Catherine C. Epkins

Integrating Etiological Models of Social Anxiety and Depression in Youth: Evidence for a Cumulative Interpersonal Risk Model

Models of social anxiety and depression in youth have been developed separately, and they contain similar etiological influences. Given the high comorbidity of social anxiety and depression, we examine whether the posited etiological constructs are a correlate of, or a risk factor for, social anxiety and/or depression at the symptom level and the diagnostic level. We find core risk factors of temperament, genetics, and parent psychopathology (i.e., depression and anxiety) are neither necessary nor sufficient for the development of social anxiety and/or depression. Instead, aspects of children’s relationships with parents and/or peers either mediates (i.e., explains) or moderates (i.e., interacts with) these core risks being related to social anxiety and/or depression. We then examine various parent- and peer-related constructs contained in the separate models of social anxiety and depression (i.e., parent–child attachment, parenting, social skill deficits, peer acceptance and rejection, peer victimization, friendships, and loneliness). Throughout our review, we report evidence for a Cumulative Interpersonal Risk model that incorporates both core risk factors and specific interpersonal risk factors. Most studies fail to consider comorbidity, thus little is known about the specificity of these various constructs to depression and/or social anxiety. However, we identify shared, differential, and cumulative risks, correlates, consequences, and protective factors. We then put forth demonstrated pathways for the development of depression, social anxiety, and their comorbidity. Implications for understanding comorbidity are highlighted throughout, as are theoretical and research directions for developing and refining models of social anxiety, depression, and their comorbidity. Prevention and treatment implications are also noted.

Cognitive specificity and affective confounding in social anxiety and dysphoria in children

Cognitive features of social anxiety and dysphoria were examined with a design that allowed for evaluation of each state alone and in combination. From a community sample of 211 8 to 12 year olds, four groups of children were defined based on previous researchers criteria: mixed (high socially anxious-dysphoric;n= 14), socially anxious (high socially anxiousnondysphoric;n= 14), dysphoric (non-socially anxious-dysphoric;n= 13), and control (non-socially anxious-nondysphoric;n= 14). The negative cognitive triad and negative cognitions pertaining to the self were associated with both dysphoria and social anxiety. Both dysphoric and socially anxious groups reported significantly more cognitive distortions than the control group, yet cognitive distortions of overgeneralizing and personalizing were specific to social anxiety and not dysphoria. Both dysphoric and socially anxious groups reported significantly more depressive cognitions than the control group, and evidence of cognitive content-specificity emerged only for anxiety, although there was some evidence for depressive content-specificity in the mothers ratings. The mixed group was the most dysfunctional on all of the cognitive measures. This study provided some evidence of cognitive-specificity as well as the confounding between the affective states of dysphoria and social anxiety. Methodological, theoretical, and treatment implications are highlighted.

Parent ratings of children's depression, anxiety, and aggression: a cross-sample analysis of agreement and differences with child and teacher ratings.

Parent ratings of depression, anxiety, and aggression in elementary school and impatient 8- to 12-year-olds were evaluated by examining their correspondence and discrepancies with parallel child and teacher ratings. Parent-child and parent-teacher correspondence was significantly better for elementary school than inpatient children on depression and anxiety. Parents and teachers reported similar levels of symptoms on all traits for elementary school children, yet parents reported significantly more symptoms than teachers in the inpatient sample. The level or severity of anxiety symptoms that parents reported in inpatient children was similar to that reported by children, yet inpatient children reported significantly less depression and aggression than parents. Elementary school children reported significantly more symptoms on all traits than parents. Age, sex, and sample differences in discrepancies were examined.

A Comparison of Two Self-Report Measures of Children's Social Anxiety in Clinic and Community Samples

Examined the relations between the Social Phobia and Anxiety Inventory for Children (SPAI-C) and the Social Anxiety Scale for Children-Revised (SASC-R) in community (n = 178) and clinic (n = 57) samples. A large proportion of children exceeded the recommended SPAI-C and SASC-R cutoffs for suggesting clinically significant levels of social phobia and social anxiety in the community (37% SPAI-C and 20% SASC-R) and clinic (58% SPAI-C and 42% SASC-R) samples. A large proportion of children scoring in the clinical range on the Child Behavior Checklist (CBCL) exceeded the SASC-R and SPAI-C cutoff scores; however, there was notable variability with respect to sample, age group (£10 years and ³11 years), sex, and measure (SPAI-C vs. SASC-R, and CBCL Internalizing vs. Social Competence scale). Using the recommended cutoffs, discriminant function analyses found the classification correspondence between the SPAI-C and SASC-R was significant, with some variability found in the 2 samples, age groups, and sexes (ranging from 82% to 91% classification correspondence). These initial findings highlight a need to consider sample, age, and sex in further examination of the utility and validity of these measures and their recommended cutoffs. Implications for future work examining the linkages between social anxiety and social phobia, as well as for the assessment of childrens social anxiety and social fears, are discussed.

Differentiating parent- and peer-related interpersonal correlates of depressive symptoms and social anxiety in preadolescent girls

One hundred preadolescent girls’ (ages 9—12) and mothers’ perceptions of parent- and peer-related interpersonal correlates of girls’ depression and social anxiety, before and after controlling for comorbid symptoms, were examined. Girls’ parental acceptance/rejection and support and perceived close friend support were more strongly related to girls’ depression than to their social anxiety. Mother-rated girls’ social acceptance was more strongly related to girls’ social anxiety than depression, and girls’ perceived social acceptance was unrelated to girls’ depression after controlling for social anxiety. Loneliness and perceived classmate support were each related to both social anxiety and depression after controlling for comorbid symptoms. Results highlight the importance of controlling for comorbid symptoms and reveal some similar, and differential, correlates of depression and social anxiety.

Peer Ratings of Internalizing and Externalizing Problems in Inpatient and Elementary School Children Correspondence with Parallel Child Self-Report and Teacher Ratings

Some reliability and validity indices of peer ratings of internalizing (depression, anxiety) and externalizing (aggression) behaviors were explored for elementary school (n = 142) and inpatient (n = 86) 8- to 12-year-old children. Interrater reliabilities for the peer ratings were very good (all above .94) for both samples on all types of behaviors. Peer ratings corresponded significantly with child self-reports on all three traits in both the elementary school and inpatient samples in both the younger (ages 8 and 9) and older (ages 10, 11, and 12) children and in both girls and boys. Peer ratings of depression and aggression corresponded significantly with teacher ratings of those same traits in both samples; however, on anxiety, peer–teacher correspondence was not significant in both samples. For both older and younger children, as well as boys and girls, same-trait peer–teacher correspondence was significant on both depression and aggression, with correspondence on anxiety significant for boys and older children and nonsignificant for girls and younger children. Inpatient children were rated significantly higher by their peers than elementary school children on all three traits. Both samples of children self-reported significantly more depression and anxiety than their peers reported, and inpatient children self-reported significantly less aggression than their peers reported. The potential utility of peer ratings is discussed.

Do Private Religious Practices Moderate the Relation Between Family Conflict and Preadolescents’ Depression and Anxiety Symptoms?:

We extended past research that focused on the relation between family conflict and preadolescents’ depressive and anxiety symptoms. In a sample of 160 11- to 12-year-olds, we examined whether private religious practices moderated the relations between family conflict and preadolescents’ depressive and anxiety symptoms. Although preadolescents’ depressive and anxiety symptoms were not significantly associated with their private religious practices, preadolescents’ private religious practices moderated the relations between: (a) both mother- and preadolescent-reported family conflict and preadolescents’ anxiety symptoms; and (b) both mother- and preadolescent-reported family conflict and preadolescents’ depression symptoms. The relation between family conflict and depression and anxiety symptoms was significantly stronger for preadolescents low, versus high, in their private religious practices. Preadolescents’ sex was not differentially related to these findings. Results highlight the role that private religious practices may play in moderating the relation between family conflict and preadolescents’ internalizing symptoms. Implications of these findings and directions for future research are discussed.

Examining Cognitive Models of Externalizing and Internalizing Problems in Subgroups of Juvenile Delinquents

The Emotion Expression Scale for Children (EESC) is a new self-report scale designed to examine 2 aspects of deficient emotion expression: lack of emotion awareness and lack of motivation to express negative emotion. Validity was assessed using self-report measures of emotion regulation and self- and peer-report of internalizing and externalizing symptoms. Using a community sample of 208 fourth- and fifth-grade children, reliability analyses revealed high internal consistency and moderate test-retest reliability of the EESC. The results provide initial support for concurrent validity for the EESC factors evidenced by relations with measures of emotion management. Associations were found between the EESC and measures of internalizing symptoms.

Exploring Modeling-based Hypotheses in Preadolescent Girls’ and Boys’ Cognitive Vulnerability to Depression

In a community sample of 163 children (ages 9–12) and their mothers, we explored modeling-based hypotheses that may underlie how cognitive vulnerability components to depression (negative cognitive triad and negative attributional style) are transmitted from mother to preadolescent children. Results found mothers’ negative cognitive triad partially mediated the relation between mothers’ depressive symptoms and children’s negative cognitive triad. Moreover, mothers’ negative cognitive triad was uniquely and significantly related to children’s negative cognitive triad, after statistically adjusting for the effects of mothers’ depressive and anxiety symptoms in our full sample, as well as in a subsample of our mothers with more depressive symptoms. Most importantly, in our full sample and our subsamples with more depressive symptoms, the amount of time that mothers reported spending with their children moderated the relation between mothers’ and children’s negative cognitive triad, with significantly stronger relations found between mothers’ and children’s negative cognitive triad when mothers reported spending higher in comparison to lower amounts of time spent together. Our modeling-based hypotheses with respect to attributional style, and child sex, were not supported. Implications of our findings for further understanding of family-based modeling mechanisms of risk, and directions for future research, are highlighted.

Mothers’ and Fathers’ Parental Warmth, Hostility/Rejection/Neglect, and Behavioral Control: Specific and Unique Relations with Parents’ Depression Versus Anxiety Symptoms

SYNOPSIS Objective. This study advanced and tested conceptualizations of parents’ depression and anxiety in relation to parental warmth, hostility/rejection/neglect, and behavioral control, before and after controlling for comorbid symptoms. Design. Two-parent families (N = 119) with girls (aged 8 to 12) completed questionnaires on parents’ and girls’ depression and anxiety and parents’ parenting. Results. Both parents’ depression and anxiety were related to more hostility/rejection/neglect; and the relations with depression remained after controlling for anxiety, yet the relations with anxiety became non-significant after controlling for depression. Mothers’ and fathers’ depression remained significantly and uniquely related to more hostility/rejection/neglect after controlling for their anxiety in addition to parental warmth, family socioeconomic status, parents’ treatment status, and girls’ depression and anxiety symptoms. Both mothers’ and fathers’ anxiety were related to higher behavioral control, before and after controlling for the parent’s depression, hostility/rejection/neglect, and treatment status, as well as family socioeconomic status and girls’ depression and anxiety symptoms. Fathers’ depression was related to lower behavioral control only after controlling for fathers’ anxiety, and remained so after also controlling for fathers’ hostility/rejection/neglect and the other control variables. Fathers’ depression and anxiety also interacted in relation to behavioral control. Conclusions. Mothers’ and fathers’ depression and anxiety symptoms are differentially related to parental warmth, hostility/rejection/neglect, and behavioral control, especially when comorbid symptoms are considered.