Understanding the impact of prior depression on stress generation: examining the roles of current depressive symptoms and interpersonal behaviours

Interpersonal predictors of stress generation: Is there a super factor?

Hammen's (1991, Journal of Abnormal Psychology, 100, 555-561) seminal paper on stress generation highlighted the reciprocal relationship between stress and depression. Not only does stress predict depression, but women with a diagnosis of depression also experienced subsequent increased levels of stress. In the ensuing years, depression researchers have moved beyond clinical predictors and examined whether depression vulnerability factors also contribute to stress generation. This interest has led to a growing focus on interpersonal vulnerability factors that contribute to stress generation. To date, the research examining interpersonal predictors of stress generation has tended to examine vulnerability factors singly and thus potential overlap and unique predictions among vulnerability factors have not been determined. This study examines interpersonal vulnerability factors from various schools of thought (dependency, attachment, and unmitigated communion) as predictors of interpersonal stress generation. Three hundred and sixty-four young adults completed baseline measures of interpersonal vulnerabilities and provided weekly reports of depressive symptoms and stressful life events. Multilevel models were estimated to examine their unique predictions of interpersonal stress generation. Despite converging theories, there does not appear to be a single super factor. Of the interpersonal vulnerability factors tested, anxious attachment emerged as a consistent predictor of interpersonal stress generation both when examined singly and when in combination with related variables.

Maternal depression and family adversity: Linked pathways to offspring depression?

There is conflicting evidence about the contribution of maternal depression and family adversity to depression experienced by offspring. Because maternal depression and family adversity are related, there is a need to determine how they independently contribute to offspring depression. Data are from a long-running prospective birth cohort study (Mater-University of Queensland Study of Pregnancy and its outcomes - MUSP). For this study some 2200 offspring were followed up at 30 years of age. We first examine the association between maternal depression and family adversity over the period from the pregnancy to the child reaching adulthood. Then we consider the extent to which maternal depression and family adversity trajectories over this period predict CIDI/DSM-IV episodes of depression in the offspring of these mothers at 30 years of age. We find a strong bi-directional association between maternal depression and family experiences of adverse life events over the entire period the child is at home. After adjustment, children reared in a family experiencing high levels of adverse life events are more likely to experience a lifetime ever DSM-IV diagnosis of depression, are more likely to have experienced multiple episodes of lifetime ever depression, and are more likely to report their first episode of depression was at a younger age. The findings suggest the association between maternal depression and offspring depression appears to be partly attributable to the higher levels of family adversity characteristic of depressed mothers.

Stressful life events in bipolar I and II disorder: cause or consequence of mood symptoms?

BACKGROUND

Life events are assumed to be triggers for new mood episodes in bipolar disorder (BD). However whether life events may also be a result of previous mood episodes is rather unclear.

METHOD

173 bipolar outpatients (BD I and II) were assessed every three months for two years. Life events were assessed by Paykel׳s self-report questionnaire. Both monthly functional impairment due to manic or depressive symptomatology and mood symptoms were assessed.

RESULTS

Negative life events were significantly associated with both subsequent severity of mania and depressive symptoms and functional impairment, whereas positive life events only preceded functional impairment due to manic symptoms and mania severity. These associations were significantly stronger in BD I patients compared to BD II patients. For the opposite temporal direction (life events as a result of mood/functional impairment), we found that mania symptoms preceded the occurrence of positive life events and depressive symptoms preceded negative life events.

LIMITATIONS

The use of a self-report questionnaire for the assessment of life events makes it difficult to determine whether life events are cause or consequence of mood symptoms. Second, the results can only be generalized to relatively stable bipolar outpatients, as the number of severely depressed as well as severely manic patients was low.

CONCLUSIONS

Life events appear to precede the occurrence of mood symptoms and functional impairment, and this association is stronger in BD I patients. Mood symptoms also precede the occurrence of life event, but no differences were found between BD I and II patients.

Improvement in quality of life with left prefrontal transcranial magnetic stimulation in patients with pharmacoresistant major depression: acute and six month outcomes

BACKGROUND

Transcranial magnetic stimulation (TMS) is a safe and effective treatment for major depression. We describe quality of life (QOL) outcomes from acute treatment with TMS, and describe the durability of benefit across 24-weeks.

METHODS

Three hundred and one medication-free patients with pharmacoresistant major depression were randomized to active or sham TMS in a 6-week controlled trial. Nonresponders to the 6-week blinded phase of the study were enrolled in a 6-week open-label study without unblinding the prior treatment assignment. Responders and partial responders to both the blinded (active or sham treatment) or open acute treatment phases were tapered off TMS over three weeks, while initiating maintenance antidepressant medication monotherapy. These subjects entered the 24-week study to examine the durability of response to TMS. The Medical Outcomes Study-36 Item Short Form (SF-36) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to measure overall function and QOL. During the 24-week durability of effect study, QOL assessments were done at study entry and at the end of 24-weeks.

RESULTS

Statistically significant improvement in both functional status and QOL outcomes was observed in patients treated with active TMS compared with sham TMS during the acute phase of the randomized, sham-controlled trial. Similar benefits were observed in patients who entered the open-label extension study. These improvements were sustained across the 24-week follow up study.

CONCLUSIONS

Acute treatment with TMS improved functional status and QOL outcomes in patients with major depression. This clinical effect was durable in long-term follow up.

Stress generation and exposure in a multi-wave study of adolescents: Transactional processes and sex differences

Given considerable overlap among individual difference predictors of stress generation, the current study sought to elucidate which individual factors are uniquely involved in the stress generation process for interpersonal and achievement events among adolescents. Further, we examined transactional processes between stressors and depressive symptoms and explored potential sex differences in the unique prediction of stress generation. At baseline, youth (6^th-10^th graders, n=350, 57% female; 53% White) reported on various individual differences hypothesized to predict prospective increases in stressors. Youth also reported on depressive symptoms and stressors for 4 waves over 5 months. Multi-level modeling showed that different individual difference factors uniquely prospectively predicted increases in dependent (interpersonal and achievement) stressors. Central to this process was interpersonal vulnerabilities and psychopathology. Some of these predictions differed for boys and girls. In addition and in support of a transactional relationship between stressors and depressive symptoms, increases in stressors predicted prospective elevations in depressive symptoms for both boys and girls. This study provides support for the transactional nature of stress and depression in a multi-wave study of adolescence. This study demonstrates that particular individual factors are uniquely associated with the generation of stress, with some associations moderated by gender.

Stress generation and adolescent depression: contribution of interpersonal stress responses

This research examined the proposal that ineffective responses to common interpersonal problems disrupt youths' relationships, which, in turn, contributes to depression during adolescence. Youth (86 girls, 81 boys; M age = 12.41, SD = 1.19) and their primary female caregivers participated in a three-wave longitudinal study. Youth completed a measure assessing interpersonal stress responses; youth and caregivers completed semi-structured interviews assessing youths' life stress and psychopathology. Consistent with the hypothesized model, ineffective stress responses (low levels of effortful engagement, high levels of involuntary engagement and disengagement) predicted the generation of subsequent interpersonal stress, which partially accounted for the association between stress responses and depression over time. Moreover, results revealed that self-generated interpersonal, but not noninterpersonal stress, predicted depression, and that this explanatory model was specific to the prediction of depression but not anxiety. This research builds on interpersonal stress generation models of depression, and highlights the importance of implementing depression-focused intervention programs that promote effective stress responses and adaptive interpersonal relationships during adolescence.

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.

History of single episode and recurrent major depressive disorder among smokers in cessation treatment: Associations with depressive symptomatology and early cessation failure

OBJECTIVES: Research and theory provide initial support for the potential utility in distinguishing between recurrent and single episode MDD smokers for cessation treatment. However, no study to date has examined differences in clinical presentation at the outset of treatment among these two groups and whether these clinical profiles are indicative of early cessation failure (smoking on quit day). METHODS: In a secondary analysis of a sample of 179 smokers entering cessation treatment, we examined baseline differences in dysfunctional attitudes, maladaptive coping, self-efficacy to manage negative affect, depressive symptoms, depressed mood, and experienced pleasure from life events between smokers with a history of recurrent major depression (MDD-R; 54.7%) and single episode major depression (MDD-S). RESULTS: Results showed that MDD-R smokers reported lower self-efficacy to cope with negative affect, greater depressive symptoms, and greater depressed mood than MDD-S smokers, although no differences were found on dysfunctional attitudes, avoidance coping, and level of experienced pleasure from daily life events. A greater number of MDD-R compared to MDD-S smokers were not abstinent on their quit day, however a history of recurrent MDD did not increase risk for early cessation failure. CONCLUSIONS: The findings indicate that although depressed mood, negative affect-regulation ability, and depression severity distinguish recurrent and single episode MDD smokers at the start of cessation treatment, these differences do not necessarily portend greater risk for cessation failure in the early stages of treatment.

Stress Generation Research in Depression: A Commentary

The concept of stress generation is a powerful tool that is consistent with existing cognitive-behavioral theories of depression. In this brief commentary on the literature on stress generation in depression, we highlight several issues that we believe will help to advance the stress generation field. Specifically, we discuss important methodological considerations, issues related to generality and specificity, and theoretical and clinical implications of stress generation. We then address common misperceptions of the stress generation hypothesis. Finally, we end by posing several questions about the mechanisms driving stress generation that should be addressed in future research. Advancing the field's knowledge about stress generation will yield a tangible direction for theory-driven, targeted intervention. Our hope is that this commentary will help to stimulate and frame future research in this exciting area.

Interpersonal predictors of stress generation

Hammen (1991) provided evidence for a stress generation process in which individuals with a history of depression contributed to the occurrence of stressors, especially interpersonal and conflict events. However, few studies have examined the factors contributing to stress generation. This study examines aspects of individuals' interpersonal style, operationalized as attachment, dependency, and reassurance seeking, as predictors of conflict stress generation within romantic relationships. These effects were examined both prospectively over a 4-week period and cross-sectionally using a 14-day daily diary in a sample of female college students. Overall, there was significant evidence that interpersonal style contributes to the occurrence of interpersonal stressors. Specifically, anxious attachment and reassurance seeking prospectively predicted romantic conflict stress over a 4-week period, and a variety of interpersonal behaviors were associated with romantic conflict stressors on a daily basis. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.