Psychosocial predictors of the short-term course and outcome of major depression: a longitudinal study of a nonclinical sample with recent-onset episodes

PCOS and Depression: Common Links and Potential Targets

PCOS or polycystic ovary syndrome is a common endocrine disorder that occurs during the reproductive age in females. It manifests in the form of a wide range of symptoms including (but not limited to) hirsutism, amenorrhea, oligomenorrhea, obesity, acne vulgaris, infertility, alopecia, and insulin resistance. The incidence of depression in PCOS population is increasing as compared to the general population. Increased depression in PCOS significantly alters the quality of life (QOL) of affected females. Also, self-esteem is found to be low in both depression and PCOS. The loss in self-esteem in such patients can be largely attributed to the associated factors including (but not limited to) obesity, acne, androgenic alopecia, and hirsutism. The reason behind the occurrence of depression in PCOS remains elusive to date. Literature suggests that there is an overlap of clinical symptoms between depression and PCOS. As the symptoms overlap, there is a possibility of common associations between depression, PCOS, and PCOS-associated abnormalities including insulin resistance (IR), obesity, CVD, and androgen excess. Studies demonstrate that depression is an inflammatory disorder marked with increased levels of inflammatory markers. On the other hand, PCOS is also regarded as a pro-inflammatory state that is characterized by increased levels of pro-inflammatory markers. Thus, there is a possibility of an inflammatory relationship existing between depression and PCOS. It is also possible that the inflammatory markers in PCOS can cross the blood-brain barrier (BBB) leading to the development of depression. Through the present review, we have attempted to shed light on common associations/shared links between depression and PCOS with respect to the levels of cortisol, androgen, vitamin D, neurotransmitters, monoaminoxidase (MAO), and insulin-like growth factor-1 (IGF-1). Tracking down common associations between depression and PCOS will help find potential drug therapies and improve the QOL of females with depression in PCOS.

Effects of College Athlete Life Stressors on Baseline Concussion Measures

CONTEXT

Concussion baseline testing helps injury evaluation by allowing postinjury comparisons to preinjury measures. To facilitate best practice, common neurocognitive, balance, and symptom report metrics used in concussion baseline testing merit examination relative to participant life stressors.

OBJECTIVE

The purpose of this study was to determine if life stressors are associated with college athlete neurocognitive function, postural control, and symptom scores at preseason baseline assessment.

DESIGN

All study variables were collected in a single laboratory session where athletes completed valid and reliable psychometrics as well as a computerized neurocognitive and balance assessments.

SETTING

Sports medicine research center on an American university campus.

PARTICIPANTS

A convenience sample of 123 college student-athletes: 47 females (age = 18.9 [4.3] y) and 76 males (age = 19.4 [1.6] y).

MAIN OUTCOME MEASURES

Participants were categorized into low, moderate, or high life stressors groups using scores from the Social Readjustment Rating Scale-Revised. Dependent variables included outcomes from the CNS Vitals Signs test, the Sensory Organization Test, and the graded symptom checklist indexing neurocognition, balance, and symptom severity, respectfully.

RESULTS

One-way analysis of variance revealed that the moderate life stressors group performed significantly worse than the low life stressors group on the baseline verbal memory domain of the CNS Vital Signs (F2,119 = 3.28; P = .04) only.

CONCLUSION

In the current college athlete sample, few baseline concussion assessment variables were found to be significantly associated with life stressors. Considering the clinical significance of these variables, psychological life stressors may not be a confounding factor in concussion evaluation.

The Role of Early Life Stress in HPA Axis and Anxiety

Substantial evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology. The most recent studies reviewed here suggest that early life stressors are associated with an increased risk for anxiety disorders in adulthood. Early life stress predisposes individuals to develop a number of psychiatric syndromes, particularly affective disorders, including anxiety disorders, and is therefore a significant health problem.This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and generalized anxiety disorder (GAD), panic disorder, and phobias and the role of early life stress as an important risk factor for HPA axis dysfunction.The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. In addition to melancholic depression, a spectrum of other conditions may be associated with increased and prolonged activation of the HPA axis, including panic, GAD, phobias and anxiety. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the anxiety syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during treatment may help identify patients who are at a higher risk for relapse. These findings suggest that this dysfunction of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in anxiety disorders. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. Early stressful life events may provoke alterations of the stress response and thus of the HPA axis that can endure during adulthood, predisposing individuals to develop psychopathology.

Predictors of depressive symptoms in college students: A systematic review and meta-analysis of cohort studies

BACKGROUND

To explore predictors of depressive symptoms in college students.

METHODS

We performed a systematic review and meta-analysis on the predictors of depressive symptoms. PubMed/Medline, Embase, Springerlink, EBSCOhost, Cochrane review, PsycINFO, China Knowledge Resource Integrated Database, Weipu database and Wanfang database were searched for cohort or longitudinal studies. Stata version 13.1 was used for statistical meta-analysis.

RESULTS

Among 30 cohort studies, 24 studies covering 25,154 college students with the NOS of 6 and over were selected for systematic review and 15 studies met the inclusion criteria for meta-analysis. The predictors of depressive symptoms in college students were gender, baseline depression, neuroticism or psychoticism, negative automatic thoughts or negative rumination, dysfunctional attitude, childhood abuse, sex abuse, and stressful life events. The combined risk ratios and its 95% confidence interval (CI) of each previous predictors were 1.11 (95% CI: 1.02, 1.21), 1.28 (95% CI: 1.10, 1.45), 1.25 (95% CI: 1.04, 1.45), 1.03 (95% CI: 1.01,1.05), 1.17 (95% CI: 1.05, 1.29), 1.05(95% CI: 1.02,1.08), 1.01 (95% CI: 1.00,1.02), and 1.16 (95% CI: 1.04, 1.27), respectively. Perceived social support and family function did not displayed significant predictive effects. Funnel plots showed that publication bias was possible.

LIMITATIONS

Screening tools for depressive symptoms do not have the power or specificity of the gold standard measures for depression like the Structured Clinical Interview (SCID) or the Composite International Diagnostic Interview (CIDI) based on Diagnostic and Statistical Manual of Mental Disorders (DSM), which would influence the study validity and the combined estimates.

CONCLUSIONS

Specific biological, psychological and environmental factors contribute to depressive symptoms in college students. Consideration of these prognostic factors might be conducive to improve understanding and management of future interventions against depressive symptoms among college students. Due to the highly sophisticated course of depression, it is crucial to summarize theoretical frameworks for depressive symptom interventions among college students.

The predictive specificity of psychological vulnerability markers for the course of affective disorders

High scores on markers of psychological vulnerability have been associated with a worse course of affective disorders. However, little is known about the specificity of those associations in predicting the course of different depressive and anxiety disorders. We examined the impact of psychological vulnerability on the short- and long-term course of depressive and anxiety disorders. Participants from the Netherlands Study of Depression and Anxiety with a current diagnosis of depression or anxiety (n = 1256) were reassessed after 2 and 6 years. Diagnostic status and chronic duration (>85% of the time) of symptoms were the outcomes. Predictors were neuroticism, extraversion, locus of control, cognitive reactivity (rumination and hopelessness reactivity), worry and anxiety sensitivity. High neuroticism, low extraversion and external locus of control predicted chronicity of various affective disorders. Rumination, however, predicted chronicity of depressive but not anxiety disorders. Worry specifically predicted chronicity of GAD and anxiety sensitivity predicted chronicity of panic disorder and social anxiety disorder. These patterns were present both at short-term and at long-term, without losing predictive accuracy. Psychological vulnerabilities that are theoretically specific to certain disorders indeed selectively predict the course of these disorders. General markers of vulnerability predicted the course of multiple affective disorders. This pattern of results supports the notion of specific as well as transdiagnostic predictors of the course of affective disorders and is consistent with hierarchical models of psychopathology.

Rethinking Rumination

The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.

Posttraumatic stress disorder in African Americans: a two year follow-up study

The present study was a prospective, naturalistic, longitudinal investigation of the two year course of posttraumatic stress disorder (PTSD) in a sample of African Americans with anxiety disorders. The study objectives were to examine the two year course of PTSD and to evaluate differences between African Americans with PTSD and anxiety disorders and African Americans with anxiety disorders but no PTSD with regard to comorbidity, psychosocial impairment, physical and emotional functioning, and treatment participation. The participants were 67 African Americans with PTSD and 98 African Americans without PTSD (mean age 41.5 years, 67.3% female). Individuals with PTSD were more likely to have higher comorbidity, lower functioning, and they were less likely to seek treatment than those with other anxiety disorders but no PTSD. The rate of recovery from PTSD over two years was 0.10 and recovery from comorbid Major Depressive Disorder was 0.55. PTSD appears to be persistent over time in this population. The rates of recovery were lower than what has been reported in previous longitudinal studies with predominantly non-Latino Whites. It is imperative to examine barriers to treatment and factors related to treatment engagement for this population.

Correlates associated with unipolar depressive disorders in a Latino population

BACKGROUND

This study reports the comparison and associations of demographic, clinical and psychosocial correlates with three unipolar depressive disorders: dysthymia (DYS), major depression (MD) and double depression (DD), and examines to which extent these variables predict the disorders.

SAMPLING AND METHOD

Previously collected data from 563 adults from a community in Puerto Rico were analyzed. One hundred and thirty individuals with DYS, 260 with MD and 173 with DD were compared by demographic variables, psychiatric and physical comorbidity, familial psychopathology, psychosocial stressors, functional impairment, self-reliance, problem recognition and formal use of mental health services. Multinomial regression was used to assess the association of the predictor variables with each of the three disorders.

RESULTS

Similarities outweighed the discrepancies between the disorders. The main differences observed were between MD and DD, while DYS shared common characteristics with both MD and DD. After other variables were controlled, anxiety, functional impairment and problem recognition most strongly predicted a DD diagnosis, while age predicted a DYS diagnosis.

CONCLUSION

MD, DYS and DD are not completely different disorders, but they do differ in key aspects that might be relevant for nosology, research and practice. A dimensional system that incorporates specific categories of disorders would better reflect the different manifestations of unipolar depressive disorders.

The role of experiential avoidance, rumination and mindfulness in eating disorders

Anorexia nervosa has been associated with high levels of ruminative thoughts about eating, shape and weight as well as avoidance of emotion and experience. This study examined the associations between disorder-specific rumination, mindfulness, experiential avoidance and eating disorder symptoms. A sample of healthy females (n=228) completed a battery of on-line self-report measures. A hierarchical regression analysis revealed that ruminative brooding on eating, weight and shape concerns was uniquely associated with eating disorder symptoms, above and beyond anxiety and depression symptoms. In a small group (n=42) of individuals with a history of anorexia nervosa, only reflection on eating weight and shape was able to predict eating disorder symptoms when controlling for depression and anxiety. The results suggest that rumination (both brooding and reflection) on eating, weight and shape concerns may be a process which exacerbates eating disorder symptoms. Examining rumination may improve understanding of the cognitive processes which underpin anorexia nervosa and this may in turn aid the development of novel strategies to augment existing interventions. Replication in a larger clinical sample is warranted.

Etiology of depression: genetic and environmental factors

In summary, depressed patients with a history of childhood trauma may have a distinct depression endophenotype characterized by a specific neurobiology and risk genotype that may be responsive to different treatment strategies than depressed patients without childhood adversity. Based on current findings, treatment strategies should be multimodal and include the following: 1. Psychotherapy that addresses a number of domains, such as emotional regulation, cognitive reframing, careful exploration of past traumatic events, attachment, and interpersonal relationships in a safe and trusting therapeutic environment. 2. The therapy should likely be longer term in order to effectively impact those domains. 3. Pharmacotherapy that will be effective in quieting the body’s hyperresponsiveness to stress and reverse epigenetic modifications induced by trauma and stress. 4. Environmental interventions that provide a support network (maternal care, a positive family environment, the support of a close friend) have all been shown to attenuate the impact of childhood abuse. In addition, there is great potential in the identification of genomic biomarkers to help guide us in the identification of traumatized individuals who are susceptible to depression. These indices may also help identify those for whom the immediate provision of treatment may have a preventive effect and may someday guide us in the development of novel pharmacologic approaches.

Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: a comparative study

Repetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. The objective of the present study is to compare obsessive and ruminative thoughts in non-depressed obsessive-compulsive and depressed patients. Thirty-four patients diagnosed with obsessive-compulsive disorder and 34 patients diagnosed with major depression disorder were asked to identify both a personally relevant obsessive and a personally relevant ruminative thought and to subsequently evaluate these thoughts on a modified version of the Cognitive Intrusions Questionnaire (CIQ) developed by Freeston, Ladouceur, Thibodeau, and Gagnon (1991). The CIQ assesses general descriptors, emotional reactions, appraisal and coping strategies on a nine-point Likert scale. A mixed-model ANOVA demonstrated that obsessive and ruminative thoughts are distinct cognitive processes, clearly distinguishable in form, appraisal and temporal orientation across disorders. In obsessive-compulsive patients, ruminative thoughts were more common and more emotionally distressing than predicted. In depressed patients, obsessive thoughts occurred infrequently and were not associated with high negative emotions. Clarifying similarities and differences between ruminative and obsessive thoughts and understanding their interaction might ultimately help to expand on the role of cognitive vulnerability factors in obsessive-compulsive and major depression disorder.

Childhood abuse and migraine: epidemiology, sex differences, and potential mechanisms

Migraine and maltreatment are both common conditions that are more prevalent in women. Epidemiological evidence supports an association between childhood abuse and headache, as well as pain in general, although some controversy exists based on methodological concerns of studying the influence of remote, traumatic, stigmatizing events in an often depressed population. There is a growing scientific body of knowledge regarding the neurobiological effects of abuse on brain function and structure that suggest a possible role of early life stress in the pathogenesis of migraine, and a differential impact based on sex. Advances in our understanding of the basic mechanisms by which an adverse environment interacts with and changes the genome, may suggest new treatment strategies.

Neurobiological and psychiatric consequences of child abuse and neglect

The effects of early-life trauma and its consequences for the treatment of depression are reviewed. The prevalence and clinical sequelae of early sexual and physical abuse, neglect and parental loss are described. An overview of preclinical studies that help guide clinical research and practice is presented. Human clinical studies on the neurobiological consequences of early trauma are summarized. Moderating factors, such as genetic variation and sex differences, are discussed. The few current treatment outcome studies relevant to this research area are described. Guidance for the management of patients with depression and a history of child abuse and neglect are provided. Most patients who have experienced early traumatic experiences are likely best treated with a combination of psychotherapy and pharmacotherapy. This review is dedicated to the memory of Seymour Levine who pioneered the field of early experience research and to a considerable extent inspired the clinical studies described in this review.

Parental bonding and depressive affect: The mediating role of coping resources

Ordinarily, when stressors are encountered, a cascade of cognitive and behavioural responses is evoked that serves to protect the individual from compromised well-being. When coping resources or skills are limited or ineffective, then psychological disturbances, such as depression, may ensue (Paykel, 2001). Although any number of factors could account for variations of stress resilience, this paper argues that early life experiences and relationships, and particularly those with parents or primary caregivers, may contribute to the development of appropriate styles of coping, which, in turn, influence affective responses in the face of stressors encountered in adulthood.

The relationship between the experience of mood symptoms, expectancy judgement and a person's current concern

This study examined expectancy judgement and current concerns in high and low depression and anxiety participants. Expectancy judgement was measured using the Personal Future Task. Depression and anxiety symptoms were measured using the Depression and Anxiety Stress Scale (DASS). A novel scale, the Current Concerns Checklist, was developed to measure ten current concerns that were thought to relate to the most salient concerns of common Axis I disorders. Using the DASS, 19 participants were allocated to the distressed group and 17 to the non-distressed group. As hypothesized, there was a main effect for the current concern concept; participants thought of more future events regarding their current concern than their non-concern. However, the hypothesis that the distressed group would generate more negative relative to positive responses than the non-distressed group within the domain of their most prominent current concern was not supported. Future research and implications for CBT are discussed.

The role of rumination in affective distress in people with a chronic physical illness: a review of the literature and theoretical formulation

The role of maladaptive cognitive content among individuals with chronic physical illness has been acknowledged in cognitive models. Rumination has been documented as a key predictor of depression, and to a lesser extent of anxiety, in non-clinical samples. This paper provides a preliminary discussion of the potential role of rumination as a causal and maintaining factor for emotional distress in the setting of chronic physical illness. Although a number of methodological limitations exist, the current research on rumination may provide a useful framework for the extension of existing cognitive models in chronic illness.

Self-focused Cognitive Styles and Bipolar Spectrum Disorders: Concurrent and Prospective Associations

We examined concurrent and prospective associations of self-focused cognitive styles with bipolar spectrum disorders. Controlling for depressive and hypomanic/manic symptoms, 125 individuals with bipolar spectrum disorders scored higher than 149 demographically similar normal controls on the rumination scale of the Response Styles Questionnaire (RSQ) and the private self-consciousness subscale of the Self-Consciousness Scale (SCS). The two groups did not differ on the distraction scale of the RSQ or the public self-consciousness and social anxiety subscales of the SCS. In addition, among the bipolar individuals, controlling for initial depressive and hypomanic/manic symptoms, rumination predicted the number, but not the likelihood of onset, of depressive episodes, whereas private self-consciousness predicted the likelihood of onset, but not the number, of hypomanic/manic episodes over a 3.5-year follow-up.

Childhood neglect and abuse as predictors of antidepressant response in adult depression

BACKGROUND

Childhood neglect and abuse are recognized as risk factors for depression, but are not often studied as predictors of treatment response in depression.

METHODS

Clinically depressed outpatients (n=195) were asked about childhood experiences before beginning a randomized antidepressant trial with either fluoxetine or nortriptyline. Three treatment outcomes were measured: Adequate trial, six-week response and two months sustained recovery.

RESULTS

Patients reporting low paternal care (paternal neglect), as measured by the Parental Bonding Instrument (PBI), were less likely to complete an adequate six-week trial of medication. Patients who reported high maternal protection (maternal overprotection) on the PBI had poorer treatment response in the short-term at six weeks, and longer term, for two months of sustained recovery. However, abuse, whether sexual, physical, or psychological in nature, did not predict treatment response.

CONCLUSIONS

The experience of having a neglectful father or an overprotective mother was more predictive of response to treatment for depression than abuse, suggesting that the quality of ongoing intra-familial relationships has a greater impact on treatment outcomes for depression than experiences of discrete abuse in childhood.

The influence of rumination and distraction on depressed and anxious mood: a prospective examination of the response styles theory in children and adolescents

The present study sought to test predictions of the response styles theory in a sample of children and adolescents. More specifically, a ratio approach to response styles was utilized to examine the effects on residual change scores in depression and anxiety. Participants completed a battery of questionnaires including measures of rumination, distraction, depression, and anxiety at baseline (Time 1) and 8-10 weeks follow-up (Time 2). Results showed that the ratio score of rumination and distraction was significantly associated with depressed and anxious symptoms over time. More specifically, individuals who have a greater tendency to ruminate compared to distracting themselves have increases in depression and anxiety scores over time, whereas those who have a greater tendency to engage in distraction compared to rumination have decreases in depression and anxiety symptoms over time. These findings indicate that a ratio approach can be used to examine the relation between response styles and symptoms of depression and anxiety in non-clinical children and adolescents. Implications of the results may be that engaging in distractive activities should be promoted and that ruminative thinking should be targeted in juvenile depression treatment.

The neurobiological toll of child abuse and neglect

Exposure to interpersonal violence or abuse affects the physical and emotional well-being of affected individuals. In particular, exposure to trauma during development increases the risk of psychiatric and other medical disorders beyond the risks associated with adult violence exposure. Alterations in the hypothalamic-pituitary-adrenal (HPA) axis, a major mediating pathway of the stress response, contribute to the long-standing effects of early life trauma. Although early life trauma elevates the risk of psychiatric and medical disease, not all exposed individuals demonstrate altered HPA axis physiology, suggesting that genetic variation influences the consequences of trauma exposure. In addition, the effects of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. Recognition of the biological consequences and transgenerational impact of violence and abuse has critical importance for both disease research and public health policy.

Rumination, distraction and mindful self-focus: effects on mood, dysfunctional attitudes and cortisol stress response

BACKGROUND

Although aggravating effects of rumination on dysfunctional cognitions and endocrine stress responses have been proposed, experimental studies testing these assumptions are lacking. In parallel, mindfulness theory suggests beneficial effects of mindfulness on dysfunctional cognitions. This study aimed to investigate the effects of induced rumination, distraction and mindful self-focus on mood and dysfunctional attitudes and to assess the possible impact of induced rumination on participants' cortisol responses.

METHOD

Sixty university students were subjected to negative mood induction and subsequently randomly assigned to a rumination, distraction or mindful self-focus condition. The latter included statements focusing on self-acceptance and awareness of the breath. Four saliva cortisol samples were selected during the session.

RESULTS

Compared to induced rumination, distraction showed a clear beneficial effect on the course of dysphoric mood, whereas a mindful self-focus did not. In contrast to distraction and mindful self-focus, participants induced to ruminate showed significant increases in dysfunctional attitudes from baseline to post-induction. Although rumination was not itself linked to higher cortisol responses, participants scoring high on the Beck Depression Inventory (BDI)-II who were induced to ruminate showed a smaller decrease in cortisol levels than those scoring low on the BDI-II.

CONCLUSIONS

This study indicates that rumination as a dysfunctional mode of cognitive processing is able to maintain depression-linked dysfunctional thought content. Furthermore, our study revealed preliminary indications for a link between induced rumination and the cortisol stress response in vulnerable individuals.

The link between childhood trauma and depression: insights from HPA axis studies in humans

Childhood trauma is a potent risk factor for developing depression in adulthood, particularly in response to additional stress. We here summarize results from a series of clinical studies suggesting that childhood trauma in humans is associated with sensitization of the neuroendocrine stress response, glucocorticoid resistance, increased central corticotropin-releasing factor (CRF) activity, immune activation, and reduced hippocampal volume, closely paralleling several of the neuroendocrine features of depression. Neuroendocrine changes secondary to early-life stress likely reflect risk to develop depression in response to stress, potentially due to failure of a connected neural circuitry implicated in emotional, neuroendocrine and autonomic control to compensate in response to challenge. However, not all of depression is related to childhood trauma and our results suggest the existence of biologically distinguishable subtypes of depression as a function of childhood trauma that are also responsive to differential treatment. Other risk factors, such as female gender and genetic dispositions, interfere with components of the stress response and further increase vulnerability for depression. Similar associations apply to a spectrum of other psychiatric and medical disorders that frequently coincide with depression and are aggravated by stress. Taken together, this line of evidence demonstrates that psychoneuroendocrine research may ultimately promote optimized clinical care and help prevent the adverse outcomes of childhood trauma.

Dysthymic disorder and double depression: prediction of 10-year course trajectories and outcomes

We sought to identify baseline predictors of 10-year course trajectories and outcomes in patients with dysthymic disorder and double depression. Eighty-seven outpatients with early-onset (<21 years) dysthymic disorder, with or without superimposed major depression, were assessed five times at 30-month intervals for 10 years. Baseline evaluations included semi-structured diagnostic interviews for Axis I and II psychopathology and childhood adversity. Direct interview and family history data were collected on first-degree relatives. Follow-up assessments included the Longitudinal Follow-up Evaluation and Hamilton Depression Rating Scale. Using mixed effects growth curve models, univariate predictors of depression severity and functional impairment at 10-year outcome included older age, less education, concurrent anxiety disorder, greater familial loading for chronic depression, a history of a poorer maternal relationship in childhood, and a history of childhood sexual abuse. In addition, longer duration of dysthymic disorder also predicted greater impairment 10 years later. Predictors of a poorer trajectory of depressive symptoms over time included ethnicity and personality disorders; predictors of a poorer trajectory of social functioning included familial loading of chronic depression and quality of the childhood maternal relationship. Thus, demographic, clinical, family history, and early adversity variables all contribute to predicting the long-term trajectory and outcome of DD. These variables should be routinely assessed in clinical evaluations and can provide clinicians with valuable prognostic information.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Childhood adversity predicts earlier onset of major depression but not reduced hippocampal volume

Childhood adversity may influence severity and age of onset of depression, potentially mediated by greater vulnerability to an existing biochemical or neural mechanism. Prior studies have suggested that reduced hippocampal volume is a result of childhood adversity. This study examined the relationship between childhood adversity, hippocampal volumes and clinical characteristics in women who were recruited for depression history rather than abuse experiences. Thirty-one women with remitted unipolar depression and 24 psychiatrically healthy women completed the Childhood Experience of Care and Abuse interview [Bifulco, A., Brown, G.W., Harris, T.O., 1994. Childhood Experience of Care and Abuse (CECA): A retrospective interview measure. Journal of Child Psychology and Psychiatry 55, 1419-1435]. High resolution MRI scans and hippocampal volumetric determination by stereological assessment were obtained. We found that childhood adversity was associated with a history of recurrent depression and with earlier age of depression onset. We did not find a relationship between childhood adversity and hippocampal volumes in this sample with mild childhood adversity. Our results suggest that the decreased hippocampal volume seen in Major Depressive Disorder may be mediated by additional factors. Further research is needed to more fully understand the interrelationships among childhood adversity, hippocampal morphology, neuroendocrine regulation, and other genetic and environmental factors influencing vulnerability to depression.

Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals

The authors examined whether parental major depressive disorder (MDD) is associated with course of depression and other psychopathology among formerly depressed adolescents as they enter adulthood. The sample consisted of 244 individuals (age 24) in a longitudinal study who had experienced MDD by 19. Maternal MDD was associated with MDD recurrence, chronicity and severity, anxiety disorders, and (among sons only) lower psychosocial functioning in offspring between the ages of 19 and 24. Paternal MDD was associated with lower functioning. Sons of depressed fathers had elevated suicidal ideation and attempt rates in young adulthood. Recurrent paternal MDD was associated with depression recurrence in daughters but not sons. The impact of parental MDD on offspring could not be attributed to characteristics of the offspring's depression prior to age 19.

Importance of studying the contributions of early adverse experience to neurobiological findings in depression

Almost four decades of intensive research have sought to elucidate the neurobiological bases of depression. Epidemiological studies have revealed that both genetic and environmental factors contribute to the risk for depression. Adverse early-life experiences influence neurobiological systems within genetic limits, leading to the neurobiological and behavioral manifestations of depression. We summarize the burgeoning evidence concerning a pre-eminent role of early adverse experience in the pathogenesis of depression. The available data suggest that (1) early adverse experience contributes to the pathophysiology of depression, (2) there are neurobiologically different subtypes of depression depending on the presence or absence of early adverse experience, likely having confounded previous research on the neurobiology of depression, and (3) early adverse experience likely influences treatment response in depression. Classification of depression based on developmental and neurobiological features will likely considerably improve future research in the field of depression, and might lead to optimized treatment strategies that directly target different neurobiological pathways to depression.

Parent-child interaction and children's depression: the relationships between parent-child interaction and children's depressive symptoms in Taiwan

This study examines how perceptions of parenting and family messages are associated with the depressive symptoms of early adolescents (N = 454, boys = 224; girls = 210; age, M = 12, S.D. = 1.01) from East Taiwan. Results show that higher levels of parental care and low levels of parental indifference were associated with lower depression scores. Moreover, perceptions of positive messages regarding children themselves, their world, and their future were found to negatively associate with depression, whereas negative messages had an opposite effect. Basically, girls' depressive symptoms were more related to maternal messages, and boys' were more related to paternal messages.

Response styles among patients with minor depression and dysthymia in primary care

Ruminative responses to depression have predicted duration and severity of depressive symptoms. The authors examined how response styles change over the course of treatment for depression and as a function of type of treatment. They also examined the ability of response styles to predict treatment outcome and status at follow-up. Primary care patients (n = 96) with dysthymia or minor depression were randomly assigned to problem-solving therapy, paroxetine, or placebo. Patients' depressive symptoms and rumination, but not distraction, decreased over time. Pretreatment rumination and distraction were associated with more depressive symptoms at the conclusion of treatment; the latter finding was not consistent with the response style theory of depression. Results are discussed in terms of their implications for this theory.

A construct validation study of the Response Styles Questionnaire Rumination Scale in participants with a recent-onset major depressive episode

This study examined the construct validity and clinical utility of S. Nolen-Hoeksema's (1991) Response Styles Questionnaire (RSQ) Rumination scale. Eighty-eight participants with recent-onset major depressive episodes were assessed and followed for 6 months, using semistructured interviews and self-report inventories. The RSQ Rumination scale exhibited poor 6-month stability and appeared to be closely linked to participants' clinical status-mood state. The scale was significantly correlated with conceptually related constructs such as emotion-focused coping, negative affectivity-temperament, and self-criticism. However, baseline negative temperament and self-criticism predicted key aspects of the 6-month course and outcome of major depressive episodes, whereas baseline rumination did not. Finally, rumination appeared to be closely associated with the severity of the depressive episode, rather than defining a distinct clinical subtype.