Preadolescent clues to understanding depression in girls

The impact of early alleged maltreatment on behavioral trajectories

OBJECTIVE

The purpose of this research was to examine the impact of alleged early child maltreatment (before age 4) on the trajectory patterns of 3 different behavioral outcomes (anxiety/depression, aggression, and attention problems) through age 10.

METHODS

Two hundred forty-two children and their primary caregivers were assessed as part of a longitudinal study. One hundred fifty-four of these children had an early history of alleged maltreatment and 88 did not; these 2 groups were compared. Child behavioral outcomes were assessed at ages 4, 6, 8, and 10 using the Child Behavior Checklist. Growth modeling was used to assess the association between early alleged maltreatment and subsequent behavioral outcomes.

RESULTS

Early alleged maltreatment significantly predicted subsequent trajectories of two forms of behavioral problems: anxiety/depression and attention problems. In both cases, early alleged maltreatment was associated with significantly steeper increases in the behavioral problems over time. There was no significant effect on the trajectory of aggression.

CONCLUSIONS

Although there were no differences between children with and without an allegation of maltreatment in early behavioral assessments, differences in anxiety/depression and attention problems emerged and grew more pronounced over time. Thus, alleged maltreatment is not simply associated with negative behavioral outcomes at particular points in time, but with a persistent pattern of behavioral dysfunction.

PRACTICE IMPLICATIONS

Behavioral problems in response to maltreatment may emerge over time. Thus, children who are alleged to be maltreated would benefit from ongoing assessments, with quality behavioral health services available if they are needed.

Comorbidity of Anxiety and Depression in Youth: Implications for Treatment and Prevention

The high level of concurrent and sequential comorbidity between anxiety and depression in children and adolescents may result from (a) substantial overlap in both the symptoms and items used to assess these putatively different disorders, (b) common etiological factors (e.g., familial risk, negative affectivity, information processing biases, neural substrates) implicated in the development of each condition, and (c) negative sequelae of anxiety conferring increased risk for the development of depression. Basic research on their various common and unique etiological mechanisms has guided the development of efficacious treatments for anxiety and depressive disorders in youth. Potential processes through which the successful treatment of childhood anxiety might prevent subsequent depression are described.

Co-occurring problems of early onset persistent, childhood limited, and adolescent onset conduct problem youth

BACKGROUND

It is increasingly recognized that youth who follow early onset persistent (EOP), childhood limited (CL) and adolescent onset (AO) trajectories of conduct problems show somewhat varying patterns of risk (in childhood) and adjustment problems (in adolescence and adulthood). Little, however, is known about how other adjustment problems differentially co-develop with the EOP, CL and AO trajectories across the childhood and adolescent years.

METHOD

Using data from the Avon Longitudinal Study of Parents and Children, an epidemiological, longitudinal cohort of boys and girls, we estimated growth curves for parent-reported hyperactivity, emotional difficulties, peer relational problems, and prosocial behaviors conditional on trajectories of conduct problems (i.e., EOP, CL and AO) from ages 4 to 13 years. At ages 7-8 years, DSM-IV-based diagnoses of conduct disorder, oppositional-defiant disorder, attention deficit/hyperactivity disorder (ADHD), anxiety, depression were examined by conduct problems trajectory.

RESULTS

Overall, the development of hyperactivity, emotional difficulties, peer relational problems, and prosocial behaviors mirrored the development of conduct problems, showing similar trajectories.

CONCLUSIONS

Results indicated that the problems of EOP youth were persistent across domains, CL youth showed decreased behavior problems while increasing in prosocial behaviors, and AO youth increased in adjustment problems after 10 years of age.

Lack of assertion, peer victimization, and risk for depression in girls: testing a diathesis-stress model

PURPOSE

To apply a diathesis × stress model to testing the association between peer victimization and depression in a sample of preadolescent girls.

METHODS

DSM-IV symptoms of depression symptoms were measured at ages 9 and 11, assertiveness and peer victimization were assessed by youth report at age 9.

RESULTS

The interaction of low levels of assertiveness and high peer victimization at age 9 was predictive of depression symptoms at age 11, controlling for earlier depression symptoms.

CONCLUSIONS

The results extend the published data on peer relations and depression by identifying a group of girls who may be particularly vulnerable to the stress of negative peer interactions.

The role of culture, family processes, and anger regulation in Korean American adolescents' adjustment problems

Using an ecologically informed, developmental psychopathology perspective, the present study examined contextual and intrapersonal predictors of depressive symptoms and externalizing problems among Korean American adolescents. Specifically, the role of cultural context (self-construals), family processes (family cohesion and conflict), and anger regulation (anger control, anger suppression, and outward anger expression) were examined. Study participants were N = 166 Korean American adolescents ranging from 11 to 15 years old (M = 13.0, SD = 1.2). Results showed that depressive symptoms were significantly associated with lower levels of perceived family cohesion, higher levels of perceived family conflict intensity, and higher levels of anger suppression. Externalizing problems were associated with male gender, a weaker interdependent self-construal, higher levels of perceived family conflict, lower levels of anger control, and higher levels of outward anger expression. The distinction between specific versus common factors associated with depressive symptoms and externalizing problems was discussed with an eye toward prevention or intervention strategies targeting specific coping mechanisms (e.g., generating alternatives to anger suppression) or developing psychoeducational approaches to facilitate family processes.

The Pittsburgh Girls Study: overview and initial findings

The Pittsburgh Girls Study is a longitudinal, community-based study of 2,451 girls who were initially recruited when they were between the ages of 5 and 8 years. The primary aim of the study was testing developmental models of conduct disorder, major depressive disorder, and their co-occurrence in girls. In the current article, we summarize the published findings from the past 5 years of the PGS and place those results in the context of what it known to date about developmental psychopathology in girls. Key results suggest that DSM-IV mental disorders tend to have an insidious onset often beginning with subsyndromal symptom manifestation, and that there appear to be shared and unique developmental precursors to disorder in subgroups of girls based on race and poverty.

Corumination, interpersonal stress generation, and internalizing symptoms: accumulating effects and transactional influences in a multiwave study of adolescents

This multiwave longitudinal study investigated potential transactional and accumulating influences among corumination, interpersonal stressors, and internalizing symptoms among a sample of early and middle adolescents (N = 350; 6th-10th graders). Youth completed self-report measures of corumination at Times 1, 2, and 4, and negative life events, internalizing symptoms (general depressive, specific anhedonic depressive, anxious arousal, general internalizing), and externalizing problems at all four time points (5 weeks between each assessment across 4 months). Results supported hypotheses. First, baseline corumination predicted prospective trajectories of all forms of internalizing symptoms but not externalizing problems. Second, baseline corumination predicted generation of interpersonal-dependent, but not interpersonal-independent or noninterpersonal stressors. Third, interpersonal-dependent events partially mediated the longitudinal association between baseline corumination and prospective internalizing symptoms. Fourth, a transactional, bidirectional set of associations was supported in that initial internalizing symptoms and stressors predicted later elevations in corumination, and in turn, corumination predicted later symptoms through the mediating role of interpersonal stressors to complete both streams in the transactional chain of influence. Fifth, girls and older adolescents exhibited higher corumination, but neither age nor sex moderated any associations. These findings are discussed within a transactional, developmental cascade model.

Emotional arousal in cocaine exposed toddlers: prediction of behavior problems

Prenatal cocaine exposure (PCE) may be associated with alterations in children's developing emotional arousal and regulation systems.

OBJECTIVE

We examined emotional responses to a frustrating task and subsequent behavior problems in 225 2 1/2 year olds (129 Prenatally Cocaine and Other Drug Exposed [PCE], 30 Non Cocaine but other drug Exposed [NCE], 66 Non Drug Exposed [NDE]).

METHOD

Children's behaviors in a frustrating toy wait task at age 2 1/2 were coded for emotional arousal and regulation behaviors.

RESULTS

Findings indicated a trend for PCE toddlers to show greater agitated emotional arousal than NCE and NDE toddlers. Further, PCE boys made more references to their caregivers in the task than NDE boys. Higher agitated arousal at age 2 1/2 years was related to greater decreases in externalizing behaviors through age 5 1/2 years.

CONCLUSION

Findings suggest a link between cocaine exposure and emotional arousal and regulation and highlight the need to understand complex relations between emotion and risk for later psychopathology in exposed youth.

Respiratory sinus arrhythmia reactivity predicts emotion regulation and depressive symptoms in at-risk and control children

We examined respiratory sinus arrhythmia (RSA), emotion regulation (ER), and prospective depressive symptoms in children at risk for depression and controls. Of the 65 children (35 boys; 5-13 years) in the sample, 39 had a parent with childhood-onset mood disorder and 26 had a parent with no history of major psychiatric disorder. RSA during pre- and post-film baselines and RSA reactivity to sad film clip were measured. Later, children's ER responses (focusing on sad/distressing affect) were assessed using a parent-reported questionnaire, and depressive symptoms were measured via clinical ratings. Results indicated that, compared to the initial baseline, a greater decrease in RSA (i.e., more vagal withdrawal) in response to the sad film clip predicted more adaptive ER responses and lower levels of clinician-rated depressive symptoms. However, tests for ER as a mediator of the association between RSA reactivity and depressive symptoms were precluded because maladaptive, but not adaptive, ER was associated with depressive symptoms. Overall, results suggest that cardiac vagal withdrawal (a greater decrease in RSA) in response to an emotional stimulus reflects more adaptive parasympathetic activity, which could facilitate children's ability to effectively manage their sadness and distress and predict lower risk of depressive symptoms over time.

Longitudinal associations between emotion regulation and depression in preadolescent girls: moderation by the caregiving environment

Identifying childhood precursors for depression has been challenging and yet important for understanding the rapid increase in the rate of depression among adolescent girls. This study examined the prospective relations of preadolescent girls' emotion regulation and parenting style with depressive symptoms. Participants were 225 children and their biological mothers recruited from a larger longitudinal community study. Girls' observed positive and negative emotion during a conflict resolution task with mothers, their ability to regulate sadness and anger, and their perception of parental acceptance and psychological control were assessed at age 9. Depressive symptoms were assessed by self-report at ages 9 and 10. The results indicated interactions between child emotion characteristics and parenting in predicting later depression. Specifically, low levels of positive emotion expression predicted higher levels of depressive symptoms in the context of moderate to high parental psychological control. Low levels of sadness regulation were predictive of high levels of depressive symptoms in the context of low to moderate parental acceptance. Findings from this study support the hypothesis that the prospective association between vulnerabilities in emotion regulation and depression are moderated by the caregiving environment.

Equanimity to excess: inhibiting the expression of negative emotion is associated with depression symptoms in girls

Emotion dysregulation is often invoked as an important construct for understanding risk for psychopathology, but specificity of domains of emotion regulation in clinically relevant research is often lacking. In the present study Gross' (2001) model of emotion regulation is used to generate hypotheses regarding the relative contribution of two specific types of deficits in emotion regulation, inhibited and disinhibited expression of negative emotion, to individual differences in depressive symptoms in preadolescent girls. A sample of 232 9-year-old girls was recruited from a community based study. Depression symptoms were assessed via diagnostic interview. The mother and interviewer rated the girl's level of impairment. Questionnaires and observations were used to assess inhibited and disinhibited expression of negative emotion. Differences in inhibited expression of negative emotion typically explained more variance in depressive symptoms and impairment across informants than did disinhibited expression of negative emotion. Although disinhibited expression of negative emotion is associated with depression and impairment, inhibited expression appeared to be a necessary ingredient, suggesting that inhibited expression may be a particularly relevant deficit in emotion regulation in the development of depression in females.

Gender, Anxiety, and Depressive Symptoms: A Longitudinal Study of Early Adolescents

Does anxiety lead to depression more for girls than for boys? This study prospectively examines gender differences in the relationship between anxiety and depressive symptoms in early adolescence. One hundred thirteen 11- to 14-year-old middle school students complete questionnaires assessing depressive symptoms and three dimensions of anxiety (worry and oversensitivity, social concerns and concentration, and physiological anxiety) as well as total anxiety symptoms at an initial assessment and 1 year later. Total anxiety and worry and oversensitivity symptoms are found to predict later depressive symptoms more strongly for girls than for boys. There is a similar pattern of results for social concerns and concentration symptoms, although this does not reach statistical significance. Physiological anxiety predicts later depressive symptoms for both boys and girls. These findings highlight the importance of anxiety for the development of depression in adolescence, particularly worry and oversensitivity among girls.

Disorders of childhood and adolescence: gender and psychopathology

Early-onset disorders (e.g., conduct problems, autism) show a marked male preponderance, whereas adolescent-onset disorders (e.g., depression, anxiety) show a marked female preponderance. A developmental psychopathology framework provides a means to investigate complex gender-related etiologies of these different disorders. This review focuses on biological and environmental factors implicated in the development of conduct problems and depression in boys and girls. Boys and girls showed certain differences in types, rates, comorbidities, antecedents, correlates, and trajectories of these problems. Origins of male and female preponderant problems are likely to be rooted, in part, in biological, physical, cognitive, and social-emotional differences in boys and girls that can precede the expression of clinical problems. These male-like and female-like characteristics are considered regarding conduct problems and depression to explore how they inform biological and environmental theories about gender and psychopathology. At the same time, because boys and girls also show many similarities, it is important to avoid sex-stereotyping mental health problems.

Empathic accuracy and adolescent romantic relationships

Although theoretical insights suggest that empathic accuracy should emerge to play a role in adolescents' romantic relationships, the nature of any such role remains unknown. The current study examined whether empathic accuracy: (1) was developmentally based, (2) differed across gender, and (3) was associated with adolescents' satisfaction with their romantic relationships. Participants were 204 male-female couples who ranged between 14 and 21 years of age and had been dating between 4 weeks and 5 years. On average, both male and female adolescents showed high levels of empathic accuracy that were positively associated with their own and their partners' relationship satisfaction. However, the direction of the associations that emerged, and gender differences in them, depended in part on the type of information being perceived. For instance, while both males' and females' accuracy for discomfort and conflict were positively associated with partners' satisfaction, males'-but not females'-accuracy for connection was negatively associated with their satisfaction, and females'-but not males'-accuracy for persuasion was positively associated with partners' satisfaction. Empathic accuracy was not significantly associated with age or relationship length. Taken together, these results reveal that a complete picture of empathic accuracy requires research on perceptions of various types of information.

Cognitive vulnerability-stress model of depression during adolescence: investigating depressive symptom specificity in a multi-wave prospective study

Depression commonly co-occurs with anxiety and externalizing problems. Etiological factors from a central cognitive theory of depression, the Hopelessness Theory (Abramson et al. Psychological Review, 96, 358-372, 1989), were examined to evaluate whether a negative inferential style about cause, consequence, and self interacted with stressors over time to predict prospective elevations in depressive symptoms specifically compared with typically co-occurring symptoms. Negative inferential style was assessed at baseline in a sample of early and middle adolescents (N = 350, sixth to tenth graders). Measures of general depressive, anhedonic depressive, anxious arousal, general internalizing, and externalizing symptoms and occurrence of stressors were assessed at four time points over a 5-month period. Results using hierarchical linear modeling show that a negative inferential style interacted with negative events to predict prospective symptoms of general and anhedonic depression specifically but not anxious arousal, general internalizing or externalizing symptoms. Negative events predicted prospective elevations of symptoms of anxious arousal, internalizing, and externalizing problems.

Callous-unemotional behaviors in young girls: shared and unique effects relative to conduct problems

Among girls, little is known about the shared and unique associations that callous-unemotional (CU) behaviors and conduct problems have with aspects of emotional and behavioral dysregulation and with parenting practices. This study examined these associations using a large community-based sample of young girls (N = 990). The findings revealed that hyperactivity-impulsivity and negative emotionality were positively and uniquely associated with conduct problems, but not with CU behaviors, after controlling for co-occurring conduct problems. Conduct problems were also positively associated with both generalized anxiety and panic/somatic anxiety. In contrast, CU behaviors were negatively related to generalized anxiety problems after controlling for co-occurring conduct problems. The results also indicated that conduct problems were more closely associated with harsh punishment and low parental warmth among girls with low versus high CU behaviors.

Using an emotion regulation framework to understand the role of temperament and family processes in risk for adolescent depressive disorders

Although recent evidence implicates the importance of the family for understanding depressive disorders during adolescence, we still lack a coherent framework for understanding the way in which the myriad of developmental changes occurring within early adolescents and their family environments actually operate to increase adolescents' vulnerability to, or to protect them from, the development of depressive disorders. In this review we propose a framework that places the mechanisms and processes of emotion regulation at the centre of these questions. We argue that emotion regulation can provide an organising rubric under which the role of various factors, such as adolescent and parent temperament and emotion regulation, and parental socialization of child emotion, as well as the interaction amongst these factors, can be understood to account for the role of the family in adolescents' risk for depression. In particular, we posit that adolescent emotion regulation functions as a mechanism through which temperament and family processes interact to increase vulnerability to developing depression.

Adolescent Prosocial Behavior: The Role of Self-Processes and Contextual Cues

Peer- and teacher-reported prosocial behavior of 339 6th-grade (11-12 years) and 8th-grade (13-14 years) students was examined in relation to prosocial goals, self-processes (reasons for behavior, empathy, perspective taking, depressive affect, perceived competence), and contextual cues (expectations of peers and teachers). Goal pursuit significantly predicted prosocial behavior, and goal pursuit provided a pathway by which reasons for behavior were related to behavior. Reasons reflected external, other-focused, self-focused, and internal justifications for behavior; each reason was related to a unique set of self-processes and contextual cues. Associations between prosocial outcomes and sex and race (Caucasian and African American) were mediated in part by self-processes and contextual cues. The implications of studying prosocial behavior from a motivational perspective are discussed.