications of the findings for theories of interpersonal competence and interventions with socially impaired children are discussed.

Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress

The authors tested a cognitive-interpersonal hypothesis of depression by examining the role of interpersonal cognitions in the prediction of depression associated with interpersonal stressors. A measure of adult attachment assessed interpersonal cognitions about ability to be close to others and to depend on others and anxiety about rejection and abandonment. Participants were women who had recently graduated from high school; they were followed for 1 year with extensive interview evaluation of life events, depression, and other symptomatology. Generally, cognitions, interpersonal events, and their interactions contributed to the prediction of interview-assessed depressive symptoms, but the effects were not specific to depression and predicted general symptomatology measured by diagnostic interviews as well, and results also varied by attachment subscale. Results were discussed in terms of a developmental psychopathology approach to disorders in young women.

Gastroschisis and reduced fetal heart-rate variability

Most liveborn babies with gastroschisis do well after surgical repair, although about one-eighth of affected cases die late in utero. Our practice is to use weekly computerised cardiotocograph (CTG) analysis after week 34 of gestation in cases of gastroschisis. In a look-back at the records in 18 such singleton pregnancies, CTG showed 7 to be highly abnormal or preterminal. All but 1 of these 7 had a normal fetal heart rate. In all 7 cases, delivery was expedited. Only 1 infant had neurological sequelae, and in all the abdominal defect was successfully repaired. Monitoring of these high-risk pregnancies with serial computerised CTG may be helpful in timing delivery.

Diaphragmatic herniae and translocations involving 8q22 in two patients

Two girls with congenital diaphragmatic herniae are reported. Both were discovered to have a balanced reciprocal translocation involving 8q22.3. In one girl the translocation was de novo, in the other it was maternally inherited. Uniparental disomy was excluded in both. 8q22.3 may be the location of a gene affecting development of the diaphragm.

Interpersonal functioning and depressive symptoms in childhood: addressing the issues of specificity and comorbidity

Research has supported linkages between depression and social impairment in youngsters, but has often focused on depressive symptoms in isolation. We collected data on depressive, anxiety, and externalizing symptoms in 161 school children. Information about interpersonal competence was gathered from several sources, including children, teachers, and behavioral observations. Depressive symptoms were found to be related to difficulties in multiple areas of competence, including maladaptive social problem-solving styles, conflict-negotiation and affect-regulation deficits, and peer rejection. Comparisons of the relative contributions made by depressive and anxiety symptoms to the prediction of functioning yielded some evidence for a specific relation between depressive symptoms and impairment. Children with cooccurring internalizing and externalizing symptoms generally suffered from the most social dysfunction. If replicated in clinical samples, findings such as these may help to guide intervention efforts with depressed children.

Macular capillary hemodynamic changes associated with Raynaud's phenomenon

BACKGROUND

Raynaud's phenomenon is an episodic, reversible spasm of the digital arterioles. Previous studies have suggested that Raynaud's phenomenon may be associated with alterations in the ocular circulation. The authors used the blue field entoptic simulation technique to study macular retinal capillary hemodynamics in patients with Raynaud's phenomenon.

METHODS

Forty-two volunteers participated in the study: 18 with a connective tissue disease and secondary Raynaud's phenomenon, 8 with a connective tissue disease and no Raynaud's phenomenon, and 16 healthy volunteers. The mean of three blue field entoptic density and velocity measurements was determined before as well as during and 10 minutes after the immersion of one hand in ice water.

RESULTS

Patients with severe Raynaud's phenomenon demonstrated a statistically significant 30% decrease in retinal capillary flow during immersion of a hand in ice water (P less than 0.05), which remained 17% reduced (P less than 0.05) for at least 10 minutes after removal. The decrease in capillary flow was not observed in control individuals or in individuals with connective tissue disease who demonstrated minimal or no Raynaud's phenomenon.

CONCLUSION

The prolonged reduction in retinal capillary flow observed in subjects with Raynaud's phenomenon is probably caused by retinal arteriolar vasoconstriction and is similar to concurrent arteriolar vasoconstriction reported in other systemic vascular beds. In the retina, the recurrent ischemic episodes may result in dysfunction or injury.

Paediatrics: developing family information leaflets

The authors offer advice on how to prepare information leaflets for the families of children admitted to paediatric units, and describe the successful implementation of such a scheme at the University Hospital, Southampton. The development of family information leaflets comprises an important part of setting quality standards.

Maternal communication: predictors of outcome at follow-up in a sample of children at high and low risk for depression

Separate lines of investigation have shown the increased risk of dysfunction for children of depressed women and impaired interaction between depressed mothers and their children. The link between the two was examined in 57 children at high and low risk for depression. Children of unipolar depressed, bipolar depressed, chronically medically ill, and normal mothers were evaluated at a 6-month follow-up. Hierarchical regression analyses suggested a relation between maternal interaction behavior on two dimensions, task focus and affective quality, and children's subsequent depression and school behavior; academic performance was related only to affective quality of interaction. Chronic stress was predictive of more negative, critical maternal behavior, whereas depressed mood was associated with less task involvement. Maternal interactions are viewed as a marker of a complex, mutual process involving interpersonal relationships in an adverse environmental context.

Timing of mother and child depression in a longitudinal study of children at risk

Temporal associations of diagnoses in mothers and children were examined in a 3-year longitudinal study of unipolar, bipolar, and comparison women and their 8- to 16-year-old offspring. There was a significant temporal association between mother and child diagnoses, especially in unipolar families, and most children who experienced a major depressive episode did so in close proximity to maternal depression. Regression analyses indicated that children's own stressful life events, maternal disorder, and the interaction of the two significantly predicted children's changes in depression. Children exposed to high stress but with nonsymptomatic mothers were significantly less depressed subsequent to stressors than those who also had symptomatic mothers. The results are discussed in terms of the reciprocal, interpersonal context of depression.