Gemma Gladstone

Do bullied children become anxious and depressed adults? A cross-sectional investigation of the correlates of bullying and anxious depression

There is little empirical research examining the historical and clinical correlates of exposure to childhood bullying in adult clinical subjects. Using structured clinical assessments, the authors studied a group of adult males and females presenting to an outpatient depression clinic, to examine the childhood risk factors and the distinguishing comorbid features associated with those reporting exposure to bullying. Just over a quarter of both men and women reported having experienced bullying that was severe and traumatic. More of these subjects also reported several other well studied childhood risk factors. Childhood correlates that were particularly relevant for exposure to bullying were parental overcontrol, illness or disability, and the tendency to have an inhibited temperament early in life. The experience of childhood bullying was strongly related to high levels of comorbid anxiety, both in terms of greater levels of state anxiety and a higher prevalence of both social phobia and agoraphobia. Independent of other childhood risk factors, exposure to bullying was especially predictive of subjects’ higher levels of general state anxiety and the tendency to express anxious arousal externally when under stress. These results are compatible with both cross-sectional and prospective studies of child and adolescent samples, and highlight the potential etiological significance of early peer victimization experiences for a percentage of adults suffering from depression with comorbid anxiety.

Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype

BACKGROUND Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. AIMS To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. METHOD Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. RESULTS Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. LIMITATIONS Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes. CONCLUSIONS These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.

Measuring a behaviorally inhibited temperament style: Development and initial validation of new self-report measures

An inhibited temperament early in life has been implicated as a risk factor for the later development of clinically meaningful anxiety and possibly depression. Most empirical investigations study young children, with fewer data obtained from older subjects. Two self-report measures, the Adult Measure of Behavioral Inhibition (AMBI) and the Retrospective Measure of Behavioral Inhibition (RMBI), were developed and evaluated psychometrically. Both instruments were multifactorial with satisfactory psychometric properties. Results indicated that the RMBI performed favorably as a measure of (retrospectively reported) childhood temperament, with good construct and discriminant validity. Designed as a measure of trait behavioral inhibition in adulthood, the AMBI also performed as a measure of contemporaneous anxiety proneness. Although the identified factor structure of both measures requires further examination in independent samples, current results support their use as valid measurement tools for studies examining the link between normal range temperament and psychopathology, especially where more rigorous prospective methods are unavailable. The RMBI may be a particularly useful instrument in this regard.

Recognizing the anxious face of depression.

“Anxious depression” is used variably both by researchers and clinicians to describe admixtures of anxiety and depressive symptoms. The authors sought to determine the best model for conceptualizing anxious depression by studying a sample of depressed patients referred to a tertiary referral unit. Anxiety and depression were assessed using a comprehensive set of mixed symptoms that were subsequently refined to provide separate anxiety and depressive factors, and patients were trichotomized into groups of low, medium, and high anxiety on the basis of their total anxiety factor scores. Associations between the constructs of anxiety and depression in different depressive subgroups were explored, and the severity of depressive symptoms and other clinical variables across the three anxiety groupings was assessed. Depression variables were not linearly associated in a consistent pattern with anxiety-defined groups, arguing against a simple interdependence model driven by a higher-order variable such as depression severity. By contrast, the state anxiety categories were linked strongly with lifetime anxiety disorder prevalence, with some associations linear and with others evidencing a trend break association. The authors found support for a model of anxious depression, whereby anxiety both predisposes to nonmelancholic depression and contributes to its presentation by shaping its clinical features. Such a model and its definition assist in clarifying the cause of anxious depression and its treatment.

Parental Characteristics as Influences on Adjustment in Adulthood

A long-standing assumption underpinning much psychiatric theorizing has been that developmental factors in childhood contribute to later adult social adjustment and behavior. More specifically, it has been argued that some developmental factors may dispose both to psychiatric conditions and to dysfunctional social and emotional relationships during adult life, either directly or by establishing a diathesis that makes the individual vulnerable to such consequences. Among the numerous developmental factors operating in the life of a child, parental behaviors and attitudes have been implicated as major influences, especially for younger children with limited social networks.

Chapter 2 – The Role of Parenting in the Development of Psychopathology: An Overview of Research Using the Parental Bonding Instrument

Publisher Summary The emotional bond between a parent or caregiver and a young child defines a core and continuing human experience. This primary parent-child union constitutes the strongest and the most important attachment for a young child, and serves as an essential ingredient for the childs growth and development, both physically and psychologically. The parental bonding instrument (PBI) was developed in response to the need for empirical data to broaden the study of parental influences, and as a research tool to examine the influence of aberrant parenting on the psychological and social functioning of recipients. The PBI is completed for the respondents first 16 years of life; thus, it represents an overall view of parent-child bonding during these years of development. Parenting is a complex set of behaviors and psychological processors that are determined by multiple factors. Some salient factors include parents own personality or the presence of parental psychopathology.

Predictors of 1‐year outcome in depression

Objective: We compared several different methods for assessing depression ‘recovery’ over a 1-year review interval, to determine the utility of the contrasting approaches. Second, we assessed baseline predictors of 1-year outcome and recovery status. Third, we examined the extent to which predictors showed consistency across the variable definitions of outcome and recovery. Methods: Twelve-month outcome was assessed in a sample of 182 subjects who at baseline assessment met DSM criteria for a major depressive episode. The contrasting methods involved a defined percentage reduction in Beck Depression Inventory self-rating scores, formalised change point definitions, no longer meeting DSM-IV major depression criteria, and clinical global improvement (CGI) ratings. Results: Sixty-one per cent reached formalised change point criteria for full remission or recovery when trajectories across the 12-month interval were examined. Other measures quantified recovery rates ranging from 43% to 70%. Those with a psychotic or melancholic depression were more likely to have achieved recovery status in some analyses. Non-recovery at 12 months was predicted most consistently by higher baseline levels of anxiety and depression; high trait anxiety and a lifetime anxiety disorder; disordered personality function; and having reported exposure to acute and enduring stressors at baseline assessment. Conclusions: While the CGI was the superior system in terms of number of significant discriminating predictors of outcome, the change point definitional approach provides much greater information across the follow-up interval, arguing for their complementary utility. As several currently identified baseline predictors of outcome (i.e. anxiety, disordered personality function) also predicted onset of depression, their relevance as both depression-inducing and depression-propagating variables is suggested.

Depressogenic cognitive schemas: enduring beliefs or mood state artefacts?

Objective: The objective of this study was to review findings from a previously posited ‘lock and key’ hypothesis which challenge a number of assumptions about cognitive theories of depression. Method: A review of existing cognitive vulnerability theories is presented. Two recent studies employed to test the lock and key hypothesis are summarized. The hypothesis is reviewed in light of other diathesis-stress models of cognitive vulnerability. Results: The identification of a depressed individuals core beliefs or cognitive schemas is a difficult task, with perhaps unresolvable difficulties in disentangling any mood state determinant. Longitudinal assessment of originally euthymic subjects appears the best method to investigate any cognitive risk to depression and the significance of diathesis-stress models. Conclusions: Empirical evidence for or against the validity of cognitive vulnerability theories is largely dependent upon the methodologies used to detect cognitive styles, as well as the nature of the subject groups studied.

The development of a patient satisfaction measure for psychiatric outpatients

Objective: To describe the first stage of development of a patient satisfaction form designed for psychiatric outpatients. Method: An initial 62-item questionnaire was completed by 172 patients, who were asked to assess the importance of a number of practice and practitioner features in contributing to their satisfaction. Results: Mean scores prioritised the psychiatrist respecting the rights of the patient; appointment and billing arrangements were of intermediate importance, while amenity issues were rated as unimportant. When rankings across the several practices were examined, very high levels of agreement were demonstrated, supporting the likely validity of the overall rankings. Four underlying domains were identified by factor analysis, the principal one being defined by respect for confidentiality, by support and adequate communication. The three remaining factors were contributed to more by practice (e.g. billing arrangements, amenities) than by practitioner features. Conclusion: We consider how a refined and modified version of the measure might be developed for use by both individual practitioners and group practices, as well as being used as a formal QA component activity.

Development of a measure profiling problems and needs of psychiatric patients in the community.

Abstract We argue the advantages of a measure profiling common problems faced by psychiatric patients in the community and indicating a likely need for service recognition, review and possible assistance. We describe the development of such a measure, the 35-item Profile of Community Psychiatry Clients (PCPC), and the identification of four relevant domains. Component scales assess coping limitations, behavioural problems, levels of social support and organic problems. High test-retest reliability was established, and a number of tests of the measures validity were undertaken. Discriminant validity was established by demonstrating that those case managed by a community mental health service returned significantly higher scale scores than a comparison group who, while having a similar diagnostic profile, were not case managed. Additionally, scale scores were associated with a number of categorical and dimensional validators reflecting aspects of service need, and distinctly with service costs. We demonstrate that PCPC scores correspond with scores generated by the Life Skills Profile (LSP), a measure of disability, and examine the extent to which PCPC scales correspond to those contained in the Health of the Nation Outcome Scales (HoNOS). We argue for the scales capacity to provide both a profile of central problems faced by patients and their likely need for community-based service assistance.