Independence of childhood life events and chronic adversities: a comparison of two patient groups and controls

The relation between self-event connections and personality functioning in youth with severe psychopathology

Objective

One way in which individuals construct their narrative identity is by making self‐event connections, which are often linked to better functioning. Being unable to make connections is related to identity discontinuity and psychopathology. Work in the general population corroborates this association, but also highlights the importance of focusing on specific aspects of these connections and on vulnerable populations.

Method

We examined the association of self‐event connections with personality functioning in youth with severe psychopathology (cross‐sectional N = 228, M_age = 19.5, longitudinal N = 84), and the role of event and connection valence in the subsample of youth who made a connection (n = 188 and n = 68). Negative affectivity was controlled for in all models.

Results

We found no evidence that self‐event connections, nor connection valence and its interaction with event valence, are related to functioning. Positive event valence was associated with better functioning. Higher negative affectivity was strongly linked to lower functioning and explained the relation between event valence and functioning. No longitudinal associations emerged.

Conclusions

These findings show that for youth with severe psychopathology making self‐event connections may not be associated with better functioning. Moreover, negative affectivity may be a distal predictor of both event valence and functioning.

Life stress moderates the effects of preschool behavioral inhibition on anxiety in early adolescence

BACKGROUND

Although a robust body of literature implicates temperamental behavioral inhibition (BI) as a prominent risk factor for anxiety disorders, many children with heightened BI do not develop anxiety. The current study examines the role of two forms of life stress (life events and natural disaster exposure) in moderating the relationship between BI in preschoolers and anxiety in early adolescence.

METHOD

A community sample of 392 3-year-old children was administered a laboratory observational assessment of temperament. When children were a mean age 10, the region was struck by a devastating hurricane and exposure to disaster-related stress was assessed. In early adolescence, youth and a parent were administered the UCLA Life Stress Interview (LSI) to assess behaviorally independent and dependent negative life events during the prior year and youth completed the Screen for Child Anxiety Related Emotional Disorders (SCARED).

RESULTS

The association between early childhood BI and anxiety symptoms in early adolescence was moderated by both independent life events and disaster-related stress. Children high in BI at age 3 reported greater anxiety symptoms at age 12 after exposure to higher levels of both forms of stress.

CONCLUSIONS

Stress moderated the association between early BI and later anxiety. Importantly, this was evident for two different kinds of stressors that were independent of the child's behavior that increases confidence in the causal role of stress in the development of anxiety in high BI children.

Parent-dependent stressors and the onset of anxiety disorders in children: links with parental psychopathology

Exposure to stressors is associated with an increased risk for child anxiety. Investigating the family origins of stressors may provide promising avenues for identifying and intervening with children at risk for the onset of anxiety disorders and their families. The aim of this study was to compare the frequency of parent-dependent negative life events and chronic adversities experienced by children with an anxiety disorder (n = 34) in the 12 months prior to the onset of the child's most recent episode, compared to healthy controls (n = 34). Life events and chronic adversities were assessed using maternal report during an investigator-based interview, which provided independent panel ratings of the extent that reported experiences were related to parent behaviour. There were no group differences in the number of parent-dependent negative life events for anxious children compared to controls. However, significantly more parent-dependent chronic adversities were present for anxious children compared to controls. Findings suggest that parents contribute to an increased frequency of chronic adversities but not negative life events prior to their child's most recent onset of anxiety. Furthermore, increased child exposure to parent-dependent chronic adversities was related to parental history of mental disorder.

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.

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety

The current study investigated the longitudinal relationships among behavioral inhibition (BI), life events, and anxiety in a sample of 102 BI children and 100 behaviorally uninhibited (BUI) children aged 3 to 4 years. Children's parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, particularly negative behavior-dependent life events (i.e., life events that are related to the children's own behaviors), and the impact of negative life events were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the 5-year follow-up period. Experiencing more positive, behavior-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behavior-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems.

Neuroticism, life events and negative thoughts in the development of depression in adolescent girls

Theories of depression suggest that cognitive and environmental factors may explain the relationship between personality and depression. This study tested such a model in early adolescence, incorporating neuroticism, stress-generation and negative automatic thoughts in the development of depressive symptoms. Participants (896 girls, mean age 12.3 years) completed measures of personality and depressive symptoms, and 12 months later completed measures of depressive symptoms, recent stressors and negative automatic thoughts. Path analysis supported a model in which neuroticism serves as a distal vulnerability for depression, conferring a risk of experiencing dependent negative events and negative automatic thoughts, which fully mediate the effect of neuroticism on later depression. A second path supported a maintenance model for depression in adolescence, with initial levels of depression predicting dependent negative events, negative automatic thoughts and subsequent depressive symptoms. Unexpectedly, initial depression was also associated with later independent life events. This study establishes potential mechanisms through which personality contributes to the development of depression in adolescent girls.

Impact of a technological disaster on young children: a five-year postdisaster multiinformant study

Children exposed to a technological disaster during an understudied part of the lifespan, preschool age and early middle childhood, were assessed in a 5-year follow-up regarding mental health problems, anxiety disorder symptoms, depressive symptoms, physical symptoms, and posttraumatic stress symptoms. Exposed children and their parents (n = 264) reported significantly more problems than controls (n = 515). The differences were greater for conduct problems (including hyperactivity) and physical symptoms, than for anxiety and depression. The long-term effects of a technological disaster on children of pre-school age at exposure appear to differ from those in children, who were victimized at a later age. This may reflect interference with completion of specific developmental tasks.

Sociocultural disadvantage, traumatic life events, and psychiatric symptoms in preadolescent children

Previous research has demonstrated impact of psychosocial adversity on the mental health of children. This cross-sectional study examined specific influences of psychosocial adversity on internalizing versus externalizing symptoms, as explained by relative neighborhood disadvantage, sociocultural disadvantage, and exposure to interpersonal and non-interpersonal traumatic life events. Participants included 258 children aged 6 to 12 years from two Swedish elementary schools located in two socioeconomically distinct neighborhood settings. Information was obtained from their parents by means of questionnaires (a demographic form including information about parental occupation and country of origin, the Strengths and Difficulties Questionnaire and the Life Incidence of Traumatic Events checklist). Neighborhood differences in mental health were explained by variability in psychosocial adversity. While controlling for gender, age, and the other symptom dimension, sociocultural disadvantage was associated with internalizing but not with externalizing symptoms. In contrast, traumatic life events and especially interpersonal traumas were related to externalizing but not to internalizing symptoms. These findings provide some support for specificity of psychosocial adversities in the impact on child mental health.

Are reported differences in life events for anxious children and controls due to comorbid disorders?

Many studies have reported that anxious children experience more negative life events than controls. However, studies have not yet addressed the possibility that this difference may be due to comorbidity with non-anxiety disorders. Furthermore, presence of psychopathology may also lead children to act in ways that increases frequency of negative life events and decreases the frequency of positive life events. Mother and child-report versions of a questionnaire measure of life events (CASE) assessed life events in the past 12 months in anxiety-disordered children (n=198), and controls (n=88). Mother reports indicated that anxious children experienced more negative and fewer positive behavior-dependent events than control children. Child reports showed a similar pattern, however significant differences were only present between anxious and control groups on the number of negative behavior-dependent events. Results indicated that anxious-control differences remain irrespective of comorbidity with non-anxiety disorders. However, the highest rates of negative life events were present in children with a comorbid disorder.

Polytraumatization and psychological symptoms in children and adolescents

Previous research on the impact of traumatic experiences in children and adolescents has focused almost entirely on the effect of single trauma. Research on cumulative traumas has been lacking, but Finkelhor (Child Abuse Negl 31:7-26, 2007) has recently directed the attention to the concept of polyvictimization. As an extension of this concept, this study examined the impact of polytraumatization, operationalized as the number of different potentially traumatic events. The study population comprised two cross-sectional samples of school-aged children (n = 270) and adolescents (n = 400). Information of life-time incidence of traumatic events was collected by the life incidence of traumatic events (LITE), and psychological symptoms by the parent version of the strengths and difficulties questionnaire (SDQ) for the school children and the self-report trauma symptom checklist for children (TSCC) for the adolescents. We found that exposure to at least one traumatic event was common in both the samples (63% of the children and 89.5% of the adolescents). The number of different traumatic events, polytraumatization, was highly predictive of symptoms in both samples, and with a few exceptions surpassed the impact of specific events in exploratory analyses. We furthermore replicated previous findings of the important impact of interpersonal over non-interpersonal events on symptoms in both samples, and found an indication that this effect differed by gender in different manners in the two samples. This study emphasizes the significance of both the quantity of traumatic events, polytraumatization, as well as the quality, interpersonal events.

Severe life events and chronic adversities as antecedents to anxiety in children: a matched control study

The present study compared the number of severe life events and chronic adversities as reported retrospectively by mothers of children with an anxiety disorder (n = 39) prior to the onset of their most recent episode, with controls (n = 39) matched for age and sex. The parent version of the Psychosocial Assessment of Childhood Experiences (PACE) was used to assess chronic adversities (long-term experiences with negative impact on child) and severe life events (discrete life events with high long-term threat). A significantly greater number of severe life events and chronic adversities were assessed prior to onset for anxious children compared to controls. The finding for severe life events held regardless of whether impact ratings were assigned by mothers or a panel of independent raters, suggesting the findings reflect actual as opposed to perceived differences. Results suggest that both discrete and chronic stressors may constitute risk for future episodes of anxiety in children.

Life events, self-reported psychopathology and sense of coherence among young men--a population-based study

The aim is to study the associations between sense of coherence (SOC), and psychopathology and major life events among adolescent boys. The study population consisted of 2314 Finnish boys born during 1981 who attended military call-up (79% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Antonovsky's Orientation to Life Questionnaire (SOC-13), which measure SOC. In univariate analysis, low parental education level, death and serious illness of parent, parental divorce and high symptom level in all YASR scales were associated with poor SOC. In multivariate analysis, most YASR syndrome scales and father's education level were independently associated with SOC. The study demonstrates the sensitivity of the SOC-13 scale to a wide range of mental health problems. The results offer additional support to the argument that SOC may be an important global measure for use in both clinical and research purposes in adolescent psychiatry.

Homeless near a thousand homes: outcomes of homeless youth in a crisis shelter

Clients who received crisis services at a homeless shelter for transition-aged youth were recruited for a study to describe the youth served, to track outcomes of care, and to examine factors associated with differing outcomes. Participants were 202 men and women who completed a battery of interviews and self-report measures at intake and at 3 follow-up points. Youth served had experienced high levels of adversity and trauma and typically had poor educational and vocational preparation. A multidisciplinary array of services was provided, and overall, participants showed significant improvement from intake to discharge and in the 6 months after discharge. Background, service, and psychological factors did not predict housing outcomes. Better vocational outcome was associated with more recent work experience. Results point to the need for providers of services to the homeless to be aware of the distinct needs and characteristics of transition-aged youth.

Environmentally mediated risks for psychopathology: research strategies and findings

OBJECTIVE

To consider the research design requirements needed to provide a rigorous test of environmental mediation hypotheses and to summarize the main findings from research using such designs.

METHOD

Selective review of empirical evidence dealing with psychopathology.

RESULTS

There is robust evidence of environmentally mediated risks for psychopathology. There are major individual differences in people's responses to risk experiences. Effects are often dependent on genetic susceptibility (operating through gene-environment interactions).

CONCLUSIONS

Many of the risks deriving from adverse experiences are reliant on nature-nurture interplay, and one of the main research needs concerns the diverse effects of the environment on the organism.

The role of stressful life events in the development of depressive symptoms in adolescence--a longitudinal community study

Depressive symptoms were measured in a cohort of community-based adolescents (n = 163) at two time-points, with 1 year intervening. At Time 2, participants also answered a scale about past-year stressful life events. Depressive symptoms increased from Time 1 to Time 2, the effect being stronger for girls than for boys. Depressive symptoms were significantly correlated with concurrent measures of recent stressful life events, but this relationship disappeared after controlling for previous depressive symptoms. Rather, previous level of depressive symptoms predicted stressful life events. This demonstrates that a unidirectional model of stressful life events as the cause of depressive symptoms in adolescents is too simplistic.

The stressful life events schedule for children and adolescents: development and validation

The development and psychometric properties of the Stressful Life Events Schedule (SLES), an interview instrument to assess stressors in children and adolescents, are described. Children (< or =12 years) and adolescents (>12 years) with psychopathology (n=30) and non-psychiatric controls (n=30) were interviewed with the SLES about the occurrence of stressful life events during the prior year. To examine concurrent validity of the SLES, all subjects also completed the self-report Life Events Checklist (LEC) and half the sample completed the Life Events and Difficulties Schedule (LEDS). To examine informant validity, the parent/guardian also reported on stressful life events occurring to their child during the year prior to interview. Test-retest reliability of the SLES was examined by re-assessing all children approximately one week after the initial interview. Subjects rated subjectively how stressful an event was on a 4-point scale. Additionally, panel ratings of objective stress and behavior-dependence/independence were made on 4-point scales. The SLES was found to have substantial inter-rater consensus reliability for objective threat (kappa=0.67) and almost perfect reliability for event behavior-dependence/independence (kappa=0.84). Similarly, the test-retest reliability of the SLES was also found to be substantial at the level of specific event comparisons (kappa=0.68). The SLES discriminated between children with and without psychopathology on all measures of stressful life events. Total stressful life events assessed with the SLES concurred well with those assessed by the LEC (ICC=0.83) and the LEDS (kappa=0.77) although, as expected, examination of specific events showed much smaller overlap between the SLES and the LEC (kappa=0.26). Child-parent agreement for the occurrence of severe events was substantial (kappa=0.73) but tended to be only moderate when all events were examined (kappa=0.48). The results of this study indicate that the SLES has good psychometric properties. The SLES is a useful, cost-effective tool for assessing stressful life events in children and adolescents.

Negative life events of anxiety disordered children: bad fortune, vulnerability, or reporter bias?

This article seeks to examine the nature of negative life events of anxiety-disordered children: to what extent are they unique, to what extent are they shared with siblings, and when they are shared, is the impact similar or different? Twenty-five anxiety-disordered children aged 8 to 13 years, referred to a child psychiatric clinic, were compared with matched non-clinical controls, and with their nearest in age nonreferred sibling aged 6 to 13 years on the number of parent-reported stressful life events. Anxiety-disordered children differ significantly from well controls in the number of negative life events reported by their parents over their lifetime, and the year preceding referral. Anxiety disordered children also differ significantly from their non-referred nearest in age sibling in the number of negative life events, both non-shared and shared. The difference in shared events is due to differences in appraisal by the parents of the impact of a shared event on the respective children. The often reported finding that children with anxiety disorders have experienced more negative life events than their healthy peers is partially due to objective differences in the occurrence of these events, but may also reflect heightened vulnerability or reporter bias.

The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice

OBJECTIVE

To examine the relationships among demographic characteristics, caregiver life stressors, and depressive symptoms of mothers and their children's asthma morbidity.

SETTING

Three pediatric asthma subspecialty programs, 2 in the inner city and 1 in the suburbs.

DESIGN

Cross-sectional census sample of caregivers of children with asthma: interviews mostly with mothers (N = 123) regarding their children's asthma symptoms and health care utilization. Information collected on demographics and caregivers' own recent life stressors and depressive symptoms.

SUBJECTS

Caregivers of children ages 18 months to 12 years with asthma at their subspecialty visit.

MEASURES

Structured interviews: a survey instrument prepared for this study and standardized instruments for depression (Center for Epidemiologic Studies--Depression) and life stressors (Crisis in Family Systems).

RESULTS

A total of 32% of respondents' children had high asthma morbidity, 28% intermediate, and 40% low. Caregiver life stressors and depression and the children's sex showed the strongest relationships to asthma morbidity in a model that also included race, residence, and Medicaid status. Children were more likely to have high morbidity if they had caregivers with more depressive symptoms and negative life stressors and if they were female.

CONCLUSIONS

Respondents experienced many life stressors and symptoms of depression while managing their children's illness. Caregivers' lives may affect their children's asthma morbidity, offering empirical evidence for the potential value of targeted case management for children in subspecialty care.

Psychosocial adversity and child psychopathology

BACKGROUND

Despite strong claims that 'genetic theory' should replace 'socialisation theory', there are good grounds for taking seriously the notion that there are psychosocial influences on child psychopathology.

AIMS

To re-evaluate this issue in the light of developments over the past half-century.

METHOD

A wide-ranging review of topics related to this issue, 1948-1998.

RESULTS AND CONCLUSIONS

The findings are used to consider the challenges still to be met as we enter the next century. It is argued that it is necessary to put aside the absurd brain-mind dualisms of the past.