Stress generation in adolescent depression: the moderating role of child abuse and neglect

Stress exposure in at-risk, depressed, and suicidal adolescents

BACKGROUND

Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High-Risk [HR]) and without (Low-Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC).

METHOD

Study 1 included LR (n = 65) and HR (n = 22) 12- to 14-year-olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid-to-late adolescents (64 females; 73.56%), including 57 MDD youth from a short-term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies.

RESULTS

We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β = .22, CI95 = 0.01-0.42, p = .041), independent (β = .34, CI95 = 0.12-0.56, p = .003), and interpersonal (β = .23, CI95 = 0.004-0.45, p = .047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β = .62, CI95 = 0.45-0.79, p < .001) and dependent (β = .41, CI95 = 0.21-0.61, p < .001) stress than the HC group, but not independent (p = .083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17-10.70, p = .026).

CONCLUSIONS

Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course.

The Mediating Role of Rumination and Self-Regulation Between Self-Generated Stress and Psychological Well-Being

In this study, we aimed to examine the relationships between self-generated stress (SGS) and psychological well-being (PWB) and the mediating role of self-critical rumination (SCR) and self-regulation in this relationship. In this direction, the Self-Generated Stress Scale (SGSS) was adapted into Turkish in the first study. In the second study, we tested the mediating role of SCR and self-regulation in the relationship between SGS and PWB in university students. The findings showed that the Self-Generated Stress Scale is a valid and reliable measurement tool for Turkish culture and PWB and self-regulation have partial mediating roles in the relationship between SGS and PWB. These results contribute to a better understanding of the association between SGS and PWB.

Stress generation in social anxiety and depression: A two-study community assessment

BACKGROUND

Stress generation theory suggests that people engage in certain behaviors that causally generate "dependent" stressful life events. Stress generation has primarily been studied in the context of depression with limited consideration of anxiety. People with social anxiety exhibit maladaptive social and regulatory behaviors that may uniquely generate stress.

METHOD

Across two studies, we examined if people with elevated social anxiety experienced more dependent stressful life events than those lower in social anxiety. On an exploratory basis, we examined differences in perceived intensity, chronicity, and self-blame of stressful life events. As a conservative test, we examined whether observed relationships held after covarying depression symptoms. Community adults (Ns = 303; 87) completed semi-structured interviews about recent stressful life events.

RESULTS

Participants with higher social anxiety symptoms (Study 1) and social anxiety disorder (SAD; Study 2) reported more dependent stressful life events than those with lower social anxiety. In Study 2, healthy controls rated dependent events as less impactful than independent events; those with SAD rated dependent and independent events as equally impactful. Regardless of social anxiety symptoms, participants placed greater blame on themselves for the occurrence of dependent than independent events.

LIMITATIONS

Life events interviews are retrospective and preclude conclusions about short-term changes. Mechanisms of stress generation were not assessed.

CONCLUSIONS

Results provide initial evidence for the role of stress generation in social anxiety that may be distinct from depression. Implications for assessing and treating unique and shared features of affective disorders are discussed.

Social thinning and stress generation after childhood maltreatment: a neurocognitive social transactional model of psychiatric vulnerability

Childhood maltreatment is associated with significant, enduring risk of psychiatric disorder. In this paper, we review how neurocognitive alterations after maltreatment might indirectly increase the risk of psychiatric disorder via their impact on social functioning. We propose a neurocognitive social transactional model, within which the neurocognitive sequelae of maltreatment are postulated to affect how an individual's social architecture is constructed across development, including the quality and quantity of relationships in an individual's social network. We review extant evidence in two areas in relation to maltreatment: stress generation (a process by which individuals are more likely to experience interpersonal stressor events) and social thinning (an attenuation in the number and quality of relationships over time). We consider how neurocognitive alterations could contribute to these interactive and autocatalytic social processes, which gradually impoverish an individual's actual or potential social environment and ultimately increase psychiatric risk. We conclude by considering the implications of this neurocognitive social transactional model for the prevention of psychiatric disorder after childhood maltreatment.

A Half Century of Research on Childhood and Adolescent Depression: Science Mapping the Literature, 1970 to 2019

In order to gain an in-depth understanding of research about childhood and adolescent depression, this article analyzes the scale, development, and geographic distribution of the literature in the field based on 8491 articles extracted from the Web of Science Core database. Using citation analysis, this article identifies influential journals, scholars, and documents in this field. The study found that in the past 15 years, the number of documents has increased significantly and geographical diversity has also increased. Most of the highly influential literature relates to depression inventories. Using keyword co-occurrence analysis, this article also identified three key research topics focusing on (a) child and adolescent depression symptoms and prevalence, (b) parental depression and child behavioral or emotional problems, and (c) childhood abuse and depression. This study uses 'science mapping' as a means to provide a better understanding of research trends about childhood and adolescent depression that have emerged over the past half century, and may serve as reference for future research.

Systematic Review of Preinjury Mental Health Problems as a Vulnerability Factor for Worse Outcome After Sport-Related Concussion

Background:

It is difficult to predict who will experience prolonged health problems after sustaining a sport-related concussion.

Purpose:

To synthesize the literature and conduct a gap analysis on the association between preinjury mental health problems and clinical outcome from sport-related concussion.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Data sources were PubMed, PsycINFO, MEDLINE (and MEDLINE in Process), CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. Studies published before February 2019 that addressed preinjury mental health problems as a possible predictor of worse clinical outcome or clinical recovery from concussion were eligible for inclusion.

Results:

Of 4013 studies screened, 358 full texts were reviewed, and 12 studies involving 3761 participants (n = 471 [12.5%] with preexisting mental health problems) were ultimately included. The participants with a preinjury history of mental health problems were at greater risk for having persistent symptoms or worse outcome in 9 of 12 studies. The studies had major methodological differences, and most studies were not focused on mental health as a primary predictor or prognostic factor. Rather, they included it as a secondary or tertiary predictor. The sample sizes with preinjury mental health problems in most studies were small or very small (ie, <25). The age of onset, type, course, severity, and duration of mental health problems were not defined. The extent to which mental health problems were present before the season, during baseline testing, was not reported.

Conclusion:

Preinjury mental health problems appear to confer risk for worse clinical outcome after sport-related concussion. Future research is needed to (1) examine this risk factor in large representative populations of middle school students, high school students, and collegiate athletes; (2) quantify the risk for each mental health condition; (3) understand the mechanisms underlying this increased risk; and (4) develop more refined treatment and rehabilitation approaches for these student-athletes.

Neurocognitive Adaptation and Mental Health Vulnerability Following Maltreatment: The Role of Social Functioning

Childhood maltreatment is associated with a lifetime increase in risk of mental health disorder. We propose that such vulnerability may stem in large part from altered patterns of social functioning. Here, we highlight key findings from the psychological and epidemiological literature indicating that early maltreatment experience compromises social functioning and attenuates social support in ways that increase mental health vulnerability. We then review the extant neuroimaging studies of children and adolescents, focusing on three domains implicated in social functioning: threat processing, reward processing, and emotion regulation. We discuss how adaptations in these domains may increase latent vulnerability to mental health problems by impacting on social functioning via increased stress susceptibility as well as increased stress generation. Finally, we explore how computational psychiatry approaches, alongside systematically reported measures of social functioning, can complement studies of neural function in the creation of a mechanistic framework aimed at informing approaches to prevention and intervention.

Interpersonal childhood adversity and stress generation in adolescence: Moderation by HPA axis multilocus genetic variation

Research suggests that childhood adversity (CA) is associated with a wide range of repercussions, including an increased likelihood of interpersonal stress generation. This may be particularly true following interpersonal childhood adversity (ICA) and for youth with high hypothalamic-pituitary-adrenal (HPA) axis-related genetic risk. In the current study, we applied a multilocus genetic profile score (MGPS) approach to measuring HPA axis-related genetic variation and examined its interaction with ICA to predict interpersonal stress generation in a sample of adolescents aged 14–17 (N = 241, Caucasian subsample n = 192). MGPSs were computed using 10 single nucleotide polymorphisms from HPA axis-related genes (CRHR1, NRC31, NRC32, and FKBP5). ICA significantly predicted greater adolescent interpersonal dependent stress. Additionally, MGPS predicted a stronger association between ICA and interpersonal dependent (but not independent or noninterpersonal dependent) stress. No gene–environment interaction (G×E) effects were found for noninterpersonal CA and MGPS in predicting adolescent interpersonal dependent stress. Effects remained after controlling for current depressive symptoms and following stratification by race. Findings extend existing G×E research on stress generation to HPA axis-related genetic variation and demonstrate effects specific to the interpersonal domain.

Heightened amygdala reactivity and increased stress generation predict internalizing symptoms in adults following childhood maltreatment

BACKGROUND

Childhood maltreatment is one of the most potent predictors of future psychopathology, including internalizing disorders. It remains unclear whether heightened amygdala reactivity to threat and elevated stress exposure may be implicated in the pathogenesis and maintenance of internalizing disorders among individuals with a history of childhood maltreatment.

METHODS

Using data from a sample of 1,144 young adults, we investigated the contribution of baseline threat-related amygdala reactivity and prospective major stressful life events to internalizing symptoms severity 1 year later (on average) in individuals with a history of maltreatment (n = 100) and propensity score matched nonmaltreated peers (n = 96).

RESULTS

Even after stringently matching for several potentially confounding variables - including baseline internalizing symptoms, socioeconomic status and IQ - childhood maltreatment status predicted increased amygdala reactivity at baseline, elevated post-baseline exposure to major stressful life events and internalizing symptoms at follow-up. We also showed, for the first time, that amygdala reactivity at baseline and also post-baseline exposure to major stressful life events mediated the association between a history of maltreatment and future internalizing symptoms.

CONCLUSIONS

These findings provide support for the view that maltreatment is a potent developmental insult leading to long-lasting neurocognitive recalibrations of the threat processing system. It is possible that such alterations, over time, may impact mental health functioning by compromising the ability to effectively negotiate everyday challenges (stress susceptibility). These alterations were not, however, found to sensitize an individual to the impact of major stressful life events. The results of this study also lend compelling support to the view that increased psychiatric risk, in the context of childhood maltreatment, follows from an increased propensity to experience major stressful life events (stress generation).

Comparison of Team and Participant Ratings of Event Dependence: Inferential Style, Cognitive Style, and Stress Generation

Introduction: Previous research has linked negative cognitive styles with stress generation. However, measures of cognitive styles have replied on ratings for hypothetical events, not experienced events. We examined the relationship between stress generation and attributional style for experienced events (i.e., inferential style) at both macro and daily levels.

Methods: We measured stress generation in college students using the traditional objective team ratings (i.e., observer) as well as via participants’ own ratings (i.e., actor), which we argue captures more information and is consistent with calls for participant-centered research.

Results: Cognitive style and inferential style positively correlated, indicating consistency between these two forms of assessment. Actor and observer identified events were significantly correlated for both dependent and independent events, suggesting that participants and teams are consistent in these categorizations. Results from both studies showed that inferential style was associated with actor but not observer identified dependent events.

Discussion: Our findings provide some of the first evidence for the role of inferential style in actor identified stress generation and indicate that it is useful to examine both participant and observer ratings of stressful life events.

Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode

For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.

Risk Factors for Depression: An Autobiographical Review

I have been given a priceless opportunity to reflect on my career in the remarkably productive field of risk factors for depression. Psychological research on depression exploded in the early years of my work. I try to give an account of the choices and challenges, and reflect on the influences, some calculated and some serendipitous, that determined the paths I have followed. I focus mostly on the robust depression risk factors that have influenced my research, including dysfunctional cognitions, stressful life events and circumstances, parental depression, interpersonal dysfunction, and being female, and I cover some of what I did but also the influential work of others. This is a selective review of depression research in the past 40 or so years, noting some of the big developments that set the stage for the remarkable activity that continues today. In the conclusion, there is a brief statement of aspirations for future developments in our field.

Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms

There is a great deal of evidence about the mental health implications of physical child abuse and environmental stressors, or hardships that people experience at the household and neighborhood level (e.g., neighborhood violence; economic hardship, substance abuse, or conflict among family members). Yet, studies often focus on either abuse or environmental stress, not both, or examine abuse and environmental stressors as a combined set of experiences. Less is known, therefore, about how child abuse and environmental stress might work as either distinct or interrelated risks to diminish mental health over time. In this longitudinal study, we used path analyses to examine the cumulative effects of physical child abuse and environmental stressors on adult depressive symptoms among a sample of children followed into adulthood (N = 356). The goal was to assess whether chronic physical child abuse remains an independent predictor of adult outcomes once we accounted for the cumulative effects of household and neighborhood stressors across the lifecourse. Cumulative measures of physical child abuse and environmental stress each independently predicted a higher likelihood of adult depressive symptoms (ß = .122, p < .01 and ß = .283, p < .001, respectively). After accounting for adolescent depressive symptoms, only cumulative environmental stressors independently predicted depressive symptoms (ß = .202, p < .001). Tests of the indirect effect of cumulative environmental stress on the relationship between cumulative physical abuse and adult depressive symptoms were marginally statistically significant. Results add to literature that examines child abuse, adversity, and lifecourse perspectives on health. (PsycINFO Database Record

Longitudinal Mediators of Relations Between Family Violence and Adolescent Dating Aggression Perpetration

Few longitudinal studies have examined the pathways through which family violence leads to dating aggression. In the current study the authors used 3 waves of data obtained from 8th- and 9th-grade adolescents (N = 1,965) to examine the hypotheses that the prospective relationship between witnessing family violence and directly experiencing violence and physical dating aggression perpetration is mediated by 3 constructs: (a) normative beliefs about dating aggression (norms), (b) anger dysregulation, and (c) depression. Results from cross-lagged regression models suggest that the relationship between having been hit by an adult and dating aggression is mediated by changes in norms and anger dysregulation, but not depression. No evidence of indirect effects from witnessing family violence to dating aggression was found through any of the proposed mediators. Taken together, the findings suggest that anger dysregulation and normative beliefs are potential targets for dating abuse prevention efforts aimed at youth who have directly experienced violence.

Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster

BACKGROUND

The current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks.

METHODS

Participants were 18,896 WTC responders, including 8466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; M(age) = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later.

RESULTS

Path analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health.

CONCLUSIONS

The present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among WTC disaster responders.

The Relation of Childhood Maltreatment to Psychotic Symptoms in Adolescents and Young Adults With Depression

This study examined the relation between a history of maltreatment and the presence of psychotic symptoms in a community sample of adolescents and young adults with major depressive disorder. One hundred and twenty-nine depressed adolescents and young adults (M = 16.02 years, 77% female, 92% White) were recruited through community advertisement and clinician referral. Clinical diagnoses and psychotic symptoms (i.e., hallucinations and delusions) were assessed using a structured diagnostic interview. Childhood maltreatment was assessed using a contextual interview and standardized rating system. Logistic regression analyses examined the relation between childhood maltreatment and psychotic symptoms. As hypothesized, individuals with psychotic symptoms were significantly more likely to report a history of severe sexual maltreatment than those without psychotic symptoms (Wald = 5.44, odds ratio = 3.86, p = .020), 95% confidence interval [1.24, 12.01]. Further, those with psychotic symptoms were more likely to report being the victims of more than one type of maltreatment than those without, χ2(2) = 6.66, p = .036 (ϕ = .23; 40% vs. 16%). Results held upon adjusting for overall level of depression symptoms. A history of severe sexual maltreatment is related to a severe presentation of major depressive disorder even in the initial onset of the syndrome in adolescence and young adulthood. These findings underscore the importance of early assessment of both depression and maltreatment history to implement interventions that have the potential to prevent the emergence of psychotic psychopathology in young people at risk.

Two prospective studies of changes in stress generation across depressive episodes in adolescents and emerging adults

The stress generation hypothesis was tested in two different longitudinal studies examining relations between weekly depression symptom ratings and stress levels in adolescents and emerging adults at varied risk for depression. The participants in Study 1 included 240 adolescents who differed with regard to their mothers' history of depressive disorders. Youth were assessed annually across 6 years (Grades 6-12). Consistent with the depression autonomy model, higher numbers of prior major depressive episodes (MDEs) were associated with weaker stress generation effects, such that higher levels of depressive symptoms predicted increases in levels of dependent stressors for adolescents with two or more prior MDEs, but depressive symptoms were not significantly related to dependent stress levels for youth with three or more prior MDEs. In Study 2, the participants were 32 remitted-depressed and 36 never-depressed young adults who completed a psychosocial stress task to determine cortisol reactivity and were reassessed for depression and stress approximately 8 months later. Stress generation effects were moderated by cortisol responses to a laboratory psychosocial stressor, such that individuals with higher cortisol responses exhibited a pattern consistent with the depression autonomy model, whereas individuals with lower cortisol responses showed a pattern more consistent with the depression sensitization model. Finally, comparing across the two samples, stress generation effects were weaker for older participants and for those with more prior MDEs. The complex, multifactorial relation between stress and depression is discussed.

'She called her partner - hence she is needy': depressed patients show increased tendencies to make spontaneous trait inferences

BACKGROUND

Interpersonal stress generation is an important maintaining factor in major depression; however, little is known about the psychological mechanisms that undermine interpersonal functioning. This study investigated the role of deficits in person perception to this regard.

METHOD

Depressed patients (n = 20) and healthy controls (n = 20) completed a false recognition task that measured participants' tendencies to make spontaneous trait inferences (STIs), that is to spontaneously ascribe personality traits to other people. Participants then reported interpersonal daily hassles for one week following the task.

RESULTS

Tendencies to make STIs were significantly higher in depressed patients, particularly those with a history of childhood trauma. The degree to which participants made STIs was significantly related to depression severity, and predicted the occurrence of interpersonal daily hassles during follow-up across, but not within groups.

CONCLUSIONS

The results suggest that depressed patients show characteristic biases in person perception that may contribute to the generation of interpersonal stress.

The role of dissociation in self-injurious behavior among female adolescents who were sexually abused

The study aimed to examine the role of dissociation (persistent versus peritraumatic) in self-injurious behavior among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse, depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale, Center for Epidemiologic Studies Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Traumatic Events Questionnaire, and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for self-injurious behavior more than threefold. Higher levels of persistent dissociation were found among girls who reported child sexual abuse compared to those who did not. Self-injurious behavior was predicted by persistent dissociation. Girls who engaged in self-injurious behavior had lower potency and higher depression levels, regardless of childhood sexual abuse history.

Childhood abuse and stress generation: the mediational effect of depressogenic cognitive styles

According to the stress generation hypothesis (Hammen, 1991), depressed and depression-prone individuals experience higher rates of negative life events influenced by their own behaviors and characteristics (i.e., dependent events), which in part may account for the often recurrent nature of depression. Relatively little is known about the interrelation between stress generation predictors, and distal risk factors for this phenomenon. This study examined whether childhood emotional, sexual, and physical abuse, each uniquely predicted negative dependent events in individuals with a history of depression. The role of negative inferential styles as a potential mediator was also assessed. A sample of 66 adults with a history of depression completed self-report measures of childhood abuse history and negative inferential styles at baseline. The "contextual threat" method was used to assess the occurrence of negative life events over a 4-month prospective follow-up period. Childhood emotional abuse, but not sexual or physical abuse, prospectively predicted greater stress generation. Negative inferential styles mediated this relation. These findings suggest that targeting negative cognitive styles in clinical settings, especially in patients with a history of childhood emotional abuse, may be important for reducing the occurrence of negative life events, thereby possibly decreasing risk for depression recurrence.

Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life

OBJECTIVES

The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression.

METHOD

We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization's QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression.

RESULTS

We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5-19.7% of variance). Good quality of parental relationship seemed protective.

CONCLUSION

The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Genes, environment, and individual differences in responding to treatment for depression

A principal weakness of evidence-based psychiatry is that it does not account for the individual variability in therapeutic response among individuals with the same diagnosis. The aim of personalized psychiatry is to remediate this shortcoming and to use predictors to select treatment that is most likely to be beneficial for an individual. This article reviews the evidence that genetic variation, environmental exposures, and gene-environment interactions shape mental illness and influence treatment outcomes, with a primary focus on depression. Several genetic polymorphisms have been identified that influence the outcome of specific treatments, but the strength and generalizability of such influences are not sufficient to justify personalized prescribing. Environmental exposures in early life, such as childhood maltreatment, exert long-lasting influences that are moderated by inherited genetic variation and mediated through stable epigenetic mechanisms such as tissue- and gene-specific DNA methylation. Pharmacological and psychological treatments act on and against the background of genetic disposition, with epigenetic annotation resulting from previous experiences. Research in animal models suggests the possibility that epigenetic interventions may modify the impact of environmental stressors on mental health. Gaps in evidence are identified that need to be bridged before knowledge about cause can inform cure in personalized psychiatry.

Parental maltreatment, bullying, and adolescent depression: evidence for the mediating role of perceived social support

The support deterioration model of depression states that stress deteriorates the perceived availability and/or effectiveness of social support, which then leads to depression. The present study examined this model in adolescent depression following parent-perpetrated maltreatment and peer-perpetrated bullying, as assessed by a rigorous contextual interview and rating system. In 101 depressed and nondepressed community adolescents between the ages of 13 and 18 (M = 15.51, SD = 1.27), peer bullying and father-perpetrated maltreatment were associated with lower perceptions of tangible support and of belonging in a social network. These forms of support mediated the association of bullying and father-perpetrated maltreatment with greater depression severity. In contrast, mother-perpetrated maltreatment was associated with higher perceptions of tangible support.

Stress generation in depression: A systematic review of the empirical literature and recommendations for future study

Within the past 20 years, depression research has given increasing consideration to the possibility of complex and reciprocal relations between stress and depression. Not only does stress increase risk for depression (i.e., a stress exposure model of depression), but depression, or depressogenic vulnerabilities, in turn, also increases susceptibility to stressful events that are at least in part influenced by the individual (i.e., stress generation; Hammen, 1991). The present review provides a systematic examination of the stress generation literature to date, with specific focus given to depression and depressogenic risk factors (i.e., past stress, negative cognitive styles, and personality and interpersonal vulnerabilities) as predictors of the stress generation effect, as well as gender differences in stress generation, the sequelae of generated stress, and the relative specificity of this phenomenon to depression. The research thus far appears most consistent in supporting the role of depression in predicting generated stress, although more research is still required. In addition to highlighting these findings, methodological limitations and conceptual gaps in the literature are discussed with the view of informing future research in this area.

Cognitive vulnerability to depression in Canadian and Chinese adolescents

The goal of the current study was to compare diathesis-stress and transactional models of cognitive vulnerability to depression in samples of Canadian (n = 118) and Chinese (n = 405) adolescents. We utilized a six-month multi-wave, longitudinal design in order to examine whether (a) perceived control moderated the association between the occurrence of dependent interpersonal stressors and subsequent increases in depressive symptoms (i.e., a diathesis-stress perspective) and (b) dependent interpersonal stressors mediated the association between perceived control and subsequent increases in depressive symptoms (i.e., a transactional perspective). Results from idiographic, time-lagged, hierarchical linear modeling analyses indicated that for Canadian adolescents both diathesis-stress and transactional models were significant predictors of depressive symptomology. When examining the diathesis-stress model, boys, but not girls, who reported lower perceived control, reported higher levels of depressive symptoms following the occurrence of dependent interpersonal stress. Gender differences, however, were not present in the transactional model. In contrast, transactional, but not diathesis-stress, models were significant in Chinese adolescents, and gender differences did not emerge. Overall, these results may reflect culturally-relevant differences in the etiology of depression in Canadian and Chinese adolescents.