Stressful life events and depressive symptoms in young adolescents: Modulation by respiratory sinus arrhythmia? The TRAILS study

Background

Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs).

Methods

In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave.

Results

Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs.

Conclusions

In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.     

Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample

Summary Background: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained.Methods: All Swedish speaking women attending their first antenatal care visit during three predestined weeks were invited to participate. Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy, two months and one year postpartum.Results: In all, 2430 women completed three questionnaires. A dose-effect relation was found between the numbers of stressful life events experienced in the year prior to pregnancy and mean EPDS score in pregnancy. The prevalence of recurrent or sustained depressive symptoms (EPDS12 on all three evaluations) was 3% (79/2430). Three factors were associated with depressive symptoms, two or more stressful life events in the year prior to pregnancy, native language other than Swedish and unemployment.Conclusions: Apart from questions about psychiatric history, a psychosocial history in early pregnancy including stressful life events, native language and employment status could help the health professionals to identify women at risk for recurrent or sustained depression during pregnancy and the year after giving birth.     

Stress and parenting predict changes in adolescent respiratory sinus arrhythmia

Adolescence is a critical period for the development of physiological emotion regulatory systems. While stressful life experiences are known to inhibit adaptive regulation, less is known about how parental socialization of emotion regulation may affect this relation. We examined the effect of stressful life experiences on changes in the resting respiratory sinus arrhythmia (RSA) levels of 107 (M_age = 12.84, SD = 0.85) young adolescents over a year, moderated by supportive parental responses to negative emotions. The significant interaction (B = 0.02, p = 0.04) indicated that young adolescents who experienced low levels of supportive parenting in the context of high levels of stressful life experiences showed significant decreases in resting RSA over the year, while adolescents who experienced high levels of supportive parenting showed minimal decreases in RSA. Thus, more supportive parenting significantly compensated for the effect of greater stressful life experiences on changes in resting RSA over time.     

Appraisal of the Event as a Factor in Coping with Malpractice Litigation

Abstract

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.     

Autonomic correlates of lifetime suicidal thoughts and behaviors among adolescents with a history of depression

Suicidal thoughts and behaviors (STBs) have been associated with emotion dysregulation and atypical responses to affective and stressful stimuli. To investigate the psychophysiology involved, we measured changes in respiratory sinus arrhythmia (RSA) and cardiac pre‐ejection period (PEP; indexing parasympathetic and sympathetic functioning, respectively) in response to stressful‐ and sadness‐eliciting laboratory probes. Our sample included adolescents with a history of depression and STBs (n = 177), adolescents with a history of depression but no history of STBs (n = 47), and healthy controls (n = 175). The outcome of interest was the most severe form of clinician‐rated STBs across the subject’s lifetime. In partial support of our hypotheses, during the stressful task, adolescents with a history of depression and STBs did not evidence the RSA decrease that was exhibited by controls and displayed greater PEP shortening compared to ever‐depressed adolescents with no lifetime STBs. No group differences were found in either RSA or PEP reactivity to the sadness‐eliciting stimulus. As expected, severity of STBs was positively correlated with the extent of PEP shortening during the stressful task. The results suggest that adolescents with a history of depression and STBs experience blunted parasympathetic responses to stress along with compensatory efforts. Our findings contribute to a better understanding of STBs among youths and underscore that future studies should examine physiological risk factors for these psychopathological outcomes.     

Cultural consonance,a 5HT2A receptor polymorphism,and depressive symptoms: A longitudinal study of gene × culture interaction in urban Brazil

In this study in urban Brazil we examine, as a predictor of depressive symptoms, the interaction between a single nucleotide polymorphism in the 2A receptor in the serotonin system (?1438G/A) and cultural consonance in family life, a measure of the degree to which an individual perceives her family as corresponding to a widely shared cultural model of the prototypical family. A community sample of 144 adults was followed over a 2‐year‐period. Cultural consonance in family life was assessed by linking individuals' perceptions of their own families with a shared cultural model of the family derived from cultural consensus analysis. The ?1438G/A polymorphism in the 2A serotonin receptor was genotyped using a standard protocol for DNA extracted from leukocytes. Covariates included age, sex, socioeconomic status, and stressful life events. Cultural consonance in family life was prospectively associated with depressive symptoms. In addition, the interaction between genotype and cultural consonance in family life was significant. For individuals with the A/A variant of the ?1438G/A polymorphism of the 2A receptor gene, the effect of cultural consonance in family life on depressive symptoms over a 2‐year‐period was larger (β = ?0.533, P < 0.01) than those effects for individuals with either the G/A (β = ?0.280, P < 0.10) or G/G (β = ?0.272, P < 0.05) variants. These results are consistent with a process in which genotype moderates the effects of culturally meaningful social experience on depressive symptoms. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Evaluating the mediating effects of social support upon life events and depressive symptoms

Previous research has yielded inconsistent results regarding the mediating effects of social support upon psychiatric illness. Using data (N = 2029) gathered as part of a major epidemiologic study in the southeastern United States, the authors examine the relationships among depressive symptoms, social support, stressful life events, and socioeconomic status. As anticipated, direct effects were found for social support, stressful life events, and socioeconomic status upon depressive symptoms. However, when the data were analyzed via three-way analysis of variance and multiple regression (including all possible interaction terms) analysis, no statistically significant interactive effects were found. The authors conclude that these findings clearly demonstrate direct effects of social support and stressful life events upon depressive symptoms. Respondents in the lower social support groups experience the greatest impact of stressful life events; in contrast, persons in high social support groups, although evidencing increased symptom scores with increasing numbers of life events, experience the buffering effect of social support by showing less severe distress.     

Predictors of exposure to traumatic events and posttraumatic stress sequelae

The relationship of traumatic events to posttraumatic symptomatology was examined in a randomized community survey (N = 2,364) of Los Angeles residents. Exposure to traumatic events was associated with younger age, less education, recent life events, and a history of psychiatric disorder. Risk of increased posttraumatic stress symptoms following traumatic event exposure was associated with older age, recent life events, sexual assault, and household strain. Level of posttraumatic stress symptoms varied according to the type of traumatic event reported after adjusting for demographic factors.     

Stress, personality and depressive symptoms in a 6.5 year follow-up of subjects at familial risk for affective disorders and controls

BACKGROUND: The aim of the study was to identify risk factors in subjects at risk for depressive disorders and controls. METHODS: In a 6.5 year follow-up study we examined the effects of personality (neuroticism, frustration intolerance, rigidity, melancholic type), adverse life events and chronic difficulties on depressive symptoms in 89 high-risk subjects (HRS, siblings and children of patients suffering from an affective disorder), without any mental illness at wave 1 (T1), and 49 controls without any personal and family history of psychiatric disorder at T1. To this end, regression analysis and path analysis using a structural equation model (only for HRS) were performed. RESULTS: Risk factors for depressive symptoms at wave 2 (T2) in HRS comprised acute adverse life events, frustration intolerance (T1) and depressive symptoms (T1). Risk factors for depressive symptoms in controls included chronic difficulties, neuroticism and rigidity. HRS had less stressful life events and the same risk for chronic difficulties, but perceived adverse events as more stressful. LIMITATION: The sample size of the control group is too small for identifying slight effects. CONCLUSION: Our results indicate that the impact on the emergence of depressive symptoms of various risk factors is different in high-risk subjects and controls. High-risk subjects are more sensitive to the depressogenic effects of acute stress and thus avoid potential stressful changes in their life to a higher extent. On the other hand, the influence of persistent factors such as personality traits (neuroticism, rigidity) and chronic difficulties on subsequent depressive symptoms was less pronounced in HRS as compared to controls.     

Stressful life event experiences of homeless adults: A comparison of single men,single women,and women with children

This article describes stressful life events experienced by a multi‐shelter sample of 162 homeless adults in the Central Florida area. Participants included homeless single men (n = 54), homeless single women (n = 54), and homeless women with children (n = 54). Subjects were interviewed with a modified version of the List of Threatening Experiences (Brugha & Cragg, 1990). Findings indicate that the two groups of women were more likely to have been both physically and sexually abused as children than single men. Single women were more likely to have experienced sexual violence over the age of 18, experienced domestic violence, and been hospitalized in a psychiatric facility. Single men were more likely to have abused drugs and alcohol, and to have been incarcerated. Women with children were more likely to have lived in foster care. Overall, single women experienced significantly more stressful life events than single men and women with children. These findings suggest that the three groups are unique and would benefit from prevention and/or treatment approaches developed for the specific subgroup. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 643–654, 2004.     

Associations among migration risk factors,cultural identity conflict,and psychological symptoms among Syrian emerging adults with refugee backgrounds in the Netherlands

Objectives

In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations.

Methods

We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18–35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress.

Results

Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses.

Conclusions

Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.     

Intergenerational transmission of depression: a launch and grow model of change across adolescence

The present study tested a "launch-and-grow" type of cascade model in which an earlier risk factor (e.g., exposure to maternal depression by age 12) was hypothesized to predict several risk processes during development (e.g., stress, family relationships, self-worth [SW]), which then set the course for the growth of children's depressive symptoms over time. Participants were 240 mothers and children (mean age = 11.87 years, SD = 0.57) who were evaluated annually across 6 years. The Structured Clinical Interview for DSM diagnoses was used to assess mothers' psychiatric history; 185 mothers had had a mood disorder and 55 mothers were lifetime free of psychiatric diagnoses. At each assessment, mothers completed measures of their current level of depressive symptoms and stressful life events; adolescents completed measures about their perceptions of the family environment and their SW; and clinicians rated adolescents' level of depressive symptoms based on separate interviews with the adolescent and mother. Latent growth curve analyses revealed that history of maternal depression significantly predicted the intercepts of the growth trajectories of adolescents' depressive symptoms, mothers' current depressive symptoms, stressful life events, family environment, and adolescents' SW. The intercepts of each of these variables then predicted the trajectory (i.e., slope) of the growth of adolescents' depressive symptoms across the 6 years of the study. These results were consistent with the hypothesized model of maternal depression launching a set of risk factors, which in turn predict the growth of depressive symptoms during adolescence. Implications for interventions aimed at preventing depression in at-risk youth are discussed.     

The role of vulnerability in stress‐related insomnia,social support and coping styles on incidence and persistence of insomnia

Individuals who are more prone to experience situational insomnia under stressful conditions may also be at greater risk to develop subsequent insomnia. While cross‐sectional data exist on the link between sleep reactivity (heightened vulnerability to stress‐related insomnia) and insomnia, limited data exist on its predictive value. The aim of the study was to evaluate prospectively whether sleep reactivity was associated with increased risk of incident and persistent insomnia in a population‐based sample of good sleepers. Social support and coping styles were also investigated as potential moderators. Participants were 1449 adults (M_age = 47.4 years, standard deviation = 15.1; 41.2% male) without insomnia at baseline and evaluated four times over 3 years. Sleep reactivity was measured using the Ford Insomnia Response to Stress Test (FIRST). Additional measures included depressive symptoms, the frequency and perceived impact of stressful life events, social support and coping styles. After controlling for prior sleep history, depressive symptoms, arousal predisposition, stressful life events and perceived impact, individuals with higher sleep reactivity had an odds ratio (OR) of 1.56 [95% confidence interval (CI): 1.13–2.16], 1.41 (95% CI: 0.87–2.30) and 2.02 (95% CI: 1.30–3.15) of developing insomnia symptoms, syndrome and persistent insomnia, respectively. Social support and coping styles did not moderate these associations. Results suggest that heightened vulnerability to insomnia is associated with an increased risk of developing new‐onset subsyndromal and persistent insomnia in good sleepers. Knowledge of premorbid differences is important to identify at‐risk individuals, as this may help to develop more targeted prevention and intervention strategies for insomnia.     

Parent‐child coregulation of parasympathetic processes varies by social context and risk for psychopathology

The parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent‐child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent‐child interactions showed overall dynamic, positive concordance in mother‐child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother‐child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent‐child physiological coregulation are discussed.     

Resting respiratory sinus arrhythmia in suicide attempters

Although suicide attempts (SA) occur across a broad range of diagnoses as well as in the absence of a diagnosable disorder, most studies to date have focused on them within a single, specific disorder. Consistent with the NIMH RDoC initiative to identify biobehavioral vulnerabilities that cut across diagnoses, the goal of the present study was to examine potential differences in resting respiratory sinus arrhythmia (RSA) levels in a large, diagnostically heterogeneous sample of women with and without a history of SA who were matched on a broad range of demographic and clinical variables. Participants were 112 women with (n = 56) and without (n = 56) a history of SA recruited from the community. The two groups were equated on approximate age, race, household income, and lifetime histories of psychiatric diagnoses. Resting electrocardiogram was recorded during a 2‐min rest period. RSA was calculated via spectral power analyses with a fast Fourier transform. We found that women with a history of SA exhibited significantly lower resting RSA levels than women with no history of SA, and this difference was maintained even after statistically controlling for the potential influence of women's history of psychiatric diagnoses and their current symptoms of depression and anxiety. These findings suggest the presence of a link between resting RSA and SA history.     

Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures

Research on psychogenic nonepileptic seizures (PNES) has focused on childhood abuse, but less is known about other stressors and psychosocial risk factors. The authors compared 25 patients with PNES with 33 control subjects with epilepsy on stressful life events and other risk factors for somatoform disorders. Compared with control subjects, patients with PNES reported significantly more prevalent and stressful negative life events (including adulthood abuse) and more current rumination, stress-related diseases, somatic symptoms, bodily awareness, and marginally more anxiety and depression. However, the relationship of many of these variables to PNES was accounted for by life stress. Groups did not differ on illness worry, alexithymia, or psychotic symptoms. The results suggest that PNES are part of a larger pattern of somatic symptoms responses to a wide range of negative events, including stress in adulthood.     

A twin study of genetic and environmental determinants of abnormal persistence of psychotic experiences in young adulthood

Evidence suggests that subclinical psychotic experiences are more likely to cause transition to psychotic disorder if their expression becomes persistent. The study of longitudinal patterns of subclinical psychotic experiences may help to distinguish subgroups with transient and persistent psychotic symptoms, who may differ in risk of later psychosis. The current study investigated patterns of developmental course of subclinical psychotic experiences in a general population sample of 566 female twins, aged 18–45 years. The positive symptoms subscale of the Community Assessment of Psychic Experiences (CAPE), completed three times in 2 years, was analyzed with growth modeling. Using Latent Class Analysis, two developmental courses were distinguished: a Persistent and a Low (expression of subclinical psychotic experiences) group. The Persistent group reported significantly higher levels of depressive and negative symptoms and worse functioning in daily life. Childhood trauma (OR: 3.26, P < 0.0001) and stressful life events over the study period (OR: 3.15, P = 0.031) predicted membership of the Persistent group. Of the monozygotic (MZ) twins with their co‐twin in the Persistent group, 49% also were in the Persistent group themselves (OR: 9.32, P < 0.0001), compared to only 14% in the dizygotic (DZ) co‐twins (OR: 1.56, P = 0.42) (χ²(2) = 22.97; P < 0.001). The findings suggest that persistence of subclinical psychosis is influenced by both genetic and environmental factors, providing the possibility to study the (possibly modifiable) etiology underlying the longitudinal process of persistence of the early expression of psychosis liability. © 2011 Wiley‐Liss, Inc.     

Frontal EEG asymmetry moderates the effects of stressful life events on internalizing symptoms in children at familial risk for depression

This study examined whether frontal alpha electroencephalographic (EEG) asymmetry moderates the association between stressful life events and depressive symptoms in children at familial risk for depression. Participants included 135 children ages 6 to 13, whose mothers had either a history of depression or no history of major psychiatric conditions. Frontal EEG was recorded while participants watched emotion-eliciting films. Symptoms and stressful life events were obtained via the Child Behavior Check List and a clinical interview, respectively. High-risk children displayed greater relative right lateral frontal activation (F7/F8) than their low-risk peers during the films. For high-risk children, greater relative left lateral frontal activation moderated the association between stressful life events and internalizing symptoms. Specifically, greater relative left lateral frontal activation mitigated the effects of stress in at-risk children.     

The effects of respiratory sinus arrhythmia on anger reactivity and persistence in major depression

The experience of anger during a depressive episode has recently been identified as a poor prognostic indicator of illness course. Given the clinical implications of anger in major depressive disorder (MDD), understanding the mechanisms involved in anger reactivity and persistence is critical for improved intervention. Biological processes involved in emotion regulation during stress, such as respiratory sinus arrhythmia (RSA), may play a role in maintaining negative moods. Clinically depressed (MDD; n = 49) and nondepressed (non‐MDD; n = 50) individuals were challenged with a stressful computer task shown to increase anger, while RSA (high frequency range 0.15–0.4 Hz) was collected. RSA predicted future anger, but was unrelated to current anger. That is, across participants, low baseline RSA predicted anger reactivity during the task, and in depressed individuals, those with low RSA during the task had a greater likelihood of anger persistence during a recovery period. These results suggest that low RSA may be a psychophysiological process involved in anger regulation in depression. Low RSA may contribute to sustained illness course by diminishing the repair of angry moods.     

Psychopathology and well‐being in civilian survivors of war seeking treatment: a follow‐up study

The goal of the current study was to examine types of exposure to traumatic events and affective and anxiety disorders of 81 civilian war survivors seeking treatment for war‐related stress almost one decade following the war in the area of former conflict. Furthermore, the study investigated changes in symptoms of mental health and in well‐being amongst these individuals during a treatment period of 6 months. The results indicated that civilian war survivors seeking treatment reported multiple war‐related traumatic events and high levels of psychiatric morbidity. Individuals assessed at follow‐up (n = 67) reported no change in post‐traumatic stress symptoms or psychological well‐being, but improvement in symptoms of depression, overall psychiatric distress and quality of life. The only significant difference between participants classified as achieving clinically significant improvement as compared with those who did not achieve such change was in less symptom severity of depression, post‐traumatic stress, general distress and higher psychological well‐being at the time of first assessment. Neither the assessment of initial diagnoses nor war or post‐war trauma types emerged as significantly different amongst the two groups. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Civilian survivors of war seeking treatment report high levels of psychiatric morbidity. ? Treatment for survivors of war may require adaptations to evidence‐based treatments based on their culture and life circumstances in order to recover from PTSD and experience general emotional relief.