Stephanie A. Gamble

Meta-analysis of depression and substance use among individuals with alcohol use disorders.

The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset of an alcohol use disorder, and higher treatment participation. Age moderated the association between depression and alcohol use and impairment such that the association was stronger in older samples.

Adolescents' Perceptions of Primary Caregivers and Cognitive Style: The Roles of Attachment Security and Gender

Prior research has established a link between negative early parent–child relationships and cognitive styles related to risk for depression. In attempting to explain this association, several theorists have proposed that attachment insecurity may play a key mediating role. The present study examined the relationships between adolescents’ perceptions of their primary caregivers and negative cognitive styles (i.e., low self-esteem, dysfunctional attitudes, and a negative attributional style), and tested whether these relations were mediated by attachment insecurity. Results from 134 high-school students suggested that adverse parenting tends to have a more negative effect on cognitive style among girls compared to boys and that the association between parenting and cognitive style is largely mediated by attachment insecurity. Adolescents who perceive their parents as critical and perfectionistic tend to report insecure attachment styles characterized by difficulties getting close to others and fears about abandonment, and in turn, these dimensions of attachment insecurity appear to contribute to low self-esteem, dysfunctional attitudes and a negative attributional style.

Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type

BACKGROUND Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events. METHOD Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed. RESULTS Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI)=5.50 (1.73, 17.53), p=0.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI)=6.05 (1.31, 28.02), p=0.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned. CONCLUSIONS Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.

Interpersonal psychotherapy for depressed women with sexual abuse histories: a pilot study in a community mental health center.

Depression among women with childhood sexual abuse histories has a chronic and treatment-refractory course, and is accompanied by high rates of comorbid illness and adult trauma exposures. Reducing the disproportionate burden of serious mental illness among depressed, traumatized women must be a priority in community mental health settings. Effective treatments are needed. The feasibility and effects of interpersonal psychotherapy (IPT) for women with major depression and childhood trauma histories were tested. Twenty-five women in a community mental health center were enrolled in a 16-session course of IPT. Symptoms, functioning, and feasibility (e.g., participation rates) were measured at baseline, 10 weeks, 24 weeks, and 36 weeks. Fifteen of the 25 participants completed eight or more sessions. Significant improvements in depression and psychological functioning, but not in social functioning, were observed. Although a 16-session course of IPT appears feasible and promising, modifications may be needed to reduce barriers to care and enhance treatment potency.

Childhood sexual abuse and depressive symptom severity: the role of neuroticism

This study examined neuroticisms role in the association between childhood sexual abuse and severity of depressive symptoms in a sample of 105 psychiatric patients 50 years of age and older diagnosed with major depressive disorder. As hypothesized, men and women who reported histories of childhood sexual abuse had more severe depressive symptoms than those without abuse histories. Further, neuroticism partially accounted for the association between severe childhood sexual abuse and depressive symptom severity. Self-consciousness, a facet of neuroticism conceptually related to shame, also partially accounted for that relationship. These findings suggest that neuroticism may be one way in which childhood sexual abuse contributes to depressive symptoms in later life. Prospective studies are needed.

Level and perceived stability of self-esteem prospectively predict depressive symptoms during psychoeducational group treatment.

OBJECTIVES To investigate the combined roles of level and perceived stability of self-esteem in prospectively predicting depression. DESIGN Symptoms of depression and anxiety were measured both before and after psychoeducational treatment for depression; level and perceived stability of self-esteem were measured before treatment. METHOD Participants were 26 adults (16 female), age range 21-75 years. RESULTS More stable self-esteem was associated with greater depressive symptomatology at treatment completion, particularly among participants who began treatment with the lowest self-esteem. Effects were specific to symptoms of depression in contrast with anxiety. CONCLUSION These results suggest that a stable, well-consolidated negative self-concept is associated with prolonged depression and a poor response to psychosocial interventions.

Current mood-state and past depression as predictors of self-esteem and dysfunctional attitudes among adolescents

This study investigated the roles of current mood-state and past depression in predicting self-esteem and dysfunctional attitudes in a sample of 110 adolescents who were presently non-depressed. First, the authors tested the hypothesis that lower self-esteem and more dysfunctional attitudes would be found among adolescents with more severe past depression (after statistically controlling current mood-state and gender). Second, the authors tested the mood-state hypothesis (Persons, J. B., & Miranda, J. (1992). Cognitive Therapy and Research, 16, 485‐502; Segal, Z. V., & Ingram, R. E. (1994). Clinical Psychology Review, 14, 663‐695) which posits that negative cognitive styles are more sensitive to the eAects of current mood-state among individuals with more severe past depression. Results suggested that lower self-esteem (but not greater dysfunctional attitudes) is associated with more severe past depressive symptomatology. In contrast to the mood-state hypothesis, we found that adolescents with more severe past depression showed less (rather than greater) congruence between negative aAect and both self-esteem and dysfunctional attitudes than those with less severe past depression. # 2001 Elsevier Science Ltd. All rights reserved.

ATTACHMENT AND ALLIANCE IN THE TREATMENT OF DEPRESSED, SEXUALLY ABUSED WOMEN

Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused womens difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse.

Pain as a predictor of depression treatment outcomes in women with childhood sexual abuse.

OBJECTIVES Childhood sexual abuse (CSA) increases risk for both depression and pain in women. Pain is associated with worse depression treatment response. The contribution of pain to depression treatment outcomes in women with histories of CSA is unknown. This study examined whether clinically significant pain would be associated with worse depression and functioning outcomes among women with CSA histories treated with interpersonal psychotherapy. METHOD Participants were 66 women with major depression and CSA who presented to a community mental health center. An interpersonal psychotherapy protocol planned for 14 weekly sessions followed by 2 biweekly sessions. Patients were classified as experiencing high pain or low pain based on reported pain severity and interference with functioning. Generalized estimating equations were used to assess change over time in intent-to-treat analyses. RESULTS High pain patients entered treatment with greater depression symptom severity than low pain patients. Although both high and low pain patients demonstrated improvement in mood, high-pain patients continued to report more depressive symptoms posttreatment. Furthermore, high pain patients demonstrated less change in their emotion-related role functioning over the course of treatment than low pain patients. LIMITATIONS Small sample size, secondary analyses, lack of a control group, and limited assessment of pain all limit confidence in the findings of this study. CONCLUSION Findings support the evidence that depression is particularly severe and difficult to treat in patients with CSA and pain. Clinicians should evaluate pain in depressed patients with CSA histories. Role functioning may prove to be a particularly important target in the treatment of patients with pain.

The relationships of attachment style and social maladjustment to death ideation in depressed women with a history of childhood sexual abuse

The current study examined the interaction of attachment orientation and acute social maladjustment as risk factors for death ideation in a sample of women with Major Depression and histories of childhood sexual abuse. Social maladjustment was associated with greater endorsement of death ideation. Avoidant and anxious attachment orientations moderated the social maladjustment and death ideation associations in some domains. Work-related maladjustment was associated with greater odds of death ideation for those with higher attachment avoidance. Parent-role maladjustment was associated with greater odds of death ideation for those with lower attachment anxiety. Findings demonstrate strong associations between death ideation and social maladjustment, and suggest that death ideation may be specific to certain domains of adjustment for anxious and avoidant attachment styles.