Kathryn E. Grant

Depression in adolescence.

Adolescence is an important developmental period for understanding the nature, course, and treatment of depression. Recent research concerned with depressive mood, syndromes, and disorders during adolescence is reviewed, including investigations of the prevalence, course, risk factors, and prevention and treatment programs for each of these three levels of depressive phenomena in adolescence. A broad biopsychosocial perspective on adolescent depression is recommended, and possible directions for future integrative research are proposed. Based on current research and knowledge, implications for research, program, and national policy are considered.

Stressors and Child and Adolescent Psychopathology: Moving From Markers to Mechanisms of Risk

In the first half of this review, the authors critically evaluate existing research on the association between stressors and symptoms of psychopathology in children and adolescents. This analysis reveals (a) problems with conceptualizations of stress, (b) variability in measurement of stressors, and (c) lack of theory-driven research. To address these problems, the authors propose a general conceptual model of the relation between stressors and child and adolescent psychopathology. The authors examine basic tenets of this general model in the second half of this article by testing a specific model in which negative parenting mediates the relation between economic stressors and psychological symptoms in young people. Results generally provide support for the specific model as well as for the broader model.

Stressors and Child and Adolescent Psychopathology: Measurement Issues and Prospective Effects

This article reviews existing research on the association between stressors and symptoms of psychopathology in children and adolescents with a focus on measurement issues and prospective effects. The first half of the article focuses on the measurement of stressors, emphasizing checklists and interviews. Available measures of stressful experiences are reviewed and critiqued. Results of this review reveal both substantial progress (i.e., development of valid stressor assessment tools) and remaining problems (i.e., inconsistent measurement across studies). The second half of this article reviews studies that have tested for prospective associations between stressors and symptoms of psychopathology in children and adolescents. Studies that have examined the prospective effects of recent or prior stressors on current psychological symptoms, while controlling for prior psychological symptoms, are reviewed. Results overall suggest that stressors predict changes in rates of symptoms of psychopathology in children and adolescents over time. Results also suggest that symptoms of psychopathology predict changes in rates of stressors over time. Implications of these findings are that conclusive evidence now exists for the importance of stressors in the development of child and adolescent psychopathology.

Stress and psychopathology in children and adolescents: is there evidence of specificity?

Research on the relations between specific stressors and specific psychological outcomes among children and adolescents is reviewed. Specificity, the notion that particular risk factors are uniquely related to particular outcomes is discussed from a theoretical perspective, and models of specificity are described. Several domains of stressors are examined from a specificity framework (e.g., exposure to violence, abuse, and divorce/marital conflict) in relation to broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted within the past 15 years are examined, and definitional problems are highlighted. Little evidence for specificity was found. Methodological problems in the literature and the lack of theory-driven specificity research are discussed, and directions for future research are identified.

Taxonomy, Assessment, and Diagnosis of Depression During Adolescence

Research on depressive phenomena during adolescence has focused on 3 separate constructs: depressed mood, depressive syndromes, and depressive disorders. Approaches to the assessment, taxonomy, and diagnosis of these 3 conceptualizations are reviewed. Each of the approaches is represented by different assessment tools measuring related but distinct aspects of depressive phenomena. The constructs share a common set of symptoms reflecting negative affectivity but differ in their inclusion of symptoms of anxiety, somatic problems, and disrupted concentration and in the duration and severity of the symptoms they include. Depressed mood, syndromes, and disorders are integrated as 3 levels of depressive phenomena in a hierarchical and sequential model, and moderating factors are hypothesized to account for the relationships among the 3 levels. The need for a stronger developmental focus to understand depressive phenomena during adolescence is emphasized.

Protective Factors Affecting Low-Income Urban African American Youth Exposed to Stress:

Individual (coping strategies), family (parent/child relationships), and community-based (religious involvement) variables were examined as potential protective factors for 224 low-income urban sixth-through eighth-grade African American adolescents. Each of those variables was examined as a moderator, and analyses were conducted to determine whether the association between stress and psychological symptoms was attenuated for youth endorsing positive coping strategies, strong parent/child relationships, and religious involvement. Results indicated that positive relationships with father figures buffered the effects of stress on externalizing symptoms for boys and for girls; religious involvement was protective for girls but not for boys. The sole coping strategy to demonstrate a protective effect was avoidant coping, which attenuated the relation between stress and externalizing symptoms for boys. Supplemental analyses focusing on specific subsets of stressful experiences indicated that avoidant coping and social support-seeking coping accentuated the relation between daily hassles and internalizing symptoms for girls.

Post-Traumatic Reactions in Adolescents: How Well Do the DSM-IV PTSD Criteria Fit the Real Life Experience of Trauma Exposed Youth?

This study examined the structure and symptom specific patterns of post traumatic distress in a sample of 1,581 adolescents who reported exposure to at least one traumatic event. Symptom reporting patterns are consistent with past literature in that females reported more symptoms than males and older youth reported more symptoms than did their younger peers. Young people reporting exposure to exclusively violent type traumas were also found to be more likely to endorse symptoms than peers exposed exclusively to non violent type traumas. Confirmatory factor analysis provided stronger support for a four-factor model of PTSD than either the DSM-IV model or an alternate model. Further examination of the four factor model revealed gender differences in factor loadings with small to moderate effect sizes for recurrent, distressing memories, flashbacks, restricted affect, difficulty remember details, detachment, limited future orientation, hypervigilance and startle symptoms. Differences in factor loadings with the four factor model were also noted between younger and older adolescents, with medium to large effect sizes on the arousal items. In contract, comparison of the factor loadings revealed only small differences between youth exposed exclusively to violent traumatic stressors and those exposed exclusively to non violent traumatic stressors, suggesting relative similarity between these two groups.

The Roles of Stress and Coping in Explaining Gender Differences in Risk for Psychopathology Among African American Urban Adolescents

This study used self-report symptom inventories administered in school classrooms to examine relations among gender, psychological symptoms, stress, and coping in 1,200 low-income African American urban early adolescents. Girls reported more symptoms than boys, accounted for by higher internalizing symptoms. Boys reported more stress than girls, particularly major events, controllable events, exposure to violence, and sexual stressors. Boys in gangs reported greater exposure to sexual stressors than non-gang members. Expressing feelings coping, used more by girls, was related to more symptoms and is posited to be a type of co-rumination. Rumination coping, used as a primary strategy by both boys and girls, was related to higher symptom levels. Risk to low-income African American boys from high violence exposure and sexual stressors, the problematic effect of maladaptive coping strategies for youth exposed to high stress, and how culture and experience are relevant to understanding gender differences in psychological symptoms are discussed.

Stress and Somatic Complaints in Low-Income Urban Adolescents

The present study examined (1) rates of somatic complaints and (2) the association between stress and somatic complaints in low-income urban youth. Participants were 1030 low-income urban 6th–8th grade adolescents. Results indicate that, for both boys and girls, somatization was the most commonly reported internalizing symptom in this sample, and that heightened rates of urban stress predicted heightened rates of somatic complaints. In addition, a significantly higher percentage of youth in this sample reported clinically elevated levels of somatic complaints (17%) relative to that reported by normative samples (5%). The 2 most common somatic complaints were stomachaches and headaches, and females reported higher rates of somatic complaints than males. These findings suggest that somatic complaints are the most common expression of internalizing symptoms among low-income urban youth, and that exposure to heightened rates of stress places low-income urban adolescents at heightened risk for somatization. Implications of these findings and directions for future research are discussed.

Psychological Symptoms Affecting Low-Income Urban Youth.

Rates and cooccurrence of internalizing and externalizing syndromes were examined in a sample of 1,520 low-income urban early adolescents. Results indicate higher rates of clinically elevated internalizing and externalizing symptoms in this sample relative to normative data. In particular, both boys and girls were more likely to score in the clinical range on the broad-band internalizing and externalizing subscales of the Youth Self-Report and on the anxious-depressed, withdrawn, somatic, delinquency, and aggression narrow-band subscales. Girls reported higher rates of internalizing symptoms on the broad-band internalizing subscale and on narrow-band anxious-depressed, withdrawn, and somatic complaints subscales. Contrary to expected, boys did not report higher rates of externalizing symptoms on any of the externalizing subscales. Results of bidirectional comorbidity analyses indicate that cooccurrence of aggressive with somatic symptoms and cooccurrence of aggressive with delinquency symptoms were significantly more common in this sample than in normative samples.