Expanding our understanding of the relationship between negative life events and depressive symptoms in black and white adolescent girls

BACKGROUND: Little is known about the extent to which negative life events predict depressive symptoms in ethnically diverse groups or whether this relationship is proximal or enduring. METHOD: The relationship between negative life events in adolescence and depressive symptoms in young adulthood was studied in a sample of over 1300 black and white female adolescents. Five domains of life events were assessed at age 16 years and depressive symptoms were measured at age 18 and again at age 21 years. Questions of interest included whether the association continued over time and whether there were specific domains of life events that predicted symptoms better than others. RESULTS: The total number of negative life events at time 1 predicted depressive symptoms at both time 2 and time 3. Interpersonal loss events and other adversities, however, predicted depressive symptoms only at time 2, whereas at time 3, only interpersonal trauma was a significant predictor. No ethnic differences were found, indicating that the relationship between life events and depressive symptoms appears to be similar for black and white adolescent girls. CONCLUSIONS: The results suggest that negative life events and some specific type of stressorsincrease the likelihood of the onset of depression symptoms in future years, for both black and white girls. Early preventive efforts should be directed at adolescents who experience loss due to death of a significant other, traumatic events, and psychosocial adversities to forestall the development of depressive symptoms.     

Personality--life event congruence effects in late-life depression

BACKGROUND: This study examined whether specific interactions of personality and life events predicted increases in depressive symptoms over time in a late-life sample. METHOD: Participants (n=55) who were in remission from a recent episode of major depression completed a depression symptom interview and a questionnaire assessing the personality constructs sociotropy and autonomy. Six months later, they completed the same personality questionnaire and a checklist of life events experienced during the past 6 months. RESULTS: As predicted, increases in depressive symptoms were significantly predicted by the congruent interaction of sociotropy with negative interpersonal events and by the congruent interaction of autonomy with negative autonomy events, but not by either of the non-congruent interactions. LIMITATIONS: A small sample prevented examinations of important depressive subtypes based on age of depression onset and vascular status. CONCLUSIONS: These findings strongly support the personality-life event congruence model of depression in a late-life sample. Clinical implications include attending to stressful events that match an older adult's personality style, to help the older adult cope with those events that are more likely to increase his or her depression.     

Life events and early onset depression: cause or consequence?

BACKGROUND: Adverse life events prior to episodes of depression are assumed to play a causal role. Earlier studies have, however, not adequately controlled for the potential confounding effects of previous depression. METHOD: A two-phase study was nested within a six-wave population based cohort study of 1947 adolescents. Interviews at two assessment phases with the CIS-R and CIDI were used to generate ICD-10 diagnoses of depressive disorder. Life events with longer-term contextual threat were reported for the 6 months before first diagnosis and categorized on the basis of participant appraisal as negative and neutral/positive in effects. Previous depressive and anxiety symptoms were measured 6 months earlier. RESULTS: Pre-existing depressive and anxiety symptoms predicted later events, increasing three-fold the risks for both neutral/positive and negative events in females and increased seven-fold the risk of negative events in males. Life events in turn predicted the onset of depressive disorder independently of previous symptoms. Single negative events held an over five-fold elevated risk and multiple events an almost eight-fold higher risk. Personal threat and loss were associated with disorder in females but not males. CONCLUSIONS: The findings are consistent with a causal role for life events in early episodes of depression. The association also reflects a reciprocal relationship in which earlier symptoms predict later events, perhaps as a result of an individual's attempts to change unfavourable social circumstances.     

Predictors for 2-year outcome of major depressive episode

In this 2-year prospective study, we searched for predictive factors influencing the 2-year outcome of major depressive episodes. Demographic characteristics (age, gender, education, employment), illness-related variables (severity, age at onset, number and duration of previous episodes), personality characteristics (DSM-IV personality disorders, trait anxiety, coping style), life context factors (life events before and during the depressive episode, social support, social adjustment), and biological markers (dexamethasone suppression test, thyroid stimulating hormone levels) of 117 inpatients with major depressive episode were assessed. A structural equation model was used to test the proposed correlational structure of the relevant variables. The non-remission of the depressive symptoms by the end of a 6-week acute treatment phase was found to be the most relevant factor predicting sustained non-remission at the end of a 2-year follow-up period. At the end of the sixth week, the severity of depression depended on the level of social support and on the severity of depression at baseline. Among the baseline variables, anxious personality traits and a lower level of education predicted a high level of depressive symptoms at the end of the 2-year follow-up. Life events before and during the depressive episode, and the biological markers at baseline had no direct effect on the outcome. The rapid remission of the depressive symptoms is the most important predictor for the favorable long-term outcome of a depressive episode. Personality characteristics, social support and level of education,--interacting with each other--also play a significant role.     

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms

BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.     

A prospective test of the hopelessness theory of depression in children.

Providing a developmental extension of the cognitive theories of depression, researchers and theorists have suggested that during early to middle childhood, attributional styles may mediate rather than moderate the association between negative life events and the development of depression. Within the context of the hopelessness theory of depression, we tested this hypothesis in a 6-month longitudinal study of 4th- and 5th-grade children. Using path analysis, we found support for the mediating role of attributional styles among both 4th and 5th graders. Supporting recent refinements in the hopelessness theory, the best fitting mediation model was one in which depressive symptoms exhibited reciprocal relations with the other variables. Specifically, attributional styles partially mediated the link between verbal victimization and residual change in depressive symptoms. In addition, initial depressive symptoms predicted negative changes in children's attributional styles and increases in verbal victimization across the follow-up. Contrary to our hypothesis, we also found support for the moderating role of attributional styles, although this was significant only among 5th graders.     

Prospective relations between bulimic pathology, depression, and substance abuse: unpacking comorbidity in adolescent girls

To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances.     

Predictors of Youths’ Posttraumatic Stress Symptoms Following a Natural Disaster: The 2010 Nashville,Tennessee, Flood

Framed by a previously established conceptual model of youths’ posttraumatic stress (PTS) responses following a disaster, the current longitudinal study examined the relation of predisaster child characteristics (age, gender, depressive symptoms, ruminative coping), predisaster environmental characteristics (negative life events and supportive and negative friendship interactions), and level of disaster exposure to youths’ PTS symptoms in the wake of a natural disaster. Prior to the 2010 Nashville, Tennessee, flood, 239 predominantly Caucasian youth from four elementary and middle schools (ages = 10–15, 56% girls) completed measures of depressive symptoms, rumination, negative life events, and social support in the form of both supportive and negative friendship interactions. Approximately 10 days after returning to school, 125 completed measures of disaster exposure and postflood PTS symptoms. Bivariate correlations revealed that disaster-related PTS symptoms were unrelated to age, gender, or predisaster supportive friendship interactions and significantly positively related to level of disaster exposure and predisaster levels of negative life events, depressive symptoms, rumination, and negative friendship interactions. After controlling for level of disaster exposure and other predisaster child and environmental characteristics, depressive symptoms and negative friendship interactions predicted postdisaster PTS symptoms. The effect of child's flood-related experiences on PTS symptoms was not moderated by any of the preexisting child characteristics or environmental indicators. Faced with limited resources after a natural disaster, school counselors and other health professionals should focus special attention on youths who experienced high levels of disaster-related losses and whose predisaster emotional and interpersonal lives were problematic.     

Psychological and behavioral risk factors for obesity onset in adolescent girls: a prospective study

Because little is known about risk factors for obesity, the authors tested whether certain psychological and behavioral variables predicted future onset of obesity. The authors used data from a prospective study of 496 adolescent girls who completed a baseline assessment at age 11-15 years and 4 annual follow-ups. Self-reported dietary restraint, radical weight-control behaviors, depressive symptoms, and perceived parental obesity--but not high-fat food consumption, binge eating, or exercise frequency-predicted obesity onset. Results provide support for certain etiologic theories of obesity, including the affect regulation model. The fact that self-reported, weight-control behaviors identified girls at risk for obesity implies that high-risk youths are not engaging in effective weight-control methods and suggests the need to promote more effective strategies.     

Reconfirming the role of life events for the timing of depressive episodes. A two-year prospective follow-up study

BACKGROUND: Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS: This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation. RESULTS: Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. Limitations: Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION: The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.     

A holistic model for understanding and predicting depressive symptoms in african-american women

A holistic model for understanding and predicting depressive symptoms in a sample of 289 African-American women was evaluated. Using a structural equation methodology, life events, social support, physical health problems, and internalized racialism were significant predictors of depressive symptoms. Although neither marital status nor religious orientation had predicted inverse effects on depressive symptoms, we found that the effects of socioeconomic status and developmental status on depressive symptoms were mediated through these and other variables specified in the model.     

Self-Reported Health in HIV-Positive African American Women: The Role of Family Stress and Depressive Symptoms

This prospective study examined the association between stressful life events and self-reported health in 72 inner-city, low-income African American women with HIV. Depressive symptoms were examined as a potential mediator of this association. Findings indicated that family stressors predicted deterioration in self-reported health status over the 15-month assessment period. Additionally, the association between family stress and self-reported physical health was mediated by depressive symptoms such that the strength of the association between family stress and self-reported health was no longer statistically significant after depressive symptoms were entered in the model. This study suggests a potentially important target for prevention and intervention efforts aimed at enhancing the quality of life of women with HIV.     

A Prospective Test of the Hopelessness Theory of Depression in Children

Providing a developmental extension of the cognitive theories of depression, researchers and theorists (e.g., Cole & Turner, 1993; Rose & Abramson, 1992) have suggested that during early to middle childhood, attributional styles may mediate rather than moderate the association between negative life events and the development of depression. Within the context of the hopelessness theory of depression (e.g., Abramson, Metalsky, & Alloy, 1989), we tested this hypothesis in a 6-month longitudinal study of 4th- and 5th-grade children. Using path analysis, we found support for the mediating role of attributional styles among both 4th and 5th graders. Supporting recent refinements in the hopelessness theory, the best fitting mediation model was one in which depressive symptoms exhibited reciprocal relations with the other variables. Specifically, attributional styles partially mediated the link between verbal victimization and residual change in depressive symptoms. In addition, initial depressive symptoms predicted negative changes in children's attributional styles and increases in verbal victimization across the follow-up. Contrary to our hypothesis, we also found support for the moderating role of attributional styles, although this was significant only among 5th graders.     

Relation of perseverative tendency and life events to depressive symptoms: findings from a prospective study in non-referred adolescents in Taiwan

This study aimed to explore the role of perseveration in the relations between life events and depression in a 2-year prospective study of non-referred adolescents. Participants were 400 middle school students randomly selected in Taipei. Baseline perseveration was measured using Perseverative Errors on the Wisconsin Card Sorting Test and psychological distress was measured using Anxious/Depressed syndrome on the Child Behavior Checklist. These individuals also completed the Life Event Checklist and the Center for Epidemiologic Studies Depression Scales at follow-up. With adjustment for initial psychological distress and demographic features, the results of multiple regression analyses showed that more perseveration at baseline was associated with greater influence of negative life events on the subsequent depressive symptoms. Perseveration might act as a moderator on the relations of life events to depressive symptoms and lowering perseveration may be a plausible way to decrease the impact of negative life events on adolescent depressive symptoms.     

Attributional style and symptoms of depression in persons with multiple sclerosis

This study was designed to assess hypotheses derived from the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), specifically that negative attributional style would be associated with depressive symptoms and that negative life events would interact with negative attributional style to explain depressive symptoms in a sample of persons with multiple sclerosis (MS). The research was cross sectional in design. Data was collected via survey from 495 persons with MS. Attributional style was positively associated with depressive symptoms across the whole sample. The proposition that negative life events would interact with negative attributional style to explain depressive symptoms was also supported, although only for global attributional style. Longitudinal studies would assist in determining the causal direction proposed by the hopelessness theory of depression in this population. It is also appropriate that clinicians consider attributional style in persons with MS whom they are treating for depression.     

Stress buffering after physical activity engagement: An experience sampling study

Objectives

While encountering daily hassles is a normative experience, it poses a threat to individuals' daily affective well-being. However, physical activity engagement may help to reduce the current stress-related impact on affective well-being (i.e. stress buffering), which we investigate in this study. Furthermore, we examined the possible moderating role of people's global stress context (i.e. exposure to major life events and chronic stress) on this within-person stress-buffering effect.

Design

We approached these ideas using six-times-a-day experience sampling assessments over a period of 22 days.

Methods

Drawing on a broad national sample of 156 middle-aged adults from the EE-SOEP-IS study, we aimed to elucidate the naturally occurring within-person dynamics of current stress, physical activity engagement, and momentary affect within individuals' everyday lives. Major life events and chronic stress were measured as between-person variables.

Results

Multilevel analyses revealed significant within-person associations of current stress and physical activity engagement with momentary affect. Stress-related negative affect was lower when individuals engaged in physical activity, in accordance with the idea of a within-person stress-buffering effect of physical activity engagement. For individuals exposed to more severe major life events, the stress-buffering effect of physical activity engagement for negative affect was lower. Chronic stress did not moderate the within-person stress-buffering effect.

Conclusions

Overall, results add to the existing literature that links physical activity to increased stress resilience and emphasizes the need for taking the global between-person stress context into account.     

Recent life events preceding suicide attempts in a personality disorder sample: findings from the collaborative longitudinal personality disorders study

Few studies have examined the relationship between life events, suicide attempts, and personality disorders (PDs), in spite of the strong associations between PDs and suicidal behavior, and the poor coping strategies often exhibited by these individuals. The authors examined whether participants with PDs who attempted suicide during the first 3 years of a prospective, longitudinal study were more likely to experience specific life events in the month during and preceding the suicide attempt. Of 489 participants with PDs, 61 attempted suicide during the 3-year, follow-up interval. Results indicated that negative life events, particularly those pertaining to love-marriage or crime-legal matters, were significant predictors of suicide attempts, even after controlling for baseline diagnoses of borderline PD, major depressive disorders, substance use disorders, and a history of childhood sexual abuse. Therefore, certain types of negative life events are unique risk factors for imminent suicide attempts among individuals with PDs.     

Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam

BACKGROUND: The present study was designed to assess onset and persistence of late-life depression, systematically comparing the factors associated with prevalence, onset and prognosis. METHODS: The data were derived from a large (n=2200), random, age and sex stratified sample of the elderly (55-85 years) in The Netherlands. Using a 3-year, prospective longitudinal design, both the onset and the persistence of depression were assessed. Depression was measured using the Center for Epidemiologic Studies Depression Scale. Risk factors associated with prevalence, onset and persistence were compared using both bivariate and multivariate analyses. RESULTS: In those not depressed at index assessment, the onset of depression was 9.7%. Among those depressed at baseline, persistence occurred in 50.4%. Risk factors predicting onset were almost identical to those associated with prevalence. Persistence was predicted by very few factors (external locus of control and chronic physical illness). CONCLUSIONS: The data suggest that cross-sectional studies are biased due to their overrepresenting chronic depressive episodes. However, the risk factors derived from cross-sectional studies do seem to adequately reflect factors associated with onset. The prognosis is not adequately predicted by variables usually included in epidemiological studies of late life depression. It is speculated that including more biological correlates of depression and data concerning positive life-changes may improve our understanding of the prognosis of late life depression.     

A Replicated Prospective Investigation of Life Stress, Coping, and Depressive Symptoms in Multiple Sclerosis

Life stress and coping responses jointly contribute to psychological adjustment in many chronic illness populations, but their significance in multiple sclerosis (MS) has not been extensively investigated. Physical disability, cognitive status, negative life stress, coping strategies, and depressive symptoms were prospectively assessed in 27 adults with definite or probable MS. Of the original subjects, 22 provided two additional assessments at 6-month intervals. After accounting for cognitive status and physical disability, life stress was positively correlated with current as well as future depressive symptoms; the prospective relationship was replicated within the second pair of prospective data waves. Escape avoidance was the only coping strategy that added to the prediction of future mood symptoms, but this was not replicated. Results suggest that MS-related depressive symptoms are a function of prior disease-related impairment, life stress, and possibly escape avoidance coping.     

Moving from ethnography to epidemiology: Lessons learned in Appalachia

Background: Anthropologists are beginning to translate insights from ethnography into tools for population studies that assess the role of culture in human behavior, biology, and health.

Aim: We describe several lessons learned in the creation and administration of an ethnographically-based instrument to assess the life course perspectives of Appalachian youth, the Life Trajectory Interview for Youth (LTI-Y). Then, we explore the utility of the LTI-Y in predicting depressive symptoms, controlling for prior depressive symptoms and severe negative life events throughout the life course.

Subjects and methods: In a sample of 319 youths (190 White, 129 Cherokee), we tested the association between depressive symptoms and two domains of the LTI-Y – life course barriers and milestones. Longitudinal data on prior depressive symptoms and negative life events were included in the model.

Results: The ethnographically-based scales of life course barriers and milestones were associated with unique variance in depressive symptoms, together accounting for 11% of the variance in this outcome.

Conclusion: When creating ethnographically-based instruments, it is important to strike a balance between detailed, participant-driven procedures and the analytic needs of hypothesis testing. Ethnographically-based instruments have utility for predicting health outcomes in longitudinal studies.