Constance Hammen

Issues and recommendations regarding use of the Beck Depression Inventory

Issues concerning use of the Beck Depression Inventory (BDI) for the self-report of depressive symptomatology are raised and considered. Discussion includes the stability of depression and the need for multiple assessment periods, specificity and the need for multiple assessment measures, and selection cut scores and the need for terminological accuracy. Recommendations for the continued use of the BDI, designed to facilitate the integration of diverse studies and improve research on self-reported depression, are provided.

Age and Gender as Determinants of Stress Exposure, Generation, and Reactions in Youngsters: A Transactional Perspective

The present study used a contextual and transactional approach to examine age and gender differences in the experience and consequences of life stress in clinic-referred preadolescents and adolescents. Eighty-eight youngsters and their parents completed the Child Episodic Life Stress Interview, a detailed semistructured interview assessing the occurrence of stressful events in multiple life domains. Interviews were coded using a contextual threat rating method to determine event stressfulness and dependence. Youngsters also completed the Childrens Depression Inventory and the Revised Child Manifest Anxiety Scale to assess self-reported symptoms of depression and anxiety. Consistent with predictions, age- and gender-related patterns of life stress varied across the type and context of stressors. Most notably, adolescent girls experienced the highest levels of interpersonal stress, especially stress and conflict that they generated within parent-child and peer relationships. Preadolescent girls experienced the highest levels of independent stress and conflict in the family context. Adolescent boys experienced the highest levels of noninterpersonal stress associated with self-generated events. Girls demonstrated particular vulnerability to depressive responses to dependent stress. The results build on and extend previous theory and research on age and gender differences in close relationships and stress, and illustrate the value of more refined conceptual models and more sophisticated methodologies in child life stress research.

Development and natural history of mood disorders

To expand and accelerate research on mood disorders, the National Institute of Mental Health (NIMH) developed a project to formulate a strategic research plan for mood disorder research. One of the areas selected for review concerns the development and natural history of these disorders. The NIMH convened a multidisciplinary Workgroup of scientists to review the field and the NIMH portfolio and to generate specific recommendations. To encourage a balanced and creative set of proposals, experts were included within and outside this area of research, as well as public stakeholders. The Workgroup identified the need for expanded knowledge of mood disorders in children and adolescents, noting important gaps in understanding the onset, course, and recurrence of early-onset unipolar and bipolar disorder. Recommendations included the need for a multidisciplinary research initiative on the pathogenesis of unipolar depression encompassing genetic and environmental risk and protective factors. Specifically, we encourage the NIMH to convene a panel of experts and advocates to review the findings concerning children at high risk for unipolar depression. Joint analyses of existing data sets should examine specific risk factors to refine models of pathogenesis in preparation for the next era of multidisciplinary research. Other priority areas include the need to assess the long-term impact of successful treatment of juvenile depression and known precursors of depression, in particular, childhood anxiety disorders. Expanded knowledge of pediatric-onset bipolar disorder was identified as a particularly pressing issue because of the severity of the disorder, the controversies surrounding its diagnosis and treatment, and the possibility that widespread use of psychotropic medications in vulnerable children may precipitate the condition. The Workgroup recommends that the NIMH establish a collaborative multisite multidisciplinary Network of Research Programs on Pediatric-Onset Bipolar Disorder to achieve a better understanding of its causes, course, treatment, and prevention. The NIMH should develop a capacity-building plan to ensure the availability of trained investigators in the child and adolescent field. Mood disorders are among the most prevalent, recurrent, and disabling of all illnesses. They are often disorders of early onset. Although the NIMH has made important strides in mood disorders research, more data, beginning with at-risk infants, children, and adolescents, are needed concerning the etiology and developmental course of these disorders. A diverse program of multidisciplinary research is recommended to reduce the burden on children and families affected with these conditions.

Chronicity, Severity, and Timing of Maternal Depressive Symptoms: Relationships with Child Outcomes at Age 5.

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on childrens behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.

Toward an interpersonal life-stress model of depression: The developmental context of stress generation

The validity of a developmentally based life-stress model of depression was evaluated in 88 clinic-referred youngsters. The model focused on (a) the role of child-environment transactions, (b) the specificity of stress-psychopathology relations, and (c) the consideration of both episodic and chronic stress. Semistructured diagnostic and life-stress interviews were administered to youngsters and their parents. As predicted, in the total sample child depression was associated with interpersonal episodic and chronic stress, whereas externalizing disorder was associated with noninterpersonal episodic and chronic stress. However, the pattern of results differed somewhat in boys and girls. Youngsters with comorbid depression and externalizing disorder tended to experience the highest stress levels. Support was obtained for a stress-generation model of depression, wherein children precipitate stressful events and circumstances. In fact, stress that was in part dependent on childrens contribution distinguished best among diagnostic groups, whereas independent stress had little discriminative power. Results suggest that life-stress research may benefit from the application of transactional models of developmental psychopathology, which consider how children participate in the construction of stressful environments.

Children of Depressed Parents

In recent years, we have come to recognize the enormous toll that depression takes on peoples’ lives. In exploring the impact of this disorder, it has also become clear that depression affects the lives of others, and nowhere is this effect more apparent and dramatic than in families. Studies of children of depressed parents have grown in number and sophistication recently, and they all point to a common conclusion: Depression runs in families, and children of depressed parents are highly likely to experience depression and other forms of disorder and maladjustment. The extent of children’s impairment is striking, apparently equaling or even exceeding that of seemingly more severe parental disorders such as schizophrenia or bipolar affective disorder. Although a genetic model often implicitly guided earlier studies of children’s risk, alternative approaches suggest a role for psychosocial factors in a diathesis—stress model: That children in families with a depressed parent are enormously stressed by the constellation of circumstances associated with their parents’ debilities, and many may lack the skills and resources that would be necessary to deal with such stress.

Sociotropy/autonomy and vulnerability to specific life events in patients with unipolar depression and bipolar disorders.

Followed samples of unipolar and bipolar patients for a 6-month period, with independent assessment of symptoms and life events. Patients were initially categorized into subtypes using Becks Sociotropy/Autonomy Scale, with the prediction that onset or exacerbation of symptoms, as well as more total symptoms, would occur for sociotropic individuals experiencing more negative interpersonal events than achievement events, and for autonomous-achievement patients experiencing more achievement events than interpersonal events. Results were confirmed for unipolars, indicating that the course of disorder was associated with the occurrence of personally meaningful life events, but not for bipolars. Further research is recommended to examine whether the effect is equally robust for both subtypes of unipolars, whether longer study duration may be required for bipolars, and whether a cognitive self-schema mechanism may account for the specific vulnerability to a subset of stressful events.

Cognitive vulnerability in children at risk for depression

Cognitive, developmental, and psychodynamic theories all hypothesize that negative self-concepts acquired in childhood may induce vulnerability to depression. Children at risk because of maternal major affective disorder, compared with children of medically ill and normal mothers, were examined for evidence of negative cognitions about themselves, and were found to have more negative self-concept, less positive self-schemas, and more negative attributional style. It was further predicted that negative cognitions about the self would be related to maternal depression and chronic stress, and to the quality of perceived and actual interactions with the mother. In general, the predicted associations were obtained, supporting speculations about how maternal affective disorder is associated with stress and with relatively negative and unsupportive relationships with children that in turn diminish childrens self-regard.

Poor interpersonal problem solving as a mechanism of stress generation in depression among adolescent women.

The authors examined C. Hammens (1991) model of stress generation in depression and the role of interpersonal problem-solving strategies (IPS) in the stress generation process in a longitudinal sample of 140 young women who entered the study at ages 17-18. Structural equation modeling was used to test a model in which IPS and subsequent interpersonal stress mediated the relationship between initial and later depressive symptoms. Results supported the main prediction of the stress generation model: Interpersonal stress mediated the relationship between initial and later depressive symptoms. In addition, IPS predicted interpersonal stress. However, no association was found between depressive symptoms and IPS. An alternative model in which IPS moderated the relationship between stress and depressive symptoms was tested; it was not supported.

Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress.

The authors tested a cognitive-interpersonal hypothesis of depression by examining the role of interpersonal cognitions in the prediction of depression associated with interpersonal stressors. A measure of adult attachment assessed interpersonal cognitions about ability to be close to others and to depend on others and anxiety about rejection and abandonment. Participants were women who had recently graduated from high school; they were followed for 1 year with extensive interview evaluation of life events, depression, and other symptomatology. Generally, cognitions, interpersonal events, and their interactions contributed to the prediction of interview-assessed depressive symptoms, but the effects were not specific to depression and predicted general symptomatology measured by diagnostic interviews as well, and results also varied by attachment subscale. Results were discussed in terms of a developmental psychopathology approach to disorders in young women.