Disinhibition domain and facets uniquely predict changes in depressive symptoms and psychosocial functioning

This study aimed to understand the role of disinhibition (low conscientiousness)-in conjunction with the other major personality traits of negative affectivity, detachment, antagonism, and psychoticism-in predicting changes in depressive symptoms and psychosocial functioning. Both the disinhibition trait domain and its primary facets (i.e., irresponsibility, impulsivity, and distractibility) were examined. In a large sample (Time 1 N = 605, Time 2 N = 497) of psychiatric outpatients and high-risk community residents, personality traits, depressive symptoms (both self-reported and interviewer-rated), and psychosocial functioning levels (i.e., daily functioning, interpersonal functioning, health-related quality of life, and global quality of life) were collected across two time points. Results showed that the disinhibition domain was the strongest predictor of changes in depressive symptoms and general quality of life levels. Disinhibition facets also predicted changes in depressive symptoms but showed a less consistent pattern compared to the broader trait domain. Finally, the irresponsibility and distractibility facets significantly and uniquely explained changes in interpersonal functioning. The study highlights the importance of assessing the disinhibition trait rather than only negative and positive affectivity (which are well-known correlates of depression), for understanding changes in depressive symptoms and psychosocial functioning. The findings identify potential targets in psychotherapy for individuals with disinhibition traits and depressive disorders.

Depression and family arguments: disentangling reciprocal effects for women and men

BACKGROUND

Depression is a debilitating condition that affects the individual and the family.

OBJECTIVE

This study sought to identify potential reciprocal influences between family arguments and depressive symptoms among clinically depressed patients over a 23-year span.

METHODS

The present study employed a longitudinal, observational design with 424 depressed patients. Separate cross-lagged path models examined longitudinal associations for women and men over 23 years while adjusting for age, income, and marital and parental status.

RESULTS

Among depressed men, more severe baseline depressive symptoms predicted more family arguments 10 years later. Among depressed women, more severe baseline depressive symptoms predicted fewer family arguments 1 year later, while more severe depressive symptoms at 10-year follow-up predicted more family arguments at 23-year follow-up. More family arguments predicted more severe depressive symptoms among women and men, with some variation in the time intervals of these associations.

CONCLUSION

These findings suggest that while depressive symptoms may temporarily diminish family arguments among women, such symptoms were associated with more family arguments over longer time intervals. Moreover, family arguments put depressed men and women at risk for more severe depressive symptoms. These results support the use of screening for family arguments and interventions to help depressed individuals develop skills to manage interpersonal conflict.

Genetic and environmental determinants of stressful life events and their overlap with depression and neuroticism

Background: Stressful life events (SLEs) and neuroticism are risk factors for major depressive disorder (MDD). However, SLEs and neuroticism are heritable and genetic risk for SLEs is associated with risk for MDD. We sought to investigate the genetic and environmental contributions to SLEs in a family-based sample, and quantify genetic overlap with MDD and neuroticism. Methods: A subset of Generation Scotland: the Scottish Family Health Study (GS), consisting of 9618 individuals with information on MDD, past 6 month SLEs, neuroticism and genome-wide genotype data was used in the present study. We estimated the heritability of SLEs using GCTA software. The environmental contribution to SLEs was assessed by modelling familial, couple and sibling components. Using polygenic risk scores (PRS) and LD score regression (LDSC) we analysed the genetic overlap between MDD, neuroticism and SLEs. Results: Past 6-month life events were positively associated with lifetime MDD status (β=0.21, r ²=1.1%, p=2.5 x 10 ^-25) and neuroticism (β =0.13, r ²=1.9%, p=1.04 x 10 ^-37) at the phenotypic level.  Common SNPs explained 8% of the phenotypic variance in personal life events (those directly affecting the individual) (S.E.=0.03, p= 9 x 10 ^-4). A significant effect of couple environment was detected accounting for 13% (S.E.=0.03, p=0.016) of the phenotypic variation in SLEs. PRS analyses found that reporting more SLEs was associated with a higher polygenic risk for MDD (β =0.05, r ²=0.3%, p=3 x 10 ^-5), but not a higher polygenic risk for neuroticism. LDSC showed a significant genetic correlation between SLEs and both MDD (r _G=0.33, S.E.=0.08 ) and neuroticism (r _G=0.15, S.E.=0.07). Conclusions: These findings suggest that SLEs should not be regarded solely as environmental risk factors for MDD as they are partially heritable and this heritability is shared with risk for MDD and neuroticism. Further work is needed to determine the causal direction and source of these associations.

Genetic and environmental determinants of stressful life events and their overlap with depression and neuroticism

Background: Stressful life events (SLEs) and neuroticism are risk factors for major depressive disorder (MDD). However, SLEs and neuroticism are heritable and genetic risk for SLEs is associated with risk for MDD. We sought to investigate the genetic and environmental contributions to SLEs in a family-based sample, and quantify genetic overlap with MDD and neuroticism.

Methods: A subset of Generation Scotland: the Scottish Family Health Study (GS), consisting of 9618 individuals with information on MDD, past 6 month SLEs, neuroticism and genome-wide genotype data was used in the present study. We estimated the heritability of SLEs using GCTA software. The environmental contribution to SLEs was assessed by modelling familial, couple and sibling components. Using polygenic risk scores (PRS) and LD score regression (LDSC) we analysed the genetic overlap between MDD, neuroticism and SLEs.

Results: Past 6-month life events were positively associated with lifetime MDD status (β=0.21, r ²=1.1%, p=2.5 x 10 ^-25) and neuroticism (β =0.13, r ²=1.9%, p=1.04 x 10 ^-37) at the phenotypic level.  Common SNPs explained 8% of the phenotypic variance in personal life events (those directly affecting the individual) (S.E.=0.03, p= 9 x 10 ^-4). A significant effect of couple environment was detected accounting for 13% (S.E.=0.03, p=0.016) of the phenotypic variation in SLEs. PRS analyses found that reporting more SLEs was associated with a higher polygenic risk for MDD (β =0.05, r ²=0.3%, p=3 x 10 ^-5), but not a higher polygenic risk for neuroticism. LDSC showed a significant genetic correlation between SLEs and both MDD (r _G=0.33, S.E.=0.08 ) and neuroticism (r _G=0.15, S.E.=0.07).

Conclusions: These findings suggest that SLEs should not be regarded solely as environmental risk factors for MDD as they are partially heritable and this heritability is shared with risk for MDD and neuroticism. Further work is needed to determine the causal direction and source of these associations.

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.

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.

Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation

BACKGROUND AND OBJECTIVES

Stressful life events are known to contribute to development of depression; however, it is possible this link is bidirectional. The present study examined whether such stress generation effects are greater than the effects of stressful life events on depression, and whether stress generation is also evident with anxiety.

DESIGN

Participants were two large age cohorts (N = 732 aged 44 years; N = 705 aged 63 years) from the West of Scotland Twenty-07 study.

METHODS

Stressful life events, depression, and anxiety symptoms were measured twice five years apart. Cross-lagged panel analysis examined the mutual influences of stressful life events on depression and on anxiety over time.

RESULTS

Life events predicted later depressive symptomatology (p = .01), but the depression predicting life events relationship was less strong (p = .06), whereas earlier anxiety predicted life events five years later (p = .001). There was evidence of sex differences in the extent to which life events predicted later anxiety.

CONCLUSIONS

This study provides evidence of stress causation for depression and weaker evidence for stress generation. In contrast, there was strong evidence of stress generation for anxiety but weaker evidence for stress causation, and that differed for men and women.

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.

Prospective risk factors for subsequent exposure to potentially traumatic events

In a sample of 1528 college students, we examined (1) whether several risk factors prospectively predicted exposure to potentially traumatic events (PTEs) over a 2-month period and (2) whether dependent events (i.e., those more likely to depend upon one's behavior or characteristics) and independent events were predicted by different risk factors. Logistic regression analyses indicated that overall subsequent PTE exposure was higher for women, those with more previous PTEs, and those who engaged in more binge drinking. Female gender and previous PTE exposure also predicted exposure to independent events. Subsequent dependent PTE exposure was predicted by more previous PTEs and binge drinking, and was somewhat higher in ethnic minority students. Implications for prevention efforts are discussed.

Generation of life events in bipolar spectrum disorders: a re-examination and extension of the stress generation theory

The extent to which stress generation occurs in bipolar spectrum disorders (BSD) is not well understood. The present study examined whether 75 BSD participants experienced elevated rates of behavior-dependent life events, as compared with 38 normal control participants. Within the BSD group, we also examined whether depressive or hypomanic symptoms prospectively predicted increases in various types of negative and positive life events. Results indicated that BSD participants experienced overall increases in behavior-dependent events over the follow-up, as compared with normal controls. At the symptom level, the event generation process occurred in more specific event domains. Results suggest that the stress generation theory of unipolar depression can be extended to BSD and that the type of generated events may be polarity-specific.

Specificity of Stress Generation: A Comparison of Adolescents with Depressive, Anxiety, and Comorbid Diagnoses

Individuals with a history of depression experience more stress that is dependent in part on their own actions. However, it is unclear whether stress generation is a unique feature of depression, or a universal process that is also present in other types of psychopathology, such as anxiety disorders. The current study addressed this issue by comparing adolescents with a history of "pure" (i.e., non-comorbid) depressive disorders, pure anxiety disorders, comorbid depression and anxiety, and no disorder, on their levels of dependent and independent stress. Results indicated that adolescents with pure depression experienced more dependent stress than adolescents with pure anxiety, and adolescents with any internalizing diagnosis experienced more dependent stress than controls. Further, adolescents with comorbid depression and anxiety reported the highest levels of stress generation. The results suggest that while stress generation may be more strongly associated with depression than anxiety in adolescence, it is not unique to depression.

Stress generation over the course of breast cancer survivorship

Depressive symptoms are frequently elevated following breast cancer diagnosis. The stress generation hypothesis states that people with depression generate stressful events and these stressors lead to subsequent depression. This study tested the stress generation hypothesis over the first 5 years of cancer survivorship. Women with stage II or III breast cancer (N = 113) were accrued. Five mediation models were constructed, one for each year. Each model tested whether stressful events in each year mediated the relationship between depression at the beginning and end of that year. Stress generation was observed in the first 2 years following cancer diagnosis but not from 2 to 5 years after diagnosis. The relationship of depression to future stress in breast cancer patients may be moderated by phase of survivorship. Screening and treatment of depressive symptoms in cancer survivors may need to consider the generation of stressful events.

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 and interpersonal predictors of stress generation in children of affectively ill parents

Stress generation is a process in which individuals, through their depressive symptoms, personal characteristics, and/or behaviors, contribute to the occurrence of stressful life events. While this process has been well documented in adults, few studies have examined it in children. The present study examines whether cognitive and interpersonal vulnerability factors to depression contribute to stress generation in children, independent of their current depressive symptoms. Participants included 140 children (ages 6 to 14) and one of their parents. During an initial assessment, children completed self-report measures assessing cognitive and interpersonal vulnerability factors to depression. Children and their parents also completed measures assessing depressive symptoms. One year later, children and their parents participated in a semi-structured interview assessing the occurrence of stressful life events in the past year. Multi-level modeling results provided strong support for the stress generation process in children of affectively ill parents and highlight the importance of considering gender and age moderation effects.

Sex differences in oxidant/antioxidant balance under a chronic mild stress regime

The deterioration of homeostasis between oxidant/antioxidant species may represent an important mechanism linking psychological stress to cardiovascular risk despite the many sex differences in stress responsiveness. The goal of the present study was to investigate the influence of chronic mild stress (CMS), a widely accepted animal model of depression, on oxidative homeostasis-allostasis markers and sICAM-1, a marker of endothelial injury, in the serum of Wistar rats, by taking into account the effect of sex. After six weeks of exposure to mild unpredictable environmental stressors, both male and female rat groups displayed typical changes in hedonic status (anhedonia), which is a core symptom of human depression. Control female rats had higher (nitrite and nitrate) NOx, lower malondealdehyde (MDA) levels with lower activity of antioxidant enzymes and sICAM-1 levels than did control males. CMS induced oxidant/antioxidant responses in both sexes. Females tended to increase their nitric oxide (NO) levels further, while MDA levels did not reach those of males, thus retaining significantly higher NO bioavailability than in males. Concerning the antioxidant enzymes, CMS-females exhibited significantly higher glutathione peroxidase (GPx) activity and lower glutathione reductase (GR) and superoxide dismutase (SOD) activity compared to CMS-males. The CMS response in females was accompanied by lower sICAM-1 levels than in males, suggesting lower endothelial injury. In conclusion, the results of the present study showed that CMS induces different oxidative stress and compensatory responses in both sexes probably due to differences in the mechanisms regulating oxidant/antioxidant pathways.

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.

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

The present study examined the role of childhood abuse and neglect and depression recurrence in moderating the generation of stressful life events in adolescent depression. Maltreatment history and stressful life events were assessed using two rigorous contextual interviews and rating systems. In a sample of 59 community depressed adolescents we found significantly higher rates of interpersonal events in the 3-month period immediately following depression episode onset versus the 3-month period immediately preceding onset in adolescents with a history of childhood maltreatment. By contrast, rates of events remained constant over a matched period in a control group of non-maltreated adolescents. Furthermore, the generation of interpersonal events only held among those on a first onset of depression. These results suggest that a history of childhood abuse and neglect exacerbates the psychosocial dysfunction associated with the onset of depression, particularly in the very first episode.

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

Stress generation is a process in which individuals contribute to stressful life events. While research has supported an association between current depression and stress generation, it has been noted that individuals with prior depression tend to contribute to stressors even when they are no longer experiencing a depressive episode. The aim of the study is to elucidate the pathways through which prior major depression predicts interpersonal stress generation in women. Specifically, we examined current subsyndromal depressive symptoms and problematic interpersonal behaviours as potential mediators. Fifty-one college women were followed prospectively for 6 weeks. Participants were interviewed to assess current and past depression as well as stressful life events they experienced over the 6-week period. The findings suggest that prior major depression continues to have an impact even after the episode has ended, as the disorder continues to contribute to stress generation through residual depressive symptoms.

Negative cognitive style as a predictor of negative life events in depression-prone individuals: a test of the stress generation hypothesis

BACKGROUND

Stress generation effects in depressed individuals have been well-documented. However, less is known about what personal attributes of depression-prone individuals may contribute to the stress generation effect. This study investigated the role of negative cognitive style in predicting the occurrence of negative life events.

METHODS

Undergraduates identified as either high (n=76) or low (n=81) in negative cognitive style were assessed for lifetime history of depression followed by periodic assessment over the course of six months for the occurrence of negative life events and depressive episodes.

RESULTS

Individuals with negative cognitive styles generated more negative life events (dependent events and interpersonal events, but not more independent or achievement-related events) than individuals with more positive cognitive styles. These results appear to be unique to women.

LIMITATIONS

Utilizing participants specifically chosen to be high or low in negative cognitive style may limit generalizability to other individuals.

CONCLUSIONS

Results suggest that an underlying negative cognitive style may account for the stress generation effect often found in depressed individuals, particularly for women. Adequately addressing cognitive patterns in treatment or prevention programs may not only effectively reduce depression, but may also reduce the likelihood of experiencing negative life events that often serve as precipitants for depression.

Stress generation in depression: reflections on origins, research, and future directions

Depressed individuals report higher rates of stressful life events, especially those that have occurred in part because of the person's characteristics and behaviors affecting interpersonal interactions. Termed stress generation, this phenomenon draws attention to the role of the individual as an active contributor rather than passive player in his or her environment, and is therefore an example of action theory. In this article, the author speculates about the intellectual origins of her stress generation perspective, and notes somewhat similar transactional approaches to the stress-disorder link outside of depression research. The literature on stress generation in depression is reviewed, including studies that attempt to explore its correlates and predictors, covering clinical, contextual, family, genetic, cognitive, interpersonal, and personality variables. Empirical and conceptual gaps in our understanding of processes contributing to stressors in the lives of depressed people remain. The author concludes with suggestions for further research, with the goal of furthering understanding both of mechanisms of depression and of dysfunctional interpersonal processes, as well as development of effective interventions to help break the stress-recurrence cycle of depression.

Depression history and coping with chronic pain: a daily process analysis

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.

A prospective investigation of the impact of attachment style on stress generation among clinically depressed individuals

The present study sought to determine if attachment style contributed to the generation of stressful life events among clinically depressed individuals during the course of treatment. Participants (N=68) were interviewed about life stressors experienced during a 3-month treatment protocol using a contextual approach (Life Events and Difficulties Schedule; [Brown, G. W., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. New York: Free Press]). Results suggested interactive effects between severity of depression and attachment style on stress associated with future sociotropic and dependent life events. Mildly depressed individuals who reported a dismissing attachment style (higher levels of avoidant attachment and lower levels of anxious attachment) or preoccupied style (lower levels of avoidant attachment and higher levels of anxious attachment) experienced higher levels of stress associated with sociotropic events. Likewise, a dismissing attachment style predicted stress associated with dependent events among mildly depressed individuals. These effects were not present among our more severely depressed participants.

Stress generation, avoidance coping, and depressive symptoms: a 10-year model

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.