Short-term course of depressive symptoms in patients with eating disorders.

After inpatient treatment focused on aberrant eating behavior, six depressed normal-weight bulimic patients showed little improvement in depressive or eating symptoms. Four depressed anorexic patients with bulimic behavior improved in both areas, and five restricting anorexic patients had an intermediate response.

Internalizing and externalizing symptoms and attributional style in youth with diabetes.

The psychiatric functioning of 28 youths with insulin-dependent diabetes mellitus was examined. Measures of psychological functioning were related to age at onset, duration of diabetes, and metabolic control, as assessed by HgbAlC. Children diagnosed with insulin-dependent diabetes mellitus at a later age were considered by teachers to have more behavioral problems. Children who had better metabolic control tended to hold themselves responsible for negative events. It is worthwhile to develop interventions to teach diabetic children a realistic balance between taking appropriate responsibility for controllable negative events without taking undue blame for uncontrollable negative events associated with the disease.

Psychopathology in urban female minority adolescents with suicide attempts.

This study examines the level of psychopathology in 53 African-American females who attempted suicide by ingestion. Parents completed a measure of adolescent psychopathology, and the youths completed measures of depression and psychopathology. Overall, the results suggested that these youths were not experiencing significant emotional distress. However, after classifying the youths into four groups by their self-reported level of depression, the incidence of parent- and youth-reported psychopathology varied. More significant levels of depression corresponded to significant internalizing difficulties, as reported by the adolescent, and myriad psychopathological difficulties, as reported by the parents. These results are discussed from a clinical perspective with a developmentally and culturally sensitive focus. Disposition decisions must consider the level of psychopathology reported by child and parent, the family's willingness to participate in outpatient treatment, and the degree to which the adolescent and her family acknowledge the significance of the suicide attempt.

Psychosocial and family functioning in children with sickle cell syndrome and their mothers.

OBJECTIVE: The purpose of this study was to compare the psychiatric functioning of 61 sickle cell youth and their families with nondiseased sibling controls. METHOD: Functioning assessed by multiple informants included indices of behavioral, cognitive, and family/interpersonal functioning, self-esteem, life events, coping strategies, temperament, adaptive behavior, and parental psychopathology. RESULTS: Key findings were that sickle cell patients evidenced more depressive symptoms and associated attributional style, and externalizing behavioral difficulties than did nondiseased siblings. With age, sickle cell youth evidence increasing adaptive behavior deficits and internalizing symptoms. Illness severity was related to symptoms of internalizing behavior and fewer daily living skills. Associations were found between maternal and child coping. CONCLUSIONS: It is recommended that psychiatric consultations routinely be conducted with these children, particularly at times of family stress and developmental transitions. Psychiatric interventions should focus on ameliorating emotional difficulties via enhancing adaptive coping strategies.

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

Parental psychopathology and children's adjustment to leukemia.

OBJECTIVE: The primary purpose of this study was to examine the relationship between parental psychopathology and psychosocial functioning of children in whom acute lymphocytic leukemia (ALL) has been diagnosed. METHOD: The sample consisted of 61 mother-child dyads. Twenty-one (34%) mothers met DSM-III-R criteria for at least one psychiatric disorder based on a Structured Clinical Interview for Diagnosis (SCID). RESULTS: Findings revealed that compared with children whose mothers did not meet DSM-III-R criteria for a psychiatric disorder, children with mothers who evidenced a psychiatric disorder self-reported more anxiety and a maladaptive attributional style and were reported by their mothers as evidencing more depression and a range of internalizing behavioral symptoms. CONCLUSIONS: Although our earlier research suggested that ALL children show relatively few symptoms of psychopathology, the present report reveals high rates of psychiatric difficulties in the mothers of ALL youth. These findings and their implications are discussed within a model that incorporates behavioral pediatrics and developmental psychopathology.

Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women.

Findings from a study comparing partner abuse in African American women suicide attempters (n = 148) and nonattempters (n = 137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse--suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided.

A cultural perspective on family theory and therapy.

Although family therapists' conceptualizations of culture include ethnicity, nationality, religion, generation, gender, class, and sexual orientation, this article focused on ethnicity and families in the United States. A review of the literature reveals that effective family therapy is both sensitive to the family's cultural heritage and attuned to the unique interactional patterns, attitudes, feelings, and behaviors of each family with whom the therapist works. Culturally sensitive family therapy attempts to transcend cultural barriers, while respecting the cultural identity and integrity of the individual family members, the family unit as a whole, and the therapist. As multiculturalism has become increasingly emphasized in the United States, family therapists are challenged to facilitate families' efforts to reconnect with their cultural heritage to preserve a sense of belonging and identity, while simultaneously helping them adapt to their evolving cultural context.

Depression and attributions in children and adolescents: a meta-analytic review.

This article presents a meta-analytic review of the association between attributional styles and depressive symptoms in children and adolescents. In 28 studies involving 7500 subjects, the correlations were consistent with those predicted by the reformulated learned helplessness model of depression. For negative outcomes, attributions along the internal, stable, and global dimensions were associated positively with depression. Conversely, higher levels of depressive symptoms were related to more external, unstable, and specific attributions for positive events. Additionally, overall composite maladaptive attributional patterns for positive and negative events were correlated with higher levels of depressive symptoms in youth. Effect sizes for these associations ranged from moderate to large (Cohen, 1977). Findings from the significance tests of the combined results support the theory. A large number of unretrieved studies revealing null effects would be needed to invalidate these findings.

A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children.

Twenty-nine children 9 to 12 years old who were identified as moderately to severely depressed using the Children's Depression Inventory were randomly assigned to either a self-control, behavioral problem-solving, or waiting list condition. The self-control treatment focused on teaching children self-management skills. The behavioral problem-solving therapy consisted of education, self-monitoring of pleasant events, and group problem solving directed toward improving social behavior. Subjects were assessed pre- and posttreatment and at 8-week follow-up with multiple assessment procedures and from multiple perspectives. At posttreatment, subjects in both active treatments reported significant improvement on self-report and interview measures of depression while subjects in the waiting list condition reported minimal change. Results were maintained at follow-up. The general success of the experimental treatments was discussed and recommendations for further treatment components were provided.

Social-cognitive and cognitive correlates of depression in children.

The present investigation examined depression and its social-cognitive and cognitive correlates in a sample of 108 elementary school children: 36 children in each of grades 1, 4, and 8. Children were classified as depressed and nondepressed according to their scores on the Children's Depression Inventory (CDI). Depression appeared stable over a 3-week time interval. Depressed children reported a higher number of "masking" symptoms, were rated as more depressed by their teachers, and perceived their family environment to be more distressed. As posited, when compared to nondepressed children, depressed children have lower self-esteem, a more depressive attributional style, and more self-control deficits. Further, they have impaired performance on some cognitive tasks (block design, coding digit span) but not all (vocabulary). The prediction that depression would be manifested differently in first-, fourth-, and eighth-graders was not supported.

Social problem solving: a moderator of the relation between negative life stress and depression symptoms in children.

The social problem-solving skill of generating effective alternative solutions was tested as a moderator of the relation between negative life stress and depressed mood in children. Boys (n = 25) and girls (n = 25), ages 8 to 12 years, from inner-city, lower socioeconomic group families, completed measures of depression symptoms, negative impact of life events, and quantity and effectiveness of alternative solutions to social problems. Results indicated that the effectiveness of alternative solutions children generate in response to peer social problems moderates the relation between stress and depression. Children who experienced a high impact of negative life events, with less effective social problem-solving skills, reported higher levels of depression compared to children who experienced a high impact of negative life events but exhibited more effective social problem-solving skills. Results are discussed in terms of alternative theoretical models for the mechanisms whereby effective social problem-solving skills moderate stress-related depression.

Psychopathology, family functioning, and cognitive style in urban adolescents with suicide attempts.

This study examined psychopathology, family functioning, and cognitive style in 121 African-American adolescents who attempted suicide. Group means suggested that these youths, when taken together, were not reporting significant psychological distress. However, after classifying the youths into three groups by level of depressive symptoms interesting findings emerged. Youth self-reports of depressive symptoms on the Children's Depression Inventory were associated with the presence of internalizing and externalizing disorders on the Youth Self-Report and Child Behavior Checklist, and with a maladaptive attributional style. Sixty-seven percent of participants classified their family types as maladaptive in terms of levels of cohesion and/or adaptability. In fact, the majority of adolescents and parents reported their families as disengaged. These findings are discussed from a culturally and developmentally sensitive framework which considers key demographic variables (race, socioeconomic status, age). Clinical implications are offered for individual and family interventions.

Problem-solving deficits and depressive symptoms among children.

Depressive symptoms among 40 fourth- and fifth-grade students as measured by the Children's Depression Inventory, correlated highly with impaired problem solving at block designs (r = .64) and anagrams (r = .67). Similar impairments have been found among depressed adults, suggesting that depression among children may be continuous with depression among adults.

Attributional style and self-control behavior in depressed and nondepressed children and their parents.

Do the reformulated model of learned helplessness and the self-control model apply to clinically depressed children? Are the related cognitive patterns specific to depression? Are the cognitive deficits associated with depression learned from one's parents? To address these questions this investigation examined three groups of children (ages 8-12) and their parents: nonclinic (n = 25), nondepressed clinic (n = 22), and depressed clinic (n = 15). Children were diagnosed depressed on the basis of Kiddie-SADS interview data. Depressed clinic children self-reported more depression, had a more depressive attributional style, and had more self-control problems. There were more depressed mothers in the clinic than in the nonclinic sample. Depressed clinic children had more depressed mothers than did nondepressed clinic children. There were no differences among the three groups of parents in their cognitive patterns. No relationship was found between the attributional style and self-control behavior of children and their parents.

Sex differences, attributional style, and depressive symptoms among adolescents.

This study examined attributional style, sex and depressive symptoms and diagnosis in high school students. The results revealed that (1) for females and males, higher levels of depressive symptoms correlated with a more depressive attributional style; (2) females and males who met diagnostic criteria for a current depressive disorder evidenced more depressogenic attributions than psychiatric controls, and never had past depressed adolescents; (3) although no sex differences in terms of attributional patterns for positive events, negative events, or for positive and negative events combined emerged, sex differences were revealed on a number of dimensional scores; (4) across the Children's Attributional Style Questionnaire (CASQ) subscale and dimensional scores, the relation between attributions and current self-reported depressive symptoms was stronger for females than males; and (5) no Sex x Diagnostic Group Status interaction effects emerged for CASQ subscale or dimensional scores. Implications of the complex findings from this large-scale, methodologically sophisticated study was addressed.

Role of secondary stressors in the parental death-child distress relation.

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death-child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed.

Risk factors for suicide attempts among low-income women with a history of alcohol problems.

This study used bivariate and multivariate analyses to examine nine risk factors for suicide attempts among 80 women (51 attempters, 29 controls) with a history of alcohol problems who were recruited from a large, inner-city hospital. Prior studies established that each of the examined factors increased the risk for suicidal behavioral, but these studies have varied according to whether or not they consisted exclusively of persons with alcohol problems. Whereas eight of the nine factors were bivariately associated with suicide attempt status in this study, only three factors (hopelessness, recent interpersonal loss, childhood trauma) remained significant in the multivariate analysis. These findings illuminate the importance of using multivariate analyses when aiming to identify factors that uniquely increase the risk for suicidal behavior among persons with alcohol problems.

Attachment and depression. Implications for family therapy.

The preceding discussion highlights the use of attachment theory in conceptualizing the interface between normal development and the manifestation of depression from infancy through adolescence. Additional research is needed to delineate better the specific nature of the association between attachment relationships and depression, particularly with regard to factors that mediate and moderate the link. The extant literature informs family-oriented clinical interventions with depressed young people with comorbid attachment problems, with or without a depressed parent. These family interventions are most likely to be effective if they incorporate developmentally informed conceptualizations and techniques and are targeted specifically to the problems of depressed youth and their families. The efficacy of such interventions remains to be determined through the implementation of treatment efficacy and effectiveness studies.

Ratings of family functioning of suicidal and nonsuicidal African American women.

This study compared ratings of family functioning between female African American suicide attempters (n = 126) and nonattempters (n = 112). Attempters reported poorer family-of-creation (physical and nonphysical partner abuse, family strengths, and marital adjustment) and family-of-origin (physical, sexual, and emotional abuse and emotional neglect) functioning than did controls. In a multivariate logistic regression, only marital discord and childhood sexual abuse were risk factors for suicide attempts. A cumulative risk model was also tested and indicated that the presence of 4 or more of the risk factors increased a woman's likelihood of making a nonfatal suicide attempt more than threefold. This study offers one of the first investigations of the families of suicidal African American women and highlights the importance of focusing on family concerns when working with this population.