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.

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.

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.

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.

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.

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.

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.

Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2½ year longitudinal study.

Little is known about which risk factors longitudinally predict non-suicidal self-injury (NSSI) during adolescence, a period when these self-injurious behaviors become alarmingly prevalent. We prospectively studied the rates, course, and longitudinal prediction of NSSI from early through middle adolescence with a community sample of 103 youth (ages 11-14) who were assessed for NSSI at baseline and 2 ½ years later (94% retention; final N=97). Multiple risk factors (temperament, cognitive and interpersonal vulnerabilities, stressors; youths' and mothers' depression) were examined as prospective predictors of NSSI over the 2½ year follow-up. Analyses showed that 18% of youth engaged in NSSI over the 2½-year follow-up; 14% for the first time. Distal risks (assessed at baseline) that differentiated youth who engaged in NSSI from those who did not included negative cognitive style and mothers' prior depression. Proximal factors (assessed 2 years after baseline) that differentiated NSSI from non-NSSI youth included stressors, depressive symptoms, poor relationship quality, excessive reassurance seeking, and mothers' onset of depression. Several of these factors predicted new engagement of NSSI over 2½ years.

Interaction of 5-HTTLPR and idiographic stressors predicts prospective depressive symptoms specifically among youth in a multiwave design.

5-HTTLPR, episodic stressors, depressive and anxious symptoms were assessed prospectively (child and parent report) every 3 months over 1 year (5 waves of data) among community youth ages 9 to 15 (n = 220). Lagged hierarchical linear modeling analyses showed 5-HTTLPR interacted with idiographic stressors (increases relative to the child's own average level over time), but not nomothetic stressors (higher stress exposure relative to the sample), to predict prospective elevations in depressive, but not anxious, symptoms. Youth with copies of the S or L(G) alleles of 5-HTTLPR, who experienced more stressors relative to their typical level, exhibited prospective increases in depressive symptoms over time. These findings suggest that 5-HTTLPR confers susceptibility to depression via stress reactivity.

The effects of rumination on the timing of maternal and child negative affect.

The current study examined whether rumination serves as a moderator of the temporal association between maternal and child negative affect. Participants included 88 mothers with a history of major depressive episodes and their 123 children. During an initial assessment, mothers and their children completed measures assessing negative affect and children completed a measure assessing the tendency to ruminate in response to such symptoms. Every 6 weeks for the subsequent year, mothers and their children completed measures assessing negative affect. Consistent with hypotheses, children with a ruminative response style were more likely than other children to report elevations in negative affect when their mothers' level of negative affect increased over time. Neither child gender nor mothers' current clinical depression status moderated the association between child rumination and maternal negative affect.

A prospective study of cognitive emotion regulation strategies and depressive symptoms in patients with essential hypertension.

The objective of the current study was to examine the relationships between cognitive emotion regulation strategies and depressive symptoms in essential hypertension patients. Both cross-sectional and prospective relationships were studied in a sample of 650 essential hypertension patients. The cognitive emotion regulation strategies accounted for considerable amounts of variance in depressive symptoms. The following subscales were significantly positively correlated with first-time measurement and follow-up measurement of depressive symptoms: self-blame, rumination, catastrophizing, and blaming others. Positive reappraisal was significantly and positively correlated with first-time measurement of depressive symptoms. In contrast, the following subscales were significantly negatively correlated with follow-up measurement of depressive symptoms: acceptance, positive refocus, refocus on planning, positive reappraisal. Results of multiple regression analyses shows that elevated levels of self-blame, rumination, catastrophizing, and blaming others predicted increases in follow-up measurement of depressive symptoms, while elevated levels of acceptance and refocus on planning predicted decreases follow-up measurement of depressive symptoms. These findings provide us with important targets for intervention programs.

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.

Coping flexibility in college students with depressive symptoms.

BACKGROUND: The current study explored the prevalence of depressed mood among Chinese undergraduate students and examined the coping patterns and degree of flexibility of flexibility of such patterns associated with such mood. METHODS: A set of questionnaire assessing coping patterns, coping flexibility, and depressive symptoms were administered to 428 students (234 men and 194 women). RESULTS: A total of 266 participants both completed the entire set of questionnaires and reported a frequency of two or more stressful life events (the criterion needed to calculate variance in perceived controllability). Findings showed that higher levels of depressive symptoms were significantly associated with higher levels of both event frequency (r = .368, p < .001) and event impact (r = .245, p < .001) and lower levels of perceived controllability (r = -.261, p < .001), coping effectiveness (r = -.375, p < .001), and ratio of strategy to situation fit (r = -.108, p < .05). Depressive symptoms were not significantly associated with cognitive flexibility (variance of perceived controllability; r = .031, p = .527), Gender was not a significant moderator of any of the reported associations. CONCLUSIONS: Findings indicate that Chinese university students with depressive symptoms reported experiencing a greater number of negative events than did non-depressed university students. In addition, undergraduates with depressive symptoms were more likely than other undergraduates to utilize maladaptive coping methods. Such findings highlight the potential importance of interventions aimed at helping undergraduate students with a lower coping flexibility develop skills to cope with stressful life events.

Understanding the role of coping in the development of depressive symptoms: symptom specificity, gender differences, and cross-cultural applicability.

OBJECTIVES: The primary aim examined whether coping deficits, a greater tendency to utilize maladaptive as opposed to adaptive coping strategies, was associated with increases in depressive symptoms following negative events. The secondary goals examined: the common vulnerability hypothesis, sex differences, and the cross-cultural generalizability. DESIGN: Following the initial assessment, Canadian adolescents completed three follow-up assessments every 6 weeks. The Chinese adolescents completed an initial assessment and six follow-up assessments occurring monthly. METHODS: At Time 1, 150 Canadian and 397 Chinese adolescents completed self-report measures assessing depressive symptoms, anxious symptoms, negative events, and coping. During each of the follow-up assessments, participants completed self-report measures assessing depressive symptoms, anxious symptoms, and negative events. RESULTS: In both samples, higher levels of coping deficits were associated with increases in depressive, but not anxious, symptoms following negative events. Gender differences did not emerge. CONCLUSIONS: The present study provides a theoretically driven model to examine the impact of broad-based coping on the development of depressive symptoms.

The cost of materialism in a collectivistic culture: predicting risky behavior engagement in Chinese adolescents.

The goals of the current study were to examine whether (a) negative events mediate the relationship between materialism and risky behavior engagement and (b) materialism moderates the relationship between stress and engagement in risky behaviors in Chinese youth. At Time 1, 406 adolescents (ages 14-19) from Yue Yang, China, completed measures assessing engagement in risky behaviors and the occurrence of negative events. Follow-up assessments occurred once a month for 6 months. In line with our hypotheses, results of hierarchical linear modeling analyses indicated that higher levels of negative events mediated the relationship higher levels of materialism and greater risky behavior engagement. In addition, adolescents who exhibited higher levels of materialism were more likely than adolescents possessing lower levels of materialism to report increased engagement in risky behaviors in response to negative life events. At the same time, the effect was only present in boys. Unexpectedly, girls who reported lower levels of materialism also exhibited increased engagement in risky behaviors in response to negative events.

Rumination as a vulnerability factor to depression in adolescents in mainland China: lifetime history of clinically significant depressive episodes.

The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and neuroticism as well as a semistructured clinical interview assessing current and past clinically significant depressive episodes. Higher levels of rumination were associated with a greater likelihood of exhibiting both a current depressive episode and a past history of depressive episodes even after controlling for neuroticism. Higher levels of rumination were also associated with greater severity and duration of current depressive episodes and greater severity of past depressive episodes even after controlling for neuroticism. Contrary to the sex differences hypothesis of the response styles theory, girls and boys did not differ in levels of rumination.

Coping and involuntary responses to stress in Chinese university students: psychometric properties of the responses to stress questionnaire.

Our objective in this study was to develop a Chinese version of the Responses to Stress Questionnaire (RSQ; Connor-Smith, Compas, Wadsworth, Thomsen, and Saltzman, 2000) and to evaluate its reliability and validity. The Chinese (C) RSQ (RSQ-C) exhibited moderate internal consistency and moderate test-retest reliability. Results of the confirmatory factor analyses indicated that the fit of a 3-factor model of voluntary coping and a separate 2-factor model of involuntary responses to stress were acceptable for the Chinese university sample. With regard to predictive validity, the Primary and Secondary Control Engagement Coping factors were associated with lower levels of depressive and anxious symptoms, whereas the Disengagement, Involuntary Engagement, and Involuntary Disengagement Coping factors were associated with higher levels of such symptoms.

Development and validation of the revised Children's Dysfunctional Attitudes Scale.

OBJECTIVES: The primary goals of the current study were to examine (a) the factor structure and reliability of the Children's Dysfunctional Attitudes Scale (CDAS) in a sample of children and early adolescents and (b) the reliability of the factor structure in two additional independent samples at different developmental stages. DESIGN: In Phase 1, we conducted a factor analysis using maximum likelihood factor extraction and promax rotation to explore the underlying structure of the 40-item CDAS. In Phase 2, we conducted a confirmatory factor analysis on the factors obtained in Phase 1. METHODS: In Phase 1, 140 children (ages 6-14) of affectively ill parents completed the CDAS and measures assessing depressive symptoms, coping strategies, and cognitive-interpersonal vulnerability factors. In Phase 2, 130 third grade children and 184 seventh grade schoolchildren completed similar measures. RESULTS: In Phase 1, a two-factor solution was obtained: (1) Self-critical Perfectionism (SCP) and (2) Personal Standards Perfectionism (PSP). In Phase 2, a two-factor solution provided a significantly better fit than a one-factor solution in both grades. The two factors obtained exhibited high internal consistency in both our high-risk and community samples. Additionally, in both samples, SCP was more strongly associated with depressive symptoms, maladaptive coping strategies, and impaired interpersonal relationships than was PSP. CONCLUSION: The results of the current study suggest that dysfunctional attitudes cluster into SCP and PSP in children as well as early adolescents. Further, SCP may have a more deleterious impact on children's psychosocial functioning as compared to PSP.

A test of the integration of the hopelessness and response styles theories of depression in middle adolescence.

The current study examined several theories of depression in a sample of middle adolescents. At Time 1, 367 ninth graders completed measures assessing depressogenic inferential styles, the tendency to ruminate in response to depressed mood, and depressive symptoms. Six weeks later, participants completed measures assessing negative events and depressive symptoms. In line with the hopelessness theory, a depressogenic weakest link interacted with negative events to predict increases in hopelessness depression symptoms but not in more general depressive symptoms. Further, providing partial support for the response styles theory, the tendency to ruminate in response to depressed mood predicted increases in hopelessness depression symptoms but not in more general depressive symptoms. Contrary to the integrative theory, the relationship between a depressogenic weakest link and increases in hopelessness depression symptoms following negative events was not moderated by a ruminative response style.

Contagious depression: negative attachment cognitions as a moderator of the temporal association between parental depression and child depression.

This study examined whether negative attachment cognitions moderate the association between the onset of depressive symptoms in children and their parents using a high-risk sample (parents with a history of major depressive episodes and their children) and a multiwave longitudinal design. During the initial assessment, 140 children (ages 6-14) completed a measure assessing parent-child attachment cognitions. Parents and children also completed measures assessing current level of depressive symptoms. Following the initial assessment, children and parents were contacted every 6 weeks for the next year to complete measures assessing depressive symptoms. The results of hierarchical linear modeling analyses indicated that children who exhibited high levels of negative attachment cognitions reported greater elevations in depressive symptoms following elevations in their parent's level of depressive symptoms than children who exhibited low levels.