Gender differences in the developmental course of depression

BACKGROUND

There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults.

METHODS

Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N=773) during adolescence (age 14 to 17) and at age 30.

RESULTS

Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females.

LIMITATIONS

The sample was from a single region of the country and consisted mostly of White adolescents.

CONCLUSIONS

Childhood depression may be a more serious risk factor for girls than for boys.

Delineation of differential temporal relations between specific eating and anxiety disorders

This study examined the temporal sequencing of eating and anxiety disorders to delineate which anxiety disorders increase eating disorder risk and whether individuals with eating disorders are at greater risk for particular anxiety disorders. The sample was drawn from the Oregon Adolescent Depression Project. Temporal relations between specific eating and anxiety disorders were examined after controlling for relevant variables (e.g., mood disorders, other anxiety disorders) over 14 years. After excluding those with anorexia nervosa (AN) in adolescence (T1), OCD was the only T1 anxiety disorder to predict AN by age 30 (T4). No T1 anxiety disorder was associated with T4 bulimia nervosa (BN). Although T1 AN did not increase risk of any T4 anxiety disorder, T1 BN appeared to increase risk for social anxiety and panic disorders. Evidence that eating disorders may have differential relations to particular anxiety disorders could inform prevention and treatment efforts.

Latent trajectory classes of depressive and anxiety disorders from adolescence to adulthood: descriptions of classes and associations with risk factors

This study used person-oriented analyses to identify subgroups of individuals who exhibit different patterns of depressive and anxiety disorders over the course of adolescence and young adulthood. Using latent class growth analysis, six trajectory classes were identified. Two classes were mainly characterized by depressive disorders; one class was mainly characterized by anxiety disorders; two classes were characterized by temporally different patterns of comorbidity; and one class was characterized by the absence of psychopathology. Classes characterized largely by depressive disorders differed in persistence and degree of comorbidity with anxiety disorders. Classes that were characterized by anxiety disorders differed in persistence, age of onset, and constellation of specific anxiety disorders. Female participants were more likely to belong to classes characterized by fluctuations in the course of depressive and anxiety disorders; sex differences were not observed in classes characterized by persistent depressive and anxiety disorders. Offspring of parents with depression were more likely to have a depressive course, whereas offspring of parents with anxiety disorders tended to have a course characterized by anxiety disorder. The findings indicate that several subgroups of adolescents exist with distinct longitudinal trajectories of depressive and anxiety disorders, and these trajectory classes are associated with different risk factors.

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed.

Subthreshold conditions as precursors for full syndrome disorders: a 15-year longitudinal study of multiple diagnostic classes

BACKGROUND

There has been increasing interest in the distinction between subthreshold and full syndrome disorders and specifically whether subthreshold conditions escalate or predict the onset of full syndrome disorders over time. Most of these studies, however, examined whether a single subthreshold condition escalates into the full syndrome form of that disorder. Equally important, though, is whether subthreshold conditions are likely to develop other full syndrome disorders and whether these associations are maintained after adjusting for comorbidity.

METHODS

A 15-year longitudinal study of subthreshold psychiatric conditions was conducted with 1,505 community-drawn young adults. We examined whether 1) subthreshold major depression, bipolar, anxiety disorders, alcohol use, substance use, conduct disorder and/or ADHD were precursors for the corresponding (homotypic) full syndrome disorder; 2) subthreshold conditions were precursors for other (heterotypic) full syndrome disorders; and 3) these homotypic and heterotypic precursors persisted after adjusting for comorbidity.

RESULTS

Subthreshold major depression, anxiety, alcohol use, substance use, and conduct all escalated into their corresponding full syndrome and nearly all homotypic developments were maintained after adjusting for comorbid subthreshold and full syndrome conditions. Many heterotypic associations were also observed and most remained after controlling for comorbidity, particularly among externalizing disorders (e.g., alcohol, substance, conduct/antisocial personality disorder).

CONCLUSIONS

Many subthreshold conditions have predictive validity as they may represent precursors for full syndrome disorders. Alternatively, dimensional conceptualizations of psychopathology which include these more minor conditions may yield greater validity. Subthreshold conditions may represent good targets for preventive interventions.

The long-term course of depression: development of an empirical index and identification of early adult outcomes

BACKGROUND

Research on the long-term course of major depressive disorder (MDD) is hindered by the absence of established course criteria and by idiosyncratic definitions of chronicity. The aims of this study were to derive an empirical index of MDD course, to examine its predictive validity, and to identify the adulthood outcomes associated with a chronic course.

METHOD

Indicators for a MDD course factor were rationally selected and subjected to principal components (PCA) and confirmatory factor analyses (CFA) among 426 subjects with a lifetime history of MDD by age 30. Scores on the index prior to age 19 were examined as predictors of course from age 19 to 30. Associations between the index and outcomes of interest at age 30 were examined.

RESULTS

Three indicators loaded highly on a chronic course index and displayed adequate internal consistency: early onset age, number of episodes, and duration of ill time. Predictive validity of the index was supported. A more chronic course was associated with greater symptom severity, greater likelihood of treatment utilization, and greater psychosocial impairment in multiple domains. Treatment utilization interacted with chronicity to predict relatively few outcomes and did not reduce the negative impact of a chronic course.

CONCLUSIONS

The course of MDD through early adulthood is best represented by a composite of early onset age, number of episodes, and duration of ill time. A chronic course through early adulthood is associated with numerous indicators of psychosocial impairment. Mental health treatment utilization in a naturalistic setting does not appear to reduce the negative impact of chronic MDD.

Characterizing major depression phenotypes by presence and type of psychomotor disturbance in adolescents and young adults

Major depressive disorder (MDD) is phenomenologically heterogeneous, which has prompted investigation of intermediate MDD phenotypes based on specific key symptoms. Presence and type of psychomotor disturbance may be an important psychopathologic feature that differentiates clinically distinct forms of juvenile MDD. This study examined the phenotypic status of three putative MDD phenotypes in a community sample of 941 youths: (1) agitated depression (MDD with psychomotor agitation), (2) retarded depression (MDD with psychomotor retardation), and (3) agitated-retarded depression (MDD with psychomotor agitation and retardation within an episode). Hasler et al.'s [2004: Neuropsychopharmacology 29:1765-1781] criteria of specificity (degree of association with relevant symptoms and conditions related to the disease of interest versus other psychiatric conditions), stability (degree of stability over time), and heritability (degree of familial aggregation with relevant conditions) were used to evaluate the phenotypic significance of these subtypes. Results were suggestive that agitated depression was a relatively specific phenotypic syndrome characterized by irritability, arousal, physical complaints, and vulnerability to anxiety disorders and alcohol dependence; low stability across depressive episodes; and low heritability. Agitated-retarded depression was relatively specific and characterized by increased severity, recurrence, vegetative symptoms, suicidal ideation, social impairment, endogeneity, and vulnerability to anxiety disorders and bulimia; low stability across episodes; and modest heritability. Although retarded depression was associated with some specific distinguishing characteristics, most associations were explained by the increased severity of this phenotype. Retarded depression evidenced little stability or heritability. These findings offer partial support of the phenotypic status of agitated and agitated-retarded depression in youths.

Intergenerational transmission of internalizing problems: effects of parental and grandparental major depressive disorder on child behavior

Effects of lifetime histories of grandparental (G1) and parental (G2) major depressive disorder (MDD) on children's (G3) internalizing problems were investigated among 267 G3 children (ages 2-18 years) who received Child Behavior Checklist (CBCL) ratings and had diagnostic data available on 267 biological G2 parents and 527 biological G1 grandparents. Results indicated that G1 MDD conferred risk for G2 MDD, but not for G3 CBCL scores. G2 MDD predicted higher G3 Internalizing and Anxious/Depressed scores. Also, there was an interaction between G1 MDD and G2 MDD in predicting higher G3 Anxious/Depressed scores such that scores were highest among children with both depressed parents and grandparents. These effects were robust to statistical adjustments for status variables and parental relationship measures but not to adjustment for concurrent parental depressive symptoms.

Development and psychometric evaluation of the pleasant activities list

This paper describes the development of a new 139-item behavioral questionnaire (PAL) assessing the frequency and enjoyability of pleasant activities occurring in the natural environment of patients with substance use disorders. The sample consisted of 265 patients with mainly substance use disorders and 272 healthy controls. Group comparisons indicated that patients reported lower frequency, enjoyability, and cross-product activity scores than controls. This study confirms previous findings that addiction is associated with a decreased level of engagement in pleasant activities. The PAL seems to be a standardized, feasible, and valid instrument to sample non-substance-related rewarding activities in patients' everyday lives.

Implications of the DSM's emphasis on sadness and anhedonia in major depressive disorder

At least five symptoms must occur for a DSM diagnosis of major depressive disorder (MDD), one of which must be sadness or anhedonia. The present study is the first known investigation of the implications of the presence or absence of these prioritized symptoms on symptom expression and clinical characteristics among 564 young adults with MDD. Differences in symptom expression and clinical characteristics occurred among MDD participants with sadness relative to those without sadness as well as among MDD participants with anhedonia relative to those without anhedonia. Differential symptom expression could have important implications for the etiology, prevention, and treatment of MDD.

Prospective relations between melancholia and substance use disorders

Examining associations between subtypes of major depressive disorder (MDD) and substance use disorders (SUDs) might elucidate mechanisms of comorbidity between MDD and SUDs. This study evaluated prospective relations between SUDs and melancholic MDD. A cohort of community-dwelling participants with lifetime history of MDD (N = 460) were assessed for DSM-IV mental disorders using structured clinical interviews at ages 24 and 30. Stimulant use disorders and melancholic MDD were prospective risk factors for each other over the 6-year-period following the age-24 assessment. Associations were robust when controlling for clinical severity/chronicity. Alcohol and cannabis use disorders were not robustly associated with melancholia.

Association between the Center for Epidemiologic Studies Depression Scale (CES-D) and mortality in a community sample: An artifact of the somatic complaints factor?

Most previous studies of the depression-mortality association have not examined distinct depressive symptom clusters. This ex post facto study examined which aspects of depression may account for its association with mortality. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 3,867 community dwelling adults. Cox proportional hazards procedures estimated the risk of mortality as a function of depression status and each of 4 CES-D factor scores. Depressed participants (CES-D ≥ 16) had a 1.23-fold higher risk of mortality (95% CI 1.03-1.49), adjusting for sociodemographics. Somatic Complaints (SC) was the only factor to predict mortality (HR 1.19, 95% CI 1.03-1.38). After excluding SC, CES-D scores no longer predicted mortality (HR .98, 95% CI .79-1.21). The association between CES-D depressive symptoms and mortality appears to be a function of the SC factor. The association between non-somatic depressive symptoms and mortality may not be as robust as past findings suggest.

Longitudinal associations between depressive and anxiety disorders: a comparison of two trait models

BACKGROUND

Depression and anxiety are highly co-morbid disorders. Two latent trait models have been proposed to explain the nature of the relationship between these disorders. The first posits that depressive and anxiety disorders are both manifestations of a single internalizing factor. The second model, based on a tripartite model proposed by Clark & Watson [Journal of Abnormal Psychology (1991) 100, 316-336], proposes that depressive and anxiety disorders reflect a combination of shared and disorder-specific factors.

METHOD

We directly compared the two models in a sample of 891 individuals from the Oregon Adolescent Depression Project who participated in up to four diagnostic assessments over approximately 15 years. Structural equation models were used to examine the relationship between depressive and anxiety disorders across different developmental periods (<14, 14-18, 19-23, 24-30 years of age).

RESULTS

The one- and three-factor models were hierarchically related. Thus, a direct comparison between the one- and three-factor models was possible using a chi2 difference test. The result found that the three-factor model fit the data better than the one-factor model.

CONCLUSIONS

The three-factor model, positing that depressive and anxiety disorders were caused by a combination of shared and disorder-specific factors, provided a significantly better fit to the data than the one-factor model postulating that a single factor influences the development of both depressive and anxiety disorders.

Family study of subthreshold psychopathology in a community sample

BACKGROUND

There has been increasing interest in the validity and familial transmission of subthreshold psychiatric conditions and the relationship between subthreshold conditions and full syndrome (FS) disorders. However, most of these studies examined a single subthreshold condition and thus fail to take into account the high co-morbidity among subthreshold conditions and between subthreshold conditions and FS disorders.

METHOD

A family study of subthreshold psychiatric conditions was conducted with 739 community-drawn young adults and their 1744 relatives. We examined (1) whether relatives of probands with subthreshold major depression, bipolar disorder, anxiety disorders, alcohol use, substance use, and/or conduct disorder exhibited an increased rate of the corresponding (homotypic) FS disorder; (2) whether subthreshold disorders were associated with increased familial rates of other (heterotypic) FS disorders; (3) whether subthreshold and FS conditions are associated with similar familial liabilities; and (4) whether these homotypic and heterotypic associations persisted after controlling for co-morbidity.

RESULTS

Significant homotypic associations were observed for subthreshold anxiety, alcohol, conduct, and a trend was observed for major depression. Only the homotypic association for alcohol and conduct remained after controlling for co-morbid subthreshold and FS conditions. Many heterotypic associations were observed and most remained after controlling for co-morbidity.

CONCLUSIONS

It is important to broaden the study of subthreshold psychopathology to multiple disorders. In particular cases, controlling for co-morbidity with other subthreshold and FS conditions altered the patterns of familial aggregation. Etiological processes that are common to particular disorders and subthreshold conditions are discussed.

Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence.

Psychosocial functioning of adults who experienced substance use disorders as adolescents

The authors examined whether substance use disorder (SUD) before age 19 was associated with functioning at age 30. Participants (N = 773) were assessed twice during adolescence and at ages 24 and 30. Eight of 14 adult measures were associated with adolescent SUD: education, unemployment, income, risky sexual behavior, suicide attempt, coping, stressful life events, and global adjustment. After adolescent comorbidity and functioning and adult SUD were controlled for, education and unemployment remained associated, and three variables emerged as significant: being a parent (significant only for participants without adult SUD), being currently married, and having decreased life satisfaction (significant only for participants with adult SUD). Adolescent SUD is associated with numerous functioning difficulties at age 30, some of which appear to be related to recurrent SUD, comorbid adolescent disorders, or functioning problems already evident in adolescence.

Mixed anxiety depression: taxometric exploration of the validity of a diagnostic category in youth

BACKGROUND

Mixed anxiety depression (MAD) is a provisional diagnosis in the DSM-IV. This study determined whether MAD represents a discrete category thereby evaluating the validity of MAD as a diagnostic entity.

METHODS

Taxometric analyses and mixture modeling were used to discern whether MAD indicators constitute a distinct psychopathological category (i.e., a taxon) in a large school-based sample of adolescents (N=706).

RESULTS

Each taxometric procedure (MAXCOV, MAMBAC) identified a taxon with a prevalence of 13%+/-2%. A non-taxometric procedure (multivariate mixture modeling) also supported the existence of a taxon with a prevalence of 12%. Bootstrapping procedures were used to construct a measure of MAD (i.e., MAD-T). Scale construction suggested that MAD may be best represented by 12 criteria that largely overlap with the DSM-IV, though some modifications were suggested. Examination of the construct validity of the MAD taxon indicated that it is associated mood and anxiety symptoms. Taxon membership was predictive of the development of mood and anxiety disorders over a 14-month longitudinal follow-up.

LIMITATIONS

This category should be studied in other populations including adult samples.

CONCLUSIONS

MAD appears to be a viable diagnostic category for youth though it is recommended that future revisions of the DSM emphasize somewhat different criteria for this diagnosis.

Major depressive disorder in adolescence: the role of subthreshold symptoms

OBJECTIVE

To examine the longitudinal association between individual subthreshold symptoms and onset of major depressive disorder (MDD) in adolescence.

METHOD

Data for analysis come from the Oregon Adolescent Depression Project, a prospective epidemiological study of psychological disorders among adolescents, ages 14 to 18 years, from the general community. A total of 1,709 adolescents completed the initial diagnostic assessments between 1987 and 1989 (T1) and approximately 1 year later (T2), 1,507 adolescents returned for readministration of assessments (88% response).

RESULTS

After controlling for history of depression and gender, seven of the nine DSM-III-R symptoms of depression predicted MDD incidence when tested in separate models. Endorsement of each symptom at T1 increased the likelihood of MDD incidence between T1 and T2. A summary model that included the seven DSM-III-R symptoms as predictors was significant, with sad mood contributing unique variance to the prediction of MDD onset (odds ratio = 2.01).

CONCLUSIONS

These findings suggest that much of the variance is shared among symptom predictors and the co-occurrence of symptoms is what constitutes the greatest risk. Moreover, the presence of sad mood contributes additional unique variance to prediction and supports the centrality of depressed mood to MDD.

Sibling similarity for MDD: evidence for shared familial factors

BACKGROUND

Sibling designs have the potential to identify familial factors that are shared and unshared between siblings. Unfortunately, this methodology has rarely been applied to mood disorders.

METHODS

The current study uses the original participants from the Oregon Adolescent Depression Project (OADP) and their closest-aged sibling to investigate familial influences on sibling similarity and differences for psychopathology. Diagnostic interviews were conducted with the original participants on three occasions and with full siblings and biological parents at the time of the third assessment.

RESULTS

Maternal major depressive disorder (MDD) was associated with sibling similarity for MDD and anxiety disorders, and maternal anxiety disorder was associated with sibling similarity for MDD. A number of maternal and paternal disorders were associated with sibling differences for psychopathology. The data suggest that maternal MDD and anxiety disorder have a greater influence than paternal MDD and anxiety disorder in influencing sibling similarity for MDD.

LIMITATIONS

Original participants were assessed on up to three occasions while their siblings were assessed only once.

CONCLUSIONS

Maternal MDD and anxiety disorder appear to act as shared familial risk factors with respect to sibling MDD. In addition, parental psychopathology has non-shared influences on sib-pairs. Future research should assess differential parental treatment and individual sibling characteristics as additional factors that may influence sibling similarity and differences in psychopathology.

A taxometric investigation of unipolar depression in a large community sample

BACKGROUND

The question of whether unipolar clinical depression differs categorically from limited depressive complaints has important implications for the disorder's assessment, treatment and research. This crucial issue has proven difficult to resolve, in part because many studies to date have relied on self-report measures or on clinically homogeneous samples. We therefore applied Meehl's taxometric method to a large, clinically heterogeneous sample, and examined the latent structure of depressive episodes using both self-report and structured clinical interview data.

METHOD

Data were derived from the Oregon Adolescent Depression Project, a large longitudinal community study. All analyses involved more than 1400 participants. MAXEIG (MAXimum EIGenvalue) and base rate estimation were performed separately for Beck Depression Inventory (BDI) items and for DSM-IV-based major depressive episode (MDE) symptoms.

RESULTS

MAXEIG analyses of the BDI and MDE indicator sets appeared to converge on a taxonic structure for unipolar depression. Base rate estimates overall implied a latent depressive episode class that occurs more frequently than diagnosable MDEs but less frequently than persistent depressed or anhedonic mood.

CONCLUSIONS

These findings provide tentative support for a categorical conceptualization and make it very clear that the continuity controversy regarding unipolar depression has not yet been decided in favor of dimensionality. To reconcile the conflicting reports to date, several data analytic and sampling issues need to be explored systematically.

Propagation of major depressive disorder: relationship between first episode symptoms and recurrence

Major depressive disorder is a highly recurrent disorder, with long-term estimates of recurrence ranging as high as 80%. The impact of first episode depressive symptoms on later recurrence has not been previously examined. The present study sought to identify risk factors for recurrent major depressive episodes by investigating first episode symptoms. It was predicted that the presence of depressed mood and sleep disturbance in the first episode would increase the likelihood of recurrence. Four hundred eighty-seven randomly selected community participants who met DSM-III-R criteria for at least one major depressive episode were assessed twice during adolescence and once in young adulthood. We examined the association between first major depressive episode symptoms and the presence of a recurrent episode. Recurrence was significant predicted by the presence of depressed mood and increased appetite at episode 1. A nonsignificant trend suggested that female gender may also be associated with recurrence. First episode depressed mood, increased appetite, and female gender may serve as specific risk factors for recurrence. The centrality of depressed mood to major depressive disorder is highlighted.

Substance Use Disorder Characteristics and Externalizing Problems Among Inpatient Adolescent Smokers

Attention deficit hyperactivity disorder (ADHD) and/or conduct disorder (CD) have been found to be associated with substance use disorders and cigarette smoking among adolescents. However, studies have often failed to explore these relationships among females from a dimensional perspective, taking into account comorbidity between ADHD and CD symptomatology, and examining ADHD symptom subtypes (i.e., inattention and hyperactivity/impulsivity) separately as they relate to substance involvement and smoking characteristics. This study takes each of the above into consideration when examining the relationship between externalizing symptomatology and substance involvement characteristics in a sample of 191 (62.3% female, mean age = 15.4 years) inpatient adolescent smokers. The results of this study suggest that ADHD and CD symptoms may be related to different types of substance use characteristics. CD symptoms were associated with early onset of substance involvement and ADHD symptoms were related to alcohol and marijuana frequency. ADHD inattention symptoms, but not hyperactivity/impulsivity symptoms, were associated with marijuana and nicotine dependence. Lastly, significant interactions suggested that ADHD symptoms among boys and CD symptoms among girls were related to frequency of any type of substance use prior to inpatient hospitalization. The results of this study point to potentially important clinical implications such as tailoring prevention and intervention efforts according to type of externalizing symptomatology and gender.

Problematic eating and feeding behaviors of 36-month-old children

OBJECTIVE

We incorporated selected items from several existing instruments to create a comprehensive multifactorial instrument to measure problematic eating behaviors in young children and to examine the prevalences and correlates of these behaviors.

METHOD

A community sample of young mothers (N = 93) completed the inventory of problematic eating behaviors for their 36-month-old children.

RESULTS

The most common child problems reported by mothers were the spitting out of food during feedings and becoming upset when food was restricted. A four-factor solution identified pickiness (e.g., child eats a limited variety of food), food refusal (e.g., child refuses to eat specific foods), struggle for control (e.g., frequent struggles with child over food), and positive parental behavior (e.g., praising child about his/her food intake) domains. Internal consistency was moderate to good for all factors. Only the struggle for control factor was related to other problematic behaviors as measured by the Child Behavior Check List (CBCL). The food refusal factor was related to mothers' lifetime history of any psychopathology. The pickiness factor was related to mothers' lifetime history of alcohol dependence.

CONCLUSION

Findings suggest that child clinicians should be sensitive to the quality of mother-child interactions during feeding.

Cigarette smoking and panic attacks among young adults in the community: the role of parental smoking and anxiety disorders

BACKGROUND

The goal of the current study is to examine the association between cigarette smoking and panic attacks and panic disorder among youth and to investigate parental anxiety disorders and parental cigarette smoking in these links.

METHODS

Data were drawn from the Oregon Adolescent Depression Project (OADP) (n = 1709). Cigarette smoking and panic attacks and panic disorder were assessed at three time points from adolescence to young adulthood.

RESULTS

Daily cigarette smoking at Time 1 was associated with a significantly increased risk of panic attacks (odds ratio [OR] = 2.6 [1.3, 5.3]) and panic disorder (OR = 4.2 [2.0, 8.9]) at Time 3. After adjusting for parental anxiety disorder and parental smoking, the association between cigarette smoking and panic attack was no longer statistically significant (OR = 2.0 [.9, 4.5]), though the association between cigarette smoking and panic disorder remained (OR = 3.7 [1.6, 8.9]). The association between smoking and panic was not evident between smoking and other anxiety disorders.

CONCLUSIONS

These findings replicate previous results showing cigarette smoking in adolescence is associated with an increased risk of panic attacks and panic disorder in early adulthood and provide initial evidence that parental anxiety and parental smoking may play a role.

Parents' reports of the body shape and feeding habits of 36-month-old children: an investigation of gender differences

OBJECTIVE

The current study examined parental perception of offspring body shape, differential reporting of offspring eating behaviors by mothers and fathers, and gender-specific patterns of offspring feeding habits.

METHODS

Parents of a community sample of 36-month-old children (N = 93) completed measures regarding their offspring's feeding patterns and body shape.

RESULTS

Results revealed noteworthy correlates (e.g., concerns about their child's appetite) of parental perception of offspring weight status. They further suggested that mothers and fathers often differed in their accounts of their child's eating habits, and that parents report certain eating behaviors differently depending on the gender of their child.

CONCLUSION

Clinical and theoretical implications are discussed.