Jessica L. Hamilton

Emotional Maltreatment, Peer Victimization, and Depressive versus Anxiety Symptoms During Adolescence: Hopelessness as a Mediator

Extensive comorbidity between depression and anxiety has driven research to identify unique and shared risk factors. This study prospectively examined the specificity of three interpersonal stressors (emotional abuse, emotional neglect, and relationally oriented peer victimization) as predictors of depressive versus anxiety symptoms in a racially diverse community sample of adolescents. We expanded on past research by examining hopelessness as a mediator of the relationships between these interpersonal stressors and symptoms. Participants included 225 adolescents (55% African American; 59% female; M age = 12.84 years) who completed measures at baseline (Time 1) and two follow-up assessments (Times 2 and 3). Symptoms of depression and anxiety (social, physical, total) were assessed at Time 1 and Time 3, whereas intervening emotional maltreatment, peer victimization, and hopelessness were assessed at Time 2. Hierarchical linear regressions indicated that emotional abuse was a nonspecific predictor of increases in both depressive symptoms and symptoms of social, physical, and total anxiety, whereas relationally oriented peer victimization predicted depressive symptoms specifically. Emotional neglect did not predict increases in depressive or anxiety symptoms. In addition, hopelessness mediated the relationships between emotional abuse and increases in symptoms of depression and social anxiety. These findings suggest that emotional abuse and relationally oriented peer victimization are interpersonal stressors that are relevant to the development of internalizing symptoms in adolescence and that hopelessness may be one mechanism through which emotional abuse contributes to an increased risk of depression and social anxiety.

Sexual Trauma History Does not Moderate Treatment Outcome in Attachment-Based Family Therapy (ABFT) for Adolescents With Suicide Ideation

Despite the well-documented association between history of sexual trauma (HSA) and suicide ideation, HSA is largely overlooked in suicide treatment studies. Existing studies showed that patients with a HSA have a weaker treatment response. In this randomized clinical trial for suicide ideation, HSA did not moderate treatment outcome for Attachment-Based Family Therapy (ABFT). Adolescents responded better to ABFT than a control condition, regardless of HSA status. At baseline, adolescents with HSA were also more likely to report past suicide attempts than those without HSA, indicating that they are a particularly important subgroup to consider when developing and evaluating interventions that target suicide ideation. Findings suggest that ABFT is a robust intervention for suicide ideation regardless of HSA.

Pubertal timing and vulnerabilities to depression in early adolescence: differential pathways to depressive symptoms by sex.

Although research implicates pubertal processes in the emergence of the sex difference in depression during adolescence, few studies have examined how cognitive and affective vulnerabilities influence the effect of pubertal timing on depressive symptoms. The current study prospectively examined whether early pubertal timing predicted increases in depressive symptoms among adolescents with more negative cognitive styles and lower emotional clarity, and whether this risk was specific to adolescent girls. In a diverse sample of 318 adolescents, early pubertal timing predicted increases in depressive symptoms among adolescent boys and girls with more negative cognitive styles and adolescent girls with poor emotional clarity. These findings suggest that earlier pubertal maturation may heighten the risk of depression for adolescents with pre-existing vulnerabilities to depression, and that early maturing adolescent girls with lower levels of emotional clarity may be particularly vulnerable to depressive symptoms, representing one pathway through which the sex difference in depression may emerge.

Stress and the Development of Cognitive Vulnerabilities to Depression Explain Sex Differences in Depressive Symptoms During Adolescence

Although cognitive vulnerabilities to depression have received considerable empirical support, little research has evaluated the differential development of cognitive vulnerabilities in adolescent girls and boys. The current study examined the role of stressful life events, as well as sex differences in reactivity and exposure to stress, in the development of negative cognitive style and rumination in a multiwave study of 382 adolescents. Path analyses indicated that interpersonal dependent stress predicted higher prospective levels of negative cognitive styles and rumination. In addition, girls’ greater exposure to interpersonal dependent stress explained their higher levels of rumination, which accounted for higher levels of depressive symptoms in girls than in boys. These findings suggest that interpersonal dependent stress is a significant risk factor for the formation of cognitive vulnerabilities to depression during adolescence, and that the sex difference in depressive symptoms may result from girls’ greater exposure to interpersonal dependent stress and ruminative response style.

Overgeneral Autobiographical Memory, Emotional Maltreatment, and Depressive Symptoms in Adolescence: Evidence of a Cognitive Vulnerability-Stress Interaction.

Overgeneral autobiographical memory (OGM) is associated with depression and may confer risk for the development of depressed mood, but few longitudinal studies have evaluated OGM as a predictor of depressive symptoms in early adolescence, particularly in the context of environmental stressors. We investigated whether OGM and emotional maltreatment would interact to predict prospective increases in depressive symptoms in early adolescents and whether these effects differed by race. Among 174 seventh-graders, OGM and familial emotional abuse interacted to predict depressive symptoms eight months later, controlling for initial depressive symptoms. Specifically, emotional abuse predicted increases in depressive symptoms among Caucasian adolescents with more OGM, but not among those with less OGM. This association was not significant for African American adolescents. These results provide support for a cognitive vulnerability-stress relationship between OGM and emotional abuse in early adolescence and suggest that these mechanisms of risk for depression may be specific to Caucasian adolescents.

Atypical reactivity of heart rate variability to stress and depression across development: Systematic review of the literature and directions for future research

Heart rate variability has received growing attention in the depression literature, with several recent meta-analyses indicating that lower resting heart rate variability is associated with depression. However, the role of fluctuations in heart rate variability (or reactivity) in response to stress in depression remains less clear. The present review provides a systematic examination of the literature on heart rate variability reactivity to a laboratory-induced stressor task and depression, including 26 studies of reactivity in heart rate variability and clinical depression, remitted (or history of) depression, and subthreshold depression (or symptom-level depression) among adults, adolescents, and children. In addition to reviewing the findings of these studies, methodological considerations and conceptual gaps in the literature are addressed. We conclude by highlighting the importance of investigating the potential transactional relationship between heart rate variability reactivity and depression and possible mechanisms underlying this relationship.

A Vulnerability-Stress Examination of Response Styles Theory in Adolescence: Stressors, Sex Differences, and Symptom Specificity

The stress-reactivity extension of the response styles theory of depression suggests that individuals who ruminate (or fail to engage in distraction or problem solving) in response to dysphoric mood are likely to experience higher levels of depression following stress. However, previous studies have not addressed (a) the specificity of these vulnerability–stress relations to symptoms of depression following different types of stressors, and (b) to what extent rumination and stress can account for the sex differences in depression that emerge during early adolescence. A community sample of 256 early adolescents (ages 12–13) completed a baseline visit and a follow-up visit 9 months later. Response styles and symptoms of depression and anxiety were assessed at baseline, and intervening life events, emotional maltreatment, peer relational victimization, and symptoms of depression and anxiety were assessed at follow-up. Higher rumination and lower distraction/problem solving interacted with several types of stressors to predict higher levels of symptoms of depression but not anxiety. Rumination was more strongly associated with elevations in depressive symptoms following the occurrence of relational victimization events in girls than in boys. In addition, dependent interpersonal stress mediated the sex difference in depressive symptoms that emerged at follow-up, and this indirect pathway was stronger among adolescents who tended to ruminate. Rumination may confer vulnerability that is specific to symptoms of depression following recent stressors during early adolescence. Girls who ruminate may be particularly likely to experience depression following relational victimization, and dependent interpersonal stressors may help to account for girls’ greater risk for depression during adolescence.

Non-suicidal self-injury prospectively predicts interpersonal stressful life events and depressive symptoms among adolescent girls

Non-suicidal self-injury (NSSI) is the deliberate self-harm of ones tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls.

Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study.

Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

The Interaction of Affective States and Cognitive Vulnerabilities in the Prediction of Non-Suicidal Self-Injury

Non-suicidal self-injury (NSSI) is a serious public health concern and remains poorly understood. This study sought to identify both cognitive and affective vulnerabilities to NSSI and examine their interaction in the prediction of NSSI. A series of regressions indicated that low levels of positive affect (PA) moderated the relationships between self-criticism and brooding and NSSI. The associations of self-criticism and brooding with greater frequency of NSSI were attenuated by higher levels of PA. The interaction of cognitive and affective vulnerabilities is discussed within the context of current NSSI theory.