Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model.

Anxiety and depressive symptoms frequently co-occur in adolescence and confer greater distress compared to experiencing either symptom alone. A causal model (anxiety symptoms predicting depressive symptoms), a correlated liabilities model (vulnerabilities interacting with stressors to predict both symptoms), and a diathesis-anxiety model (vulnerabilities interacting with anxiety symptoms to predict depressive symptoms) have all been proposed as explanations for the relation between depression and anxiety. To date, however, research has mostly examined these models among North American/Western European adolescents. In response, the present study sought to identify the best explanatory model concerning the relationship between anxiety and depressive symptoms among Chinese adolescents. 494 10th grade students were assessed for their perceived levels of family cohesion and conflict, stressors, and depressive and anxiety symptoms. Every 3 months for 18 months, youth reported their symptoms and stressors. Symptoms and stressors were person-mean and grand-mean centered to compare nomothetic and idiographic conceptualizations of vulnerability. Overall, evidence suggested a reciprocal, versus causal, relation between anxiety and depressive symptoms. Further, while cohesion and conflict independently predicted anxiety and depressive symptoms, their interactions with stressors were not supported. Ultimately, strong support was found for a diathesis-anxiety model using an idiographic conceptualization of anxiety, such that low perceived family cohesion interacted with within-subject fluctuations of anxiety to predict prospective depressive symptoms. This study provides cross-cultural support for a diathesis-anxiety model and shows the importance of distinguishing between positive and negative family functioning when examining vulnerability in Chinese adolescents. Research and clinical implications of these findings are discussed.

Predictors of Stress Generation in Adolescents in Mainland China.

The current longitudinal study examined whether the personality vulnerabilities of self-criticism and dependency prospectively predicted stress generation in Chinese adolescents. Participants included 1,116 adolescents (588 girls and 528 boys), aged 15 to 18 years from rural, urban and ultra-urban mainland China. Participants completed self-report measures of personality, depressive and anxious symptoms and participated in a clinical interview assessing lifetime history of depression. The occurrence of negative life events was measured using a contextual-threat interview every 6-months for a total period of 18-months. Logistic regression analyses showed that after controlling for past depressive episodes and current depressive and anxious symptoms, self-criticism was prospectively associated with the occurrence of interpersonal stress generation, but not noninterpersonal stress generation. Dependency also predicted interpersonal stress generation, although only in girls and not boys. In line with previous Western findings, girls reported more interpersonal stress generation. Analyses across 3 levels of urbanization revealed several significant differences including higher reported interpersonal stress generation in urban girls than urban boys and overall higher levels of negative life events in ultra-urban youth. In sum, findings from the current study suggest that the stress generation process may be generalizable to Chinese youth.

Emotional Awareness: A Transdiagnostic Predictor of Depression and Anxiety for Children and Adolescents.

Research increasingly suggests that low emotional awareness may be associated with symptoms of depression and anxiety among children and adolescents. However, because most studies have been cross-sectional, it has remained unclear whether low emotional awareness predicts subsequent internalizing symptoms. The current study used longitudinal data to examine the role of emotional awareness as a transdiagnostic predictor of subsequent symptoms of depression and anxiety. Participants were 204 youth (86 boys and 118 girls) ages 7-16 who completed self-report measures of emotional awareness, depressive symptoms, and anxiety symptoms at baseline, as well as measures of depression and anxiety symptoms every 3 months for a year. Results from hierarchical mixed effects modeling indicated that low baseline emotional awareness predicted both depressive and anxiety symptoms across a 1-year period. These findings suggest that emotional awareness may constitute a transdiagnostic factor, predicting symptoms of both depression and anxiety, and that emotional awareness training may be a beneficial component of treatment and prevention programs for youth depression and anxiety.

Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress.

Depression is a debilitating mental illness with clear developmental patterns from childhood through late adolescence. Here, we present data from the Gene Environment Mood (GEM) study, which used an accelerated longitudinal cohort design with youth (N = 665) starting in 3rd, 6th, and 9th grades, and a caretaker, who were recruited from the general community, and were then assessed repeatedly through semistructured diagnostic interviews every 6 months over 3 years (7 waves of data) to establish and then predict trajectories of depression from age 8 to 18. First, we demonstrated that overall prevalence rates of depression over time, by age, gender, and pubertal status, in the GEM study closely match those trajectories previously obtained in past developmental epidemiological research. Second, we tested whether a genetic vulnerability-stress model involving 5-HTTLPR and chronic peer stress was moderated by developmental factors. Results showed that older aged adolescents with SS/SL genotype, who experienced higher peer chronic stress over 3 years, were the most likely to be diagnosed with a depressive episode over time. Girls experiencing greater peer chronic stress were the most likely to develop depression. This study used repeated assessments of diagnostic interviewing in a moderately large sample of youth over 3 years to show that depression rates increase in middle to late adolescence, or postpubertally, and that the gender difference in depression emerges earlier in adolescence (age 12.5), or postpubertally. Additionally, genetically susceptible older adolescents who experience chronic peer stress were the most likely to become depressed over time.

The Development of Self-Criticism and Dependency in Early Adolescence and Their Role in the Development of Depressive and Anxiety Symptoms.

According to Blatt and others (e.g., A. T. Beck), self-definition, or one's sense of self, and one's sense of relatedness to others represent core lifespan developmental tasks. This study examined the role of events pertaining to self-definition or relatedness in the development of personality traits from each domain (self-criticism and dependency), and their relationship to the development of depressive and anxiety symptoms. Two hundred seventy-six early adolescents completed a measure of self-criticism and dependency at baseline and again 24 months later, along with measures of depressive and anxiety symptoms. Every 3 months, participants completed a measure of life events, which were coded as self-definitional or relatedness oriented (80% rater agreement, kappa = .70). Structural equation models showed that self-definitional events predicted increases in self-criticism, which in turn predicted increases in depressive symptoms, whereas relatedness events predicted increases in dependency, although dependency was unrelated to change in symptoms.

Interpersonal Risk Profiles for Youth Depression: A Person-Centered, Multi-Wave, Longitudinal Study.

Independent lines of research illustrate the benefits of social support and the negative consequences of conflict and emotional neglect across family and peer contexts with regard to depression. However, few studies have simultaneously examined negative and positive interactions across relationships. We sought to address this gap in the literature by utilizing a person-centered approach to a) understand empirical, interpersonal profiles in youth and b) understand how these profiles confer risk for prospective depression. At baseline, 678 youth (380 females; 298 males) 3rd (N = 208), 6th (N = 245), and 9th graders (N = 225) completed self-report measures for self-perceived negative/positive relationships across family and peers, anxiety symptoms, and depressive symptoms in a laboratory setting. Next, youth were called every 3 months for 18 months and completed self-report depressive and anxiety symptom forms. Two-step cluster analyses suggested that children and adolescents fell into one of three interpersonal clusters, labeled: Support, Conflict, and Neglect. Our analyses supported a convergence model in which the quality of relationship was consistent across peers and family. Furthermore, mixed-level modeling (MLM) findings demonstrated that youth in the Conflict cluster were at increased risk for prospective depressive symptoms, while the Supported and Neglected profiles demonstrated similar symptom levels. Findings were unique to depressive symptoms and consistent across sex and age. Conflict seemed to uniquely confer risk for depression as findings concerning anxiety were not significant. These findings influence our interpersonal conceptualization of depression as well as clinical implications for how to assess and treat depression in youth.

Trajectories of suicide ideation and nonsuicidal self-injury among adolescents in mainland China: Peer predictors, joint development, and risk for suicide attempts.

OBJECTIVE: This study expanded knowledge about the development of suicide ideation and nonsuicidal self-injury (NSSI) among adolescents by investigating (a) peer experiences as predictors of trajectories of suicide ideation and NSSI, (b) the joint development of suicide ideation and NSSI, and (c) the risk for suicide attempts (SA) across joint trajectories of suicide ideation and NSSI. METHOD: At baseline, 565 tenth-grade Chinese adolescents (48.3% males) reported depressive symptoms and friend support. Moreover, peer victimization and friendships were assessed using a sociometric procedure. After baseline, participants completed measures of suicide ideation, NSSI, and SA every 3 months for 2 years. RESULTS: Three similar trajectories of suicide ideation and NSSI were identified. After accounting for depressive symptoms, peer victimization differentiated adolescents in the high trajectory of suicide ideation and NSSI from those in the low and moderate trajectories of suicide ideation and NSSI, respectively. Friend support and friendlessness distinguished between the high and low and the moderate and low NSSI trajectories, respectively. Joint trajectory models revealed a strong overlap between the course of suicide ideation and NSSI: Adolescents in the chronically high suicide ideation trajectory were at the highest risk to follow a chronically high NSSI trajectory and vice versa. Finally, adolescents in the joint chronically high trajectory were approximately 5 times more likely to report SA than were their peers, above and beyond prior SA. CONCLUSIONS: Findings highlight the role of negative peer experiences as risk factors for NSSI and suicide ideation, which, in turn, can potentially increase risk for SA. (PsycINFO Database Record

Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset.

Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

Depressogenic thinking and shame proneness in the development of internalizing problems.

This study examined depressogenic thinking and shame proneness as factors in the development of internalizing problems in a longitudinal sample of 174 children (99 boys, 75 girls). At 7.6-9.4 years of age (Time 1), mothers assessed general internalizing problems in their children and depressogenic thinking, shame proneness, and anxiety were assessed by child self report. At 10.2-11.8 years of age (Time 2), mothers reassessed internalizing problems, and children reported their anxiety and depression. At 12.3-13.1 years of age (Time 3), children who had been high on any Time 2 measure of internalizing problems were selected for assessment of anxiety and depressive disorders. Depressogenic thinking and shame were significantly correlated and predicted subsequent problems. Depressogenic thinking predicted internalizing problems and anxious and depressive symptoms. Shame directly predicted boys' depressive symptoms, and indirectly predicted boys' general internalizing problems and girls' social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. Findings suggest that both shame and depressive thinking contribute to the development of children's internalizing problems.

Nonsuicidal self-injury in adolescence: longitudinal course, trajectories, and intrapersonal predictors.

Although prevalence rates of nonsuicidal self-injury (NSSI) has been established throughout adolescence, little is known about the progression of NSSI, and consequently, about the risk factors for youth NSSI engagement. This study aimed to describe the overall longitudinal course of NSSI and the latent trajectory classes of NSSI in a population-based sample of adolescents using multi-wave data. Moreover, this study examined whether sex, lifetime history of depression, rumination, and negative attributional style predicted the longitudinal course of NSSI and trajectory group membership. Participants were 617 Chinese adolescents in Grades 10 through 12 (51.4 % girls). NSSI was assessed across eight waves of data. History of depression, rumination, and negative attributional style were assessed at baseline. Latent growth curve modeling revealed that only lifetime depression predicted the longitudinal course of NSSI from Grades 10 to 12, with depressed adolescents showing greater and more stable NSSI engagement over time than non-depressed adolescents. Group-based trajectory modeling yielded three distinct trajectory classes of NSSI engagement: low (69.2 %), moderate (26.1 %), and chronic (4.7 %). Negative attributional style distinguished adolescents in the chronic vs. low and moderate NSSI trajectory classes. Sex, rumination, and lifetime depression predicted membership in the chronic and/or moderate vs. low NSSI trajectory class. NSSI trajectory classes, based on frequency of NSSI, exist and are differentiated by sex, depression history, rumination, and negative attributional style. This study suggests that during this period of adolescence NSSI may be a relatively stable behavior, especially for some adolescents. Negative attributional style may be a salient risk factor for chronic NSSI engagement.

Self-Structures, Negative Events, and Adolescent Depression: Clarifying the Role of Self-Complexity in a Prospective, Multiwave Study.

The purpose of this multiwave longitudinal study was to examine the structure of self-complexity, and its relation to depressive symptoms, in 276 adolescents (M = 12.55; SD = 1.04). Self-complexity, depressive symptoms, and negative events were assessed during a laboratory assessment at baseline, and then depressive symptoms and negative events were tracked every 3 months over the next 2 years. Findings from the present research showed that girls had higher levels of Overlap (e.g., the degree to which one sees his or her roles as similar) and NASPECTS (the number of aspects) compared with boys, and that older adolescents had lower levels of Overlap. Furthermore, the present study demonstrated that low levels of positive Overlap (e.g., utilizing the same positive adjectives to describe numerous roles) predicted depressive symptoms, especially in the presence of negative events. Other findings along with developmental and clinical implications for this research are discussed.

Why are anxiety and depressive symptoms comorbid in youth? A multi-wave, longitudinal examination of competing etiological models.

BACKGROUND: The present study sought to clarify the development of comorbid emotional distress by comparing different explanations for how youth develop anxiety and depressive symptoms. Specifically, we introduced the diathesis-anxiety approach (whether cognitive vulnerabilities interact with anxiety symptoms), and compared it to a causal model (anxiety symptoms predicting depressive symptoms), and a correlated liabilities model (whether cognitive vulnerabilities interacted with stressors to predict both anxiety and depressive symptoms) to examine which model best explained the relation between depressive and anxiety symptoms in youth. METHODS: 678 3rd (n=208), 6th (n=245), and 9th (n=225) grade girls (n=380) and boys (n=298) completed self-report measures at baseline assessing cognitive vulnerabilities (rumination and self-criticism), stressors, depressive and anxiety symptoms. Every 3 months over the next 18 months, youth completed follow-up measures of symptoms and stressors. RESULTS: While limited support was found for a causal (p>0.10) or correlated-liability model (p>0.05) for comorbidity, findings did support a diathesis-anxiety approach for both self-criticism (t(2494)=3.36, p<0.001) and rumination (t(2505)=2.40, p<0.05). LIMITATIONS: The present study׳s findings are based on self-report measure and makes inferences concerning comorbidity with a community sample. CONCLUSIONS: These results may help clarify past research concerning comorbidity by introducing a diathesis-anxiety approach as a viable model to understand which youth are most at-risk for developing comorbid emotional distress.

PERSONALITY PREDISPOSITIONS IN CHINESE ADOLESCENTS: THE RELATION BETWEEN SELF-CRITICISM, DEPENDENCY, AND PROSPECTIVE INTERNALIZING SYMPTOMS.

The present study examined the prospective relation between two personality predispositions, self-criticism and dependency, and internalizing symptoms. Specifically, it was examined whether self-criticism and dependency predicted symptoms of depression and social anxiety, and if a moderation (e.g. diathesis-stress) or mediation model best explained the relation between the personality predispositions and emotional distress in Chinese adolescents. Participants included 1,150 adolescents (597 females and 553 males) from mainland China. Participants completed self-report measures of self-criticism, dependency, and neuroticism at baseline, and self-report measures of negative events, depressive symptoms, and social anxiety symptoms once a month for six months. Findings showed that self-criticism predicted depressive symptoms, while dependency predicted social anxiety symptoms. In addition, support was found for a mediation model, as opposed to a moderation model, with achievement stressors mediating the relation between self-criticism and depressive symptoms. Overall, these findings highlight new developmental pathways for the development of depression and social anxiety symptoms in mainland Chinese adolescents. Implications for cross-cultural developmental psychopathology research are discussed.

Negative attachment cognitions and emotional distress in mainland Chinese adolescents: a prospective multiwave test of vulnerability-stress and stress generation models.

The present study examined the relation between attachment cognitions, stressors, and emotional distress in a sample of Chinese adolescents. Specifically, it was examined whether negative attachment cognitions predicted depression and anxiety symptoms, and if a vulnerability-stress or stress generation model best explained the relation between negative attachment cognitions and internalizing symptoms. Participants included 558 adolescents (310 females and 248 males) from an urban school in Changsha and 592 adolescents (287 female, 305 male) from a rural school in Liuyang, both in Hunan province located in mainland China. Participants completed self-report measures of negative attachment cognitions at baseline, and self-report measures of negative events, depression symptoms, and anxiety symptoms at baseline and at regular 1-month intervals for an overall 6-month follow-up (i.e., six follow-up assessments). Higher levels of negative attachment cognitions predicted prospective depression and anxiety symptoms. Furthermore, support was found for a stress generation model that partially mediated this longitudinal association. No support was found for a vulnerability-stress model. Overall, these findings highlight new developmental pathways for development of depression and anxiety symptoms in mainland Chinese adolescents.

Rates of nonsuicidal self-injury in youth: age, sex, and behavioral methods in a community sample.

OBJECTIVE: The goal was to assess the rate and behavioral methods of nonsuicidal self-injury (NSSI) in a community sample of youth and examine effects of age and sex. METHODS: Youth in the third, sixth, and ninth grades (ages 7-16) at schools in the community were invited to participate in a laboratory study. A total of 665 youth (of 1108 contacted; 60% participation rate) were interviewed about NSSI over their lifetime via the Self-Injurious Thoughts and Behaviors Interview. RESULTS: Overall, 53 (8.0%) of the 665 youth reported engaging in NSSI; 9.0% of girls and 6.7% of boys reported NSSI engagement; 7.6% of third-graders, 4.0% of sixth-graders, and 12.7% of ninth-graders reported NSSI engagement. There was a significant grade by gender interaction; girls in the ninth grade (19%) reported significantly greater rates of NSSI than ninth-grade boys (5%). Behavioral methods of NSSI differed by gender. Girls reported cutting and carving skin most often, whereas boys reported hitting themselves most often. Finally, 1.5% of youth met some criteria for the proposed fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of NSSI. CONCLUSIONS: Children and adolescents engage in NSSI. Ninth-grade girls seem most at risk, as they engage in NSSI at 3 times the rate of boys. Behavioral methods of NSSI also vary by grade and gender. As possible inclusion of an NSSI diagnosis in the fifth edition of the DSM-5 draws near, it is essential to better understand NSSI engagement across development and gender.

Personality predispositions to depression in children of affectively-ill parents: the buffering role of self-esteem.

A major theory of personality predispositions to depression posits that individuals who possess high levels of self-criticism and/or dependency are vulnerable to developing depression following negative life events. The goal of the current study was to test this theory of personality predispositions and the self-esteem buffering hypothesis in a sample of youth using an idiographic approach, a high-risk sample, and a multiwave longitudinal design. One hundred forty children aged 6 to 14 completed measures of dependency, self-criticism, self-esteem, and depressive symptoms. Over the course of the following year, 8 follow-up assessments were conducted 6 weeks apart during which all children were administered measures assessing depressive symptoms and the occurrence of negative events. Results of hierarchical linear modeling analyses indicated that higher levels of dependency were associated with greater increases in depressive symptoms following negative events among children possessing low, but not high, self-esteem. In contrast, self-criticism was not associated with changes in depressive symptoms over time regardless of children's levels of stress and/or self-esteem.

Assessing measurement invariance of the children's depression inventory in Chinese and Italian primary school student samples.

This study tested the measurement invariance of Children's Depression Inventory (CDI) and compared its factorial variance/covariance and latent means among Chinese and Italian children. Multigroup confirmatory factor analysis of the original five factors identified by Kovacs revealed that full measurement invariance did not hold. Further analysis showed that 4 of 21 factor loadings, 14 of 26 intercepts, and 12 of 26 item errors were noninvariant. Factor variance and covariance invariant tests revealed significant differences between Chinese and Italian samples. The latent factor mean comparison suggested no significant difference across the two groups. Nevertheless, the finding of partial metric and scalar invariance suggested that observed mean differences on the CDI items cannot be fully explained by the mean differences in the latent factor. These results suggest that researchers and practitioners exercise caution when gauging the size of the true national population differences in depressive symptoms among Italian and Chinese children when assessed via CDI. In addition to providing needed evidence on the use of the CDI in Italian and Chinese children specifically, the methods used in this research can serve more generally as an example for other cross-cultural assessment research to test structural equivalence and measurement invariance of scales and to determine why it is important to do so.

Multi-wave prospective examination of the stress-reactivity extension of response styles theory of depression in high-risk children and early adolescents.

The current study tested the stress-reactivity extension of response styles theory of depression (Nolen-Hoeksema Journal of Abnormal Psychology 100:569-582, 1991) in a sample of high-risk children and early adolescents from a vulnerability-stress perspective using a multi-wave longitudinal design. In addition, we examined whether obtained results varied as a function of either age or sex. During an initial assessment, 56 high-risk children (offspring of depressed parents; ages 7-14) completed measures assessing rumination and depressive symptoms. Children were subsequently given a handheld personal computer which signalled them to complete measures assessing depressive symptoms and negative events at six randomly selected times over an 8-week follow-up interval. In line with hypotheses, higher levels of rumination were associated with prospective elevations in depressive symptoms following the occurrence of negative events. Sex, but not age, moderated this association. Rumination was more strongly associated with elevations in depressive symptoms following the occurrence of negative events in girls than in boys.

Rumination and Excessive Reassurance Seeking: Investigation of the Vulnerability Model and Specificity to Depression.

Recent research investigating cognitive and interpersonal models of depression have conceptualized rumination and excessive reassurance seeking (ERS) as vulnerabilities for the etiology of depression. However, research testing the vulnerability hypothesis for these constructs among youth is lacking. Additionally, the specificity of rumination and excessive reassurance seeking to depression is unclear. Two studies investigated associations between these constructs to depression and anxiety. In Study 1, concurrent associations between these constructs and depressive and anxious arousal were examined among 194 minority, underserved youth. Study 2 examined concurrent and longitudinal associations between both constructs and depressive and general anxiety symptoms in a community sample of 402 youth. Results from both studies supported rumination as a specific vulnerability for depressive symptoms, whereas ERS appeared to be a concomitant of negative affect common to depressive and anxiety symptoms. Findings inform cognitive and interpersonal theories of depression by advancing knowledge of how rumination and ERS relate to aspects of internalizing problems among diverse populations of youth.

Chronic family stress interacts with 5-HTTLPR to predict prospective depressive symptoms among youth.

BACKGROUND: Previous research, predominantly with adults, has shown that the serotonin transporter gene (5-HTTLPR) interacts with stress (G × E) to predict depressive symptoms; however, few G × E studies have been conducted with youth using rigorous methods, particularly a prospective design and contextual interview to assess stress. This study examined the interaction between 5-HTTLPR and stress, both chronic and episodic, to predict longitudinal change in depressive symptoms among children and adolescents. METHODS: A general community sample of youth (N = 200; 57% girls; mean age: 12.09 years old) was genotyped for 5-HTTLPR (rs 25531) at baseline. They were interviewed via contextual stress procedures to ascertain chronic family stress and episodic stressors and completed depressive symptoms questionnaires at baseline and 6 months later. RESULTS: A significant G × E showed that chronic family stress predicted prospective increases in depressive symptoms over 6 months among youth possessing the high-risk S allele. This G × E was not found for episodic stressors occurring in the last 6 months. There was no moderation by sex or pubertal status. CONCLUSIONS: These findings advance knowledge on G × E effects in depression among youth. This is the first study to show that chronic family stress, but not episodic stressors, when ascertained by rigorous stress interview, interacts with 5-HTTLPR to prospectively predict depressive symptoms among children and adolescents.