Jeremy W. Pettit

Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide.

Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the plans vs. desire dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point plans dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.

Evidence-based assessment of depression in adults

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and suicidality; (d) an approach to suicidality that distinguishes between resolved plans and preparations and desire and ideation; (e) assessment of the atypical, seasonal, and melancholic subtypes; (f) parameters of course and chronicity; and (g) comorbidity and bipolarity. These complexities need to be accounted for when certain assessment approaches are preferred, and when ambiguity exists regarding the categorical versus dimensional nature of depression, and whether and when clinician ratings outperform self-report. The authors conclude that no one extant procedure is ideal and suggest that the combination of certain interviews and self-report scales represents the state of the art for evidence-based assessment of depression.

Problem solving moderates the effects of life event stress and chronic stress on suicidal behaviors in adolescence

The present study examined the unique and interactive effects of stress and problem-solving skills on suicidal behaviors among 102 inpatient adolescents. As expected, life event stress and chronic stress each significantly predicted suicidal ideation and suicide attempt. Problem solving significantly predicted suicidal ideation, but not suicide attempt. Problem solving moderated the associations between life event stress and suicidal behaviors, as well as between chronic stress and suicidal ideation, but not chronic stress and suicide attempt. At high levels of stress, adolescents with poor problem-solving skills experienced elevated suicidal ideation and were at greater risk of making a nonfatal suicide attempt. The interactive effects decreased to non-significance after controlling for depressive symptoms and hopelessness. Clinical implications are discussed.

Suicidal ideation and anxiety disorders: elevated risk or artifact of comorbid depression?

Research into the possible relationship between anxiety disorders and suicidal ideation has yielded mixed results, leading some to suggest that the positive findings between anxiety and suicidal ideation might simply be a by-product of comorbid depression. Recent work has suggested that having an anxiety disorder without history of mood disorder does convey increased risk for suicidal ideation, although the study could not assess for the possible impact of subsyndromal depressiveness. This current study, therefore, examined the relationship between anxiety disorder symptoms and suicidality using continuous scales and controlling for depressiveness. Data regarding the severity of panic, social anxiety, generalized anxiety, and obsessive-compulsive symptoms were obtained from a sample of 166 college students. Results generally supported the conclusions that anxiety disorders convey risk for suicidal ideation above and beyond any co-occurring depressiveness, and anxiety and depression together conveyed an additional interactive risk.

Propagation of major depressive disorder: Relationship between first episode symptoms and recurrence

Major depressive disorder is a highly recurrent disorder, with long-term estimates of recurrence ranging as high as 80%. The impact of first episode depressive symptoms on later recurrence has not been previously examined. The present study sought to identify risk factors for recurrent major depressive episodes by investigating first episode symptoms. It was predicted that the presence of depressed mood and sleep disturbance in the first episode would increase the likelihood of recurrence. Four hundred eighty-seven randomly selected community participants who met DSM-III-R criteria for at least one major depressive episode were assessed twice during adolescence and once in young adulthood. We examined the association between first major depressive episode symptoms and the presence of a recurrent episode. Recurrence was significant predicted by the presence of depressed mood and increased appetite at episode 1. A nonsignificant trend suggested that female gender may also be associated with recurrence. First episode depressed mood, increased appetite, and female gender may serve as specific risk factors for recurrence. The centrality of depressed mood to major depressive disorder is highlighted.

Intergenerational transmission of internalizing problems: effects of parental and grandparental major depressive disorder on child behavior.

Effects of lifetime histories of grandparental (G1) and parental (G2) major depressive disorder (MDD) on childrens (G3) internalizing problems were investigated among 267 G3 children (ages 2–18 years) who received Child Behavior Checklist (CBCL) ratings and had diagnostic data available on 267 biological G2 parents and 527 biological G1 grandparents. Results indicated that G1 MDD conferred risk for G2 MDD, but not for G3 CBCL scores. G2 MDD predicted higher G3 Internalizing and Anxious/Depressed scores. Also, there was an interaction between G1 MDD and G2 MDD in predicting higher G3 Anxious/Depressed scores such that scores were highest among children with both depressed parents and grandparents. These effects were robust to statistical adjustments for status variables and parental relationship measures but not to adjustment for concurrent parental depressive symptoms.

Anxiety Sensitivity as a Specific and Unique Marker of Anxious Symptoms in Youth Psychiatric Inpatients

We addressed several questions regarding the relation of anxiety sensitivity to anxious symptoms among 47 youth psychiatric inpatients (18 boys, 29 girls), ages 9–17 (M = 14.23, SD = 1.89). Participants completed measures of anxiety sensitivity, anxious and depressive symptoms, trait anxiety, and positive and negative affect; chart diagnoses were available. Consistent with hypotheses, we found that (a) anxiety sensitivity was associated with anxious symptoms, even controlling for trait anxiety and depressive symptoms; and (b) anxiety sensitivity displayed symptom specificity to anxious versus depressive symptoms (i.e., was associated with anxiety controlling for depression but not with depression controlling for anxiety). Furthermore, regarding factors of anxiety sensitivity, we obtained mixed support for our prediction that phrenophobia would be associated with both depression and anxiety, whereas fear of physical arousal would be associated with anxiety but not depression. Implications for the construct validity of anxiety sensitivity were discussed.

The long-term course of depression: development of an empirical index and identification of early adult outcomes

BACKGROUNDnResearch on the long-term course of major depressive disorder (MDD) is hindered by the absence of established course criteria and by idiosyncratic definitions of chronicity. The aims of this study were to derive an empirical index of MDD course, to examine its predictive validity, and to identify the adulthood outcomes associated with a chronic course.nnnMETHODnIndicators for a MDD course factor were rationally selected and subjected to principal components (PCA) and confirmatory factor analyses (CFA) among 426 subjects with a lifetime history of MDD by age 30. Scores on the index prior to age 19 were examined as predictors of course from age 19 to 30. Associations between the index and outcomes of interest at age 30 were examined.nnnRESULTSnThree indicators loaded highly on a chronic course index and displayed adequate internal consistency: early onset age, number of episodes, and duration of ill time. Predictive validity of the index was supported. A more chronic course was associated with greater symptom severity, greater likelihood of treatment utilization, and greater psychosocial impairment in multiple domains. Treatment utilization interacted with chronicity to predict relatively few outcomes and did not reduce the negative impact of a chronic course.nnnCONCLUSIONSnThe course of MDD through early adulthood is best represented by a composite of early onset age, number of episodes, and duration of ill time. A chronic course through early adulthood is associated with numerous indicators of psychosocial impairment. Mental health treatment utilization in a naturalistic setting does not appear to reduce the negative impact of chronic MDD.

Specificity of information processing styles to depressive symptoms in youth psychiatric inpatients

Although information processing has been widely studied with depressed adults, little emphasis has been placed on the specificity of resultant findings to depression, as opposed to other psychological disorders. Analogously, even less effort has been directed toward examining the information processing styles of depressed children and adolescents. The present study investigated the specificity of information processing styles to depression and anxiety among 58 youth psychiatric inpatients. To assess information processing, we used a self-referent encoding task, in which participants were presented with positive and negative adjectives; participants were asked whether these adjectives described them or not, and were then tested on recall of the adjectives. After controlling for age and gender, lower rates of positive adjective endorsement and lower rates of positive adjective recall were found to be associated with depression, but not anxiety. Additionally, negative adjective endorsement was associated with anxiety symptoms. These results suggest specific cognitive features of depressive symptoms.

Relative left-frontal activity is associated with increased depression in high reassurance-seekers

Excessive reassurance-seeking, which has been associated with depression in many studies, can be defined as the relatively stable tendency to seek assurance perseveratively from others. We hypothesized that although depression has been associated with left-frontal EEG hypoactivity, reassurance-seekers may possess a unique diathesis that is more likely to be associated with increased left-frontal activity. Data were collected from 12 volunteers who were receiving therapeutic services from a University Clinic. EEG asymmetry scores were averaged over two measurement occasions at least 3 weeks apart. As predicted, stable relative right-frontal activity was associated with increased depression in those who were low on reassurance-seeking, while stable relative left-frontal activity was associated with increased depression among high reassurance-seekers. Perhaps those who seek reassurance excessively do so because of their inability to alter their behavior even when environmental cues are no longer reinforcing, which can maintain or exacerbate their depressive symptoms.