The role of fathers in child and adolescent psychopathology: make room for daddy.

This review summarizes research concerning the relation between paternal factors and child and adolescent psychopathology. When compared with mothers, fathers continue to be dramatically underrepresented in developmental research on psychopathology. However, findings from studies of children of clinically referred fathers and nonreferred samples of children and their fathers indicate that there is substantial association between paternal characteristics and child and adolescent psychopathology. Findings from studies of fathers of clinically referred children are stronger for fathers' effects on children's externalizing than internalizing problems. In most cases the degree of risk associated with paternal psychopathology is comparable to that associated with maternal psychopathology. Evidence indicates that the presence of paternal psychopathology is a sufficient but not necessary condition for child or adolescent psychopathology.

Taxonomy, assessment, and diagnosis of depression during adolescence.

Research on depressive phenomena during adolescence has focused on 3 separate constructs: depressed mood, depressive syndromes, and depressive disorders. Approaches to the assessment, taxonomy, and diagnosis of these 3 conceptualizations are reviewed. Each of the approaches is represented by different assessment tools measuring related but distinct aspects of depressive phenomena. The constructs share a common set of symptoms reflecting negative affectivity but differ in their inclusion of symptoms of anxiety, somatic problems, and disrupted concentration and in the duration and severity of the symptoms they include. Depressed mood, syndromes, and disorders are integrated as 3 levels of depressive phenomena in a hierarchical and sequential model, and moderating factors are hypothesized to account for the relationships among the 3 levels. The need for a stronger developmental focus to understand depressive phenomena during adolescence is emphasized.

Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research.

Progress and issues in the study of coping with stress during childhood and adolescence are reviewed. Definitions of coping are considered, and the relationship between coping and other aspects of responses to stress (e.g., temperament and stress reactivity) is described. Questionnaire, interview, and observation measures of child and adolescent coping are evaluated with regard to reliability and validity. Studies of the association of coping with symptoms of psychopathology and social and academic competence are reviewed. Initial progress has been made in the conceptualization and measurement of coping, and substantial evidence has accumulated on the association between coping and adjustment. Problems still remain in the conceptualization and measurement of coping in young people, however, and aspects of the development and correlates of coping remain to be identified. An agenda for future research on child-adolescent coping is outlined.

Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment.

Associations between self-blame and anxiety and depression symptoms in a sample of 76 women with breast cancer were investigated. At diagnosis, behavioral self-blame was associated with increased distress; at 3 months postdiagnosis, characterological self-blame was positively associated with affective symptoms and behavioral self-blame approached significance (p = .07); and at 6 months, behavioral self-blame was related to increased distress. Prospective analyses revealed that characterological self-blame at diagnosis approached significance in predicting distress at 3 months (p = .055) and was significant in predicting distress at 6 months and at 1 year after diagnosis. These data indicate that behavioral self-blame is a correlate of concurrent affective symptoms, whereas characterological self-blame predicts increased distress over time. Implications for social-cognitive processes in adaptation to breast cancer are discussed.

When mom or dad has cancer: II. Coping, cognitive appraisals, and psychological distress in children of cancer patients.

Cognitive appraisals and coping were examined in children, adolescents, and young adults (N = 134) faced with the diagnosis of cancer in a parent. All 3 age groups perceived low personal control and high external control over their parent's illness and used relatively little problem-focused coping. Adolescents and young adults reported more emotion-focused coping and dual-focused coping (both problem- and emotion-focused in intent) than did preadolescent children. Stage and prognosis of parent's cancer were related to appraisals of greater seriousness and stressfulness, and to more avoidance; however, only appraisals of stress were related to symptoms of anxiety-depression. Emotion-focused coping was related to greater avoidance and to higher symptoms of anxiety-depression; coping and control beliefs did not interact in their association with anxiety-depression symptoms.

Predictors of cancer progression in young adult men and women: avoidance, intrusive thoughts, and psychological symptoms.

Psychological symptoms, avoidance, and intrusive thoughts were examined prospectively as predictors of cancer progression over a period of 1 year. Sixty-six male and female cancer patients who differed in their diagnoses and initial disease-severity ratings participated. Measures of psychological factors, disease severity, and type of treatment were obtained near time of diagnosis and disease status (no cancer, continued or recurrent cancer, or deceased) 1 year later. Cross-sectional analyses near the time of diagnosis showed that initial psychological variables were intercorrelated with one another but unrelated to initial disease prognosis. Longitudinal findings revealed that, after controlling for initial disease parameters and age, avoidance predicted disease status 1 year later; however, neither psychological symptoms nor intrusive thoughts and emotions accounted for additional variance in disease outcomes.

Psychological adjustment in breast cancer: processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I-Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis, and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted.

When mom or dad has cancer: markers of psychological distress in cancer patients, spouses, and children.

This study assessed anxiety/depression and stress response symptoms in adult cancer patients (n = 117), spouses (n = 76), and their children (n = 110, ages 6 to 30 years old) near the patients' diagnoses to identify family members at risk for psychological maladjustment. Patients' and family members' distress was related to appraisals of the seriousness and stressfulness of the cancer but not related to objective characteristics of the disease. Patients and spouses did not differ in anxiety/depression or in stress-response symptoms. Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient. Adolescent girls whose mothers had cancer were the most significantly distressed. Implications for understanding the impact of cancer on the family are highlighted.

Adolescents' subjective distress over their emotional/behavioral problems.

This study analyzed the relations among 151 7th- and 8th-grade adolescents' self-evaluations of the occurrence of their behavior, their own subjective distress over their behavior, their perceptions of their personal competence, their perceptions of their mothers' and fathers' distress over these behaviors, and their parents' reports of the occurrence of adolescent behaviors. As hypothesized, adolescents' self-reports of occurrence of their behaviors were significantly but moderately correlated with their subjective distress about these behaviors, and adolescents made a distinction between the occurrence of a behavior and their distress about it. Externalizing behaviors were rated by adolescents as more distressing to mothers and to fathers than to adolescents themselves, and conversely, internalizing behaviors were rated as more distressing to self than to parents. Ratings of subjective distress were significantly related to self-perceptions of behavioral conduct and self-worth, whereas parents' ratings of the occurrence of behavior were not related to these self-perceptions.

Stress and anxious-depressed symptoms among adolescents: searching for mechanisms of risk.

This study was an examination of the possible mechanisms of risk among adolescents (n = 55) exposed to the stress associated with the diagnosis of cancer in a parent. Girls whose mothers had cancer reported significantly more anxious-depressed symptoms than girls whose fathers were ill or boys whose mothers or fathers had cancer. Increased family responsibilities and the use of ruminative coping were examined as possible mechanisms leading to increased distress in girls with ill mothers. Although girls reported the use of more ruminative coping, rumination did not account for the impact of maternal cancer on girls' distress. Girls whose mothers were ill reported more stressful events reflecting family responsibilities. Furthermore, family responsibility stress fully accounted for the interaction of gender of the ill parent and gender of the adolescent in predicting anxious-depressed symptoms.

Risk factors for emotional/behavioral problems in young adolescents: a prospective analysis of adolescent and parental stress and symptoms.

Stressful events in the lives of 309 10- to 15-year-olds and stressful events and psychological symptoms reported by their parents were examined in a 9-month study. Ss' self-reported emotional/behavioral problems were predicted by their reports of stressful events and their fathers' reports of psychological symptoms in cross-sectional analyses. Analyses at follow-up after controlling for initial reports of emotional/behavioral problems and prospective analyses predicting from first assessment to follow-up yielded significant effects for Ss' self-reported stressful events. Mothers' reports of children's problems were predicted by mothers' psychological symptoms in cross-sectional analyses and at follow-up after controlling for initial emotional/behavioral problems. Only prior levels of maternal reports of emotional/behavioral problems predicted mothers' reports of their children's problems 9 months later.

Responses to stress in adolescence: measurement of coping and involuntary stress responses.

The development of a measure of coping and involuntary stress responses in adolescence is described. The Responses to Stress Questionnaire (RSQ) reflects a conceptual model that includes volitional coping efforts and involuntary responses to specific stressful events or specified domains of stress. The psychometric characteristics of the RSQ were examined across 4 domains of stress in 3 samples of adolescents and parent reports obtained in 2 samples. The factor structure of the RSQ was tested and replicated with an adequate degree of fit using confirmatory factor analysis across 3 stressors in 2 samples. Internal consistency and retest reliability for the 5 factors were adequate to excellent. Concurrent validity was established through correlations with another measure of coping, heart rate reactivity, and correlations of self- and parent-reports. Significant correlations with both adolescents' and parents' reports of internalizing and externalizing symptoms were consistent with hypotheses.

Covariation of the anxious-depressed syndrome during adolescence: separating fact from artifact.

Nosological (symptom overlap) and methodological (informant) artifact in the covariation of an empirically derived syndrome of anxious-depressed symptoms with 7 other syndromes of emotional and behavior problems was examined in reports by parents, teachers, and adolescents on a nationally representative sample of 908 adolescents. Although minor symptom overlap was observed and the effects of informant were significant, the anxious-depressed syndrome covaried significantly with all other syndromes after controlling for these effects. Indices of covariation controlling for informant effects were all significant and ranged for all syndromes except for delinquent behavior from .619 to .681, reflecting significant covariation of the anxious-depressed syndrome with both externalizing and internalizing syndromes. Covariation of the anxious-depressed syndrome and delinquent behavior was .470. Implications for research on the comorbidity-covariation of depressive syndromes during childhood and adolescence are highlighted.

Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa.

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths.

Gender differences in depressed mood, a syndrome of mixed anxiety-depression, and an analogue of major depressive disorder were compared in parents' and adolescents' reports in 2 large, demographically matched national samples of clinically referred and nonreferred adolescents. Referral status accounted for the greatest share of the variance in these problems. Gender differences were moderate in size and consistent in referred youths, with referred girls scoring higher than referred boys on all measures, whereas gender differences in nonreferred adolescents were either nonsignificant or small in magnitude. Gender differences were also larger in magnitude in adolescents' self-reports than in parents' reports. The interaction of age and gender was nonsignificant in all analyses. Implications for understanding the extent of gender differences in adolescents' depressive symptoms are highlighted.

Depression in adolescence.

Adolescence is an important developmental period for understanding the nature, course, and treatment of depression. Recent research concerned with depressive mood, syndromes, and disorders during adolescence is reviewed, including investigations of the prevalence, course, risk factors, and prevention and treatment programs for each of these three levels of depressive phenomena in adolescence. A broad biopsychosocial perspective on adolescent depression is recommended, and possible directions for future integrative research are proposed. Based on current research and knowledge, implications for research, program, and national policy are considered.

Adult daughters of alcoholics: are they unique?

To test the assertion in the clinical literature that adult children of alcoholics (ACOAs) are uniquely impacted by their parents' alcohol abuse, 25-35 year old daughters (N = 184) of alcohol-abusing, psychiatrically distressed, comorbid and normal parents were compared on measures of fear of intimacy, generalized psychological distress, perceived love inconsistency from parents and perceived interparental conflict. Neither fear of intimacy nor daughters' psychological distress differed across groups. Daughters of psychiatrically distressed and comorbid mothers recalled greater love inconsistency from mother than from father. Daughters of psychiatrically distressed and comorbid fathers recalled greater interparental conflict and daughters of comorbid fathers recalled greater love inconsistency from fathers than did daughters of alcoholic fathers. The proposed unique features of ACOA daughters and of the alcoholic family environment were not identified. The findings are discussed in terms of the clinical literature on ACOAs.

Coping and attention: implications for child health and pediatric conditions.

Child health and illness are best conceptualized in terms of the interaction of biological, psychological, and social processes. Among the central factors in biopsychosocial models of health and illness are processes of coping and attention in response to stress. As a guide to research on biopsychosocial processes in child health and illness, a dual-process model of responses to stress is described, distinguishing between stress responses that are involuntary/automatic and those responses that are voluntary/controlled. Research on coping with stress is briefly reviewed, along with research on attentional processes in response to stress. The relationships between coping and attention are highlighted, along with the implications of this research for understanding children's health and illness. Throughout the article, examples are drawn from research on pediatric recurrent abdominal pain to illustrate important aspects of coping and attention.

Children's and parents' daily stressful events and psychological symptoms.

Associations of children's daily stressful events and their parents' daily hassles and psychological symptoms with children's emotional/behavioral problems were examined in a sample of fourth- and fifth-grade children and their parents. Correlational analyses indicated that children's self-reports of depressive symptoms were associated with children's daily stressors and mothers' daily hassles, and children's self-reports of anxiety symptoms were associated with children's daily stressors and both mothers' and fathers' daily hassles. Mothers' and fathers' reports of their children's internalizing emotional/behavioral problems were correlated with mothers' and fathers' daily stressors and symptoms. Hierarchical multiple-regression analyses revealed that (a) children's self-reports of depressive symptoms were associated with children's daily stressors, (b) children's self-reports of anxiety symptoms were associated with their parents' daily hassles, (c) mothers' reports of their children's internalizing emotional/behavioral problems were marginally associated with parents' symptoms, and (d) fathers' reports of their children's internalizing emotional/behavioral problems were associated with parents' symptoms and children's self-reports of daily stressors.

Parent and child causal attributions related to the child's clinical problem.

Parents and children were asked to give causal attributions related to the child's learning or behavior problems and an area of success. Actor-observer differences and tendencies of actors to make differential attributions for their positive and negative outcomes were examined. A significant number of parents and children were in disagreement regarding the cause of the child's problem. Parents made significantly more internal than external attributions for children's presenting problems. In contrast, children were evenly distributed in problem attributions. Both parents and children made significantly more internal success attributions. Research with clinical child populations is highlighted as a valuable way to validate, expand, and refine attribution theory while clarifying its practical applications.