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Hammen C, Rudolph K, Weisz J, Rao U, Burge D. The context of depression in clinic-referred youth: neglected areas in treatment. J Am Acad Child Adolesc Psychiatry 1999; 38:64-71. [PMID: 9893418 DOI: 10.1097/00004583-199901000-00021] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the empirical, methodological, and conceptual limitations of psychotherapy and pharmacotherapy for childhood and adolescent depression and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment. METHOD Interview-based assessment of psychiatric features and psychosocial functioning, family psychopathology and marital adjustment, and child and parent stressful life events was performed in a sample of 43 depressed youngsters seeking outpatient treatment. RESULTS The empirical and conceptual review indicated that treatments based on downward extensions of adult procedures are limited in number and success. Also, the treatments generally neglect the following characteristics revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe stressors. CONCLUSIONS Treatments need to be informed by and address the actual characteristics of depressed youngsters and their environments, which are highly dysfunctional.
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Daley SE, Hammen C, Davila J, Burge D. Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood. J Consult Clin Psychol 1998. [PMID: 9735575 DOI: 10.1037//0022-006x.66.4.595] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined 2 models of the relationship between personality disorder symptomatology and depression, incorporating life stress as an intervening variable. In a community sample of late adolescent women, symptoms of Cluster B disorders predicted interpersonal chronic stress and self-generated episodic stress over 2 years, controlling for initial depression. Cluster A symptoms also predicted subsequent chronic interpersonal stress, over initial depression. Cluster C pathology did not predict subsequent stress. Personality disorder symptomatology was also associated with partner-reported relationship dissatisfaction. Support was found for a mediation model whereby women with higher levels of initial personality disturbance in Clusters A and B generated excessive amounts of episodic stress and interpersonal chronic stress in the next 2 years, which, in turn, increased vulnerability for depressive symptoms. A moderation model, whereby the presence of greater personality disorder symptoms would increase the likelihood of depression in response to stress, was not supported.
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Daley SE, Hammen C, Davila J, Burge D. Axis II symptomatology, depression, and life stress during the transition from adolescence to adulthood. J Consult Clin Psychol 1998; 66:595-603. [PMID: 9735575 DOI: 10.1037/0022-006x.66.4.595] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined 2 models of the relationship between personality disorder symptomatology and depression, incorporating life stress as an intervening variable. In a community sample of late adolescent women, symptoms of Cluster B disorders predicted interpersonal chronic stress and self-generated episodic stress over 2 years, controlling for initial depression. Cluster A symptoms also predicted subsequent chronic interpersonal stress, over initial depression. Cluster C pathology did not predict subsequent stress. Personality disorder symptomatology was also associated with partner-reported relationship dissatisfaction. Support was found for a mediation model whereby women with higher levels of initial personality disturbance in Clusters A and B generated excessive amounts of episodic stress and interpersonal chronic stress in the next 2 years, which, in turn, increased vulnerability for depressive symptoms. A moderation model, whereby the presence of greater personality disorder symptoms would increase the likelihood of depression in response to stress, was not supported.
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Prophet S, Hammen C. Coding compliance: practical strategies for success. JOURNAL OF AHIMA 1998; 69:50-61; quiz 63-4. [PMID: 10174723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
Adult attachment research has proceeded on the assumption that attachment style is relatively stable and affects future functioning. However, researchers have become interested in attachment instability and predictors of attachment style change. In this article, 2 conceptualizations of attachment style change were examined: Attachment style change is a reaction to current circumstances, and attachment style change is an individual difference in susceptibility to change that is associated with stable vulnerability factors. A total of 155 women were assessed after high school graduation, and 6 months and 2 years later. Results primarily supported the conceptualization of attachment style change as an individual difference. Specifically, some women may be prone to attachment fluctuations because of adverse earlier experiences, and women who show attachment fluctuations are similar to women with stably insecure attachments.
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Compas BE, Oppedisano G, Connor JK, Gerhardt CA, Hinden BR, Achenbach TM, Hammen C. Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths. J Consult Clin Psychol 1997. [PMID: 9256563 DOI: 10.1037//0022-006x.65.4.617] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gender differences in depressed mood, a syndrome of mixed anxiety-depression, and an analogue of major depressive disorder were compared in parents' and adolescents' reports in 2 large, demographically matched national samples of clinically referred and nonreferred adolescents. Referral status accounted for the greatest share of the variance in these problems. Gender differences were moderate in size and consistent in referred youths, with referred girls scoring higher than referred boys on all measures, whereas gender differences in nonreferred adolescents were either nonsignificant or small in magnitude. Gender differences were also larger in magnitude in adolescents' self-reports than in parents' reports. The interaction of age and gender was nonsignificant in all analyses. Implications for understanding the extent of gender differences in adolescents' depressive symptoms are highlighted.
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Compas BE, Oppedisano G, Connor JK, Gerhardt CA, Hinden BR, Achenbach TM, Hammen C. Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths. J Consult Clin Psychol 1997; 65:617-26. [PMID: 9256563 DOI: 10.1037/0022-006x.65.4.617] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gender differences in depressed mood, a syndrome of mixed anxiety-depression, and an analogue of major depressive disorder were compared in parents' and adolescents' reports in 2 large, demographically matched national samples of clinically referred and nonreferred adolescents. Referral status accounted for the greatest share of the variance in these problems. Gender differences were moderate in size and consistent in referred youths, with referred girls scoring higher than referred boys on all measures, whereas gender differences in nonreferred adolescents were either nonsignificant or small in magnitude. Gender differences were also larger in magnitude in adolescents' self-reports than in parents' reports. The interaction of age and gender was nonsignificant in all analyses. Implications for understanding the extent of gender differences in adolescents' depressive symptoms are highlighted.
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Daley SE, Hammen C, Burge D, Davila J, Paley B, Lindberg N, Herzberg DS. Predictors of the generation of episodic stress: a longitudinal study of late adolescent women. JOURNAL OF ABNORMAL PSYCHOLOGY 1997. [PMID: 9131845 DOI: 10.1037//0021-843x.106.2.251] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effects of depression and Axis I comorbidity on subsequent self-generated life stress were examined in a longitudinal sample of 134 late adolescent women. The results indicated that specific forms of psychopathology constitute a risk factor for future self-generated episodic stress, even when controlling for prior chronic stress. Comorbid depression had a particularly salient effect in the prediction of stress related to interpersonal conflicts. The effects of family psychopathology and sociotropy were mediated through participant psychiatric status, whereas autonomy made an independent contribution to the prediction of episodic stress. These results support C. Hammen's (1991b) stress generation model in a community sample, demonstrating how individuals with depression play a role in the creation of stress, and also refine prior work by showing that only the comorbid form of depression is associated with subsequent conflict-related stress.
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Abstract
OBJECTIVE Two questions were posed: Does stress precipitate episodes of bipolar I disorder, and does sensitivity to stress differ in episodes later in the course of illness compared to early ones? METHOD Fifty-two patients with bipolar I disorder were followed longitudinally for up to 2 years; clinical course was monitored, and interview assessments of life events were made every 3 months. RESULTS The patients who had episodes of illness during follow-up had experienced significantly more severe stressors and more total stress in the preceding 6 months, and more total stress in the preceding 3 months, than those without episodes. Inconsistent with Post's stress "sensitization" hypothesis, patients with more prior episodes were more likely to have episodes following major stressors, and they relapsed more rapidly. CONCLUSIONS Stressors may precipitate episodes of bipolar illness, especially for patients with more prior episodes. Different versions of the stress sensitization model remain to be tested.
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Daley SE, Hammen C, Burge D, Davila J, Paley B, Lindberg N, Herzberg DS. Predictors of the generation of episodic stress: a longitudinal study of late adolescent women. JOURNAL OF ABNORMAL PSYCHOLOGY 1997; 106:251-9. [PMID: 9131845 DOI: 10.1037/0021-843x.106.2.251] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effects of depression and Axis I comorbidity on subsequent self-generated life stress were examined in a longitudinal sample of 134 late adolescent women. The results indicated that specific forms of psychopathology constitute a risk factor for future self-generated episodic stress, even when controlling for prior chronic stress. Comorbid depression had a particularly salient effect in the prediction of stress related to interpersonal conflicts. The effects of family psychopathology and sociotropy were mediated through participant psychiatric status, whereas autonomy made an independent contribution to the prediction of episodic stress. These results support C. Hammen's (1991b) stress generation model in a community sample, demonstrating how individuals with depression play a role in the creation of stress, and also refine prior work by showing that only the comorbid form of depression is associated with subsequent conflict-related stress.
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Rudolph KD, Hammen C, Burge D. A cognitive-interpersonal approach to depressive symptoms in preadolescent children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1997; 25:33-45. [PMID: 9093898 DOI: 10.1023/a:1025755307508] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cognitive and interpersonal aspects of depressive symptoms were investigated in a community sample of children. Eighty-one 8- to 12-year-olds completed scales assessing cognitive representations of social relationships and symptoms of depression and anxiety. Teachers provided ratings of peer rejection. Children with elevated levels of depressive symptoms displayed increased negativity in their beliefs about self, family, and peers, as well as distinct patterns of interpersonal information processing. Anxiety symptoms did not make a unique contribution beyond depression to negative representations of family and peers; in contrast, symptom-specific profiles of self-representations were found. Structural equation analysis supported a model linking negative interpersonal representations, peer rejection, and depressive symptoms. The findings suggest that future studies may benefit from approaches that incorporate both cognitive and interpersonal variables as predictors of child depression.
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Burge D, Hammen C, Davila J, Daley SE, Paley B, Lindberg N, Herzberg D, Rudolph KD. The relationship between attachment cognitions and psychological adjustment in late adolescent women. Dev Psychopathol 1997; 9:151-67. [PMID: 9089129 DOI: 10.1017/s0954579497001119] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This longitudinal study of 137 female high school seniors investigated the relationship of attachment cognitions, current psychological functioning, and psychological functioning 12 months later. Attachment cognitions, assessed with the Revised Adult Attachment Scale and the Inventory of Parent and Peer Attachment, were significantly associated with current symptomatology. The Revised Adult Attachment Scale, in interaction with initial symptomatology, predicted depression, substance abuse, eating disorders, and personality disorders 12 months later. The Inventory of Parent and Peer Attachment parent subscales predicted eating disorder and personality disorder symptomatology, whereas the peer subscales predicted substance abuse, eating disorder, and personality disorder symptomatology.
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Abstract
OBJECTIVE The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy. METHOD Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale. RESULTS Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction. CONCLUSIONS Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.
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Davila J, Hammen C, Burge D, Paley B, Daley SE. Poor interpersonal problem solving as a mechanism of stress generation in depression among adolescent women. JOURNAL OF ABNORMAL PSYCHOLOGY 1995; 104:592-600. [PMID: 8530761 DOI: 10.1037/0021-843x.104.4.592] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors examined C. Hammen's (1991) model of stress generation in depression and the role of interpersonal problem-solving strategies (IPS) in the stress generation process in a longitudinal sample of 140 young women who entered the study at ages 17-18. Structural equation modeling was used to test a model in which IPS and subsequent interpersonal stress mediated the relationship between initial and later depressive symptoms. Results supported the main prediction of the stress generation model: Interpersonal stress mediated the relationship between initial and later depressive symptoms. In addition, IPS predicted interpersonal stress. However, no association was found between depressive symptoms and IPS. An alternative model in which IPS moderated the relationship between stress and depressive symptoms was tested; it was not supported.
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Rudolph KD, Hammen C, Burge D. Cognitive representations of self, family, and peers in school-age children: links with social competence and sociometric status. Child Dev 1995; 66:1385-402. [PMID: 7555222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Attachment and social-cognitive theories of interpersonal relations have underscored the integral role that internalized cognitive representations may play as mediators of the link between family and peer relationships. 3 predictions consistent with this conceptualization received support in the present study of 161 7-12-year-old school children. In Part 1 of the study, significant connections were found among different components of cognitive representations, including social perceptions, interpersonal expectancies, and schematic organization and processing of social information. Moreover, generalization was found among children's representations across 3 interpersonal domains--that is, family, peer, and self. In Part 2, negative representations of self and others were found to be associated with increased social impairment, including dysfunctional social behavior and less positive status in the peer group. Implications of the findings for theories of interpersonal competence and interventions with socially impaired children are discussed.
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Swendsen J, Hammen C, Heller T, Gitlin M. Correlates of stress reactivity in patients with bipolar disorder. Am J Psychiatry 1995; 152:795-7. [PMID: 7726323 DOI: 10.1176/ajp.152.5.795] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The authors examined individual differences in stress reactivity as well as whether features of the illness itself or psychological characteristics differentiate between patients with bipolar disorder who are highly stress reactive and those who are not. METHOD They assessed stressors and bipolar episodes in 58 patients with bipolar disorder followed for at least 1 year. RESULTS Not only did stress level predict relapse, so did personality variables such as introversion and obsessionality and their interaction with stress. Number of previous episodes of bipolar illness, however, did not affect stress response. CONCLUSIONS These results are not consistent with the view that episodes of bipolar disorder become increasingly independent of stressors after initial episodes. However, psychological traits may affect reactivity to stressors.
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Rudolph KD, Hammen C, Burge D. Interpersonal functioning and depressive symptoms in childhood: addressing the issues of specificity and comorbidity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1994; 22:355-71. [PMID: 8064038 DOI: 10.1007/bf02168079] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Research has supported linkages between depression and social impairment in youngsters, but has often focused on depressive symptoms in isolation. We collected data on depressive, anxiety, and externalizing symptoms in 161 school children. Information about interpersonal competence was gathered from several sources, including children, teachers, and behavioral observations. Depressive symptoms were found to be related to difficulties in multiple areas of competence, including maladaptive social problem-solving styles, conflict-negotiation and affect-regulation deficits, and peer rejection. Comparisons of the relative contributions made by depressive and anxiety symptoms to the prediction of functioning yielded some evidence for a specific relation between depressive symptoms and impairment. Children with cooccurring internalizing and externalizing symptoms generally suffered from the most social dysfunction. If replicated in clinical samples, findings such as these may help to guide intervention efforts with depressed children.
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Hammen C. Unmasking unmasked depression in children and adolescents: The problem of comorbidity. Clin Psychol Rev 1994. [DOI: 10.1016/0272-7358(94)90018-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hamilton EB, Jones M, Hammen C. Maternal interaction style in affective disordered, physically ill, and normal women. FAMILY PROCESS 1993; 32:329-340. [PMID: 8243622 DOI: 10.1111/j.1545-5300.1993.00329.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Affective style (AS) and communication deviance (CD) have been suggested as markers of dysfunctional family environments that may be associated with psychiatric illness. Studies have focused mainly on parental responses during family interactions when an offspring is the identified patient. The present study is unique in examining AS and CD in mothers with unipolar depression, bipolar disorder, or chronic physical illness, and in normal controls. The sample consisted of 64 mothers with children ages 8 to 16. Unipolar mothers were more likely to show negative AS than were any other maternal group. There were no group differences for CD. Chronic stress, few positive life events, and single parenting were associated with AS. CD was associated solely with lower socioeconomic status. Results suggest that dysfunctional interactions are determined not only by maternal psychopathology, but also by an array of contextual factors that are related to the quality of the family environment.
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Hausman B, Hammen C. Parenting in homeless families: the double crisis. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 1993; 63:358-369. [PMID: 8372903 DOI: 10.1037/h0079448] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The same factors that impede a mother's ability to maintain a stable residence are likely to impair her capacity to nurture children. This double crisis of homelessness and child rearing confronts caregivers with a special set of ethical and practical dilemmas. Psychosocial characteristics of homeless mothers and children are reviewed, and the need to support these mothers is underscored.
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Adrian C, Hammen C. Stress exposure and stress generation in children of depressed mothers. J Consult Clin Psychol 1993; 61:354-9. [PMID: 8473589 DOI: 10.1037/0022-006x.61.2.354] [Citation(s) in RCA: 144] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two hypotheses were tested: (a) One mechanism contributing to the high rate of disorder in children of women with affective disorders is elevated exposure to stressful events and conditions and (b) the children of depressed women, particularly women with unipolar depression, contribute to event occurrence because of increased interpersonal conflict. Life stress interview assessments were made at 6-month intervals for 3 years on 53 children of unipolar, bipolar, medically ill, and normal women. Both hypotheses were confirmed. Transactional models of risk and further studies of the interpersonal functioning of children at risk for depression are needed.
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Hamilton EB, Hammen C, Minasian G, Jones M. Communication styles of children of mothers with affective disorders, chronic medical illness, and normal controls: a contextual perspective. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1993; 21:51-63. [PMID: 8463504 DOI: 10.1007/bf00910488] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Research has demonstrated impaired parent-child relationships in families with affective disorders. The present study examines the association of children's interactional style during a direct conflict-solving task to both the mother's interactional style and the child's diagnostic status. The sample includes 63 children, ages 8 to 16, of mothers with affective disorders, chronic medical illness, and normal controls. Children's dominant coping style profile (CS) (autonomous, neutral, or critical) was related to their mother's affective style (AS) (benign or negative). Affective disorder in the child at 6-month followup was associated with a critical CS profile at intake, while the child's nonaffective symptomatology was unrelated to CS. Findings indicate that children's affective disturbance is linked to interpersonal deficits in affectively charged situations. Results suggest that the child's CS is more strongly predicted by maternal AS than by either the child's or the mother's diagnostic status.
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Hammen C, Davila J, Brown G, Ellicott A, Gitlin M. Psychiatric history and stress: predictors of severity of unipolar depression. JOURNAL OF ABNORMAL PSYCHOLOGY 1992. [PMID: 1537972 DOI: 10.1037//0021-843x.101.1.45] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Unipolar depression is frequently a recurrent or chronic disorder. In studies on predicting its course, outcomes are typically linked to either psychiatric features or stressful life events. In order to integrate the 2 approaches, 51 unipolar patients were assessed periodically over at least 1 year for symptoms, stressful events, and chronic stressors. It was hypothesized that adverse family history and early age of onset impair role functioning and coping capabilities, thereby contributing to stressful circumstances that predict severity of depressive reactions. Results of causal modeling analyses supported a model in which background factors were associated with severity of depressive outcomes as mediated by their effects on stress variables. Such a model implicates the self-perpetuating nature of clinical depression, both for the individual and across generations.
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Hammen C, Davila J, Brown G, Ellicott A, Gitlin M. Psychiatric history and stress: Predictors of severity of unipolar depression. JOURNAL OF ABNORMAL PSYCHOLOGY 1992; 101:45-52. [PMID: 1537972 DOI: 10.1037/0021-843x.101.1.45] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Unipolar depression is frequently a recurrent or chronic disorder. In studies on predicting its course, outcomes are typically linked to either psychiatric features or stressful life events. In order to integrate the 2 approaches, 51 unipolar patients were assessed periodically over at least 1 year for symptoms, stressful events, and chronic stressors. It was hypothesized that adverse family history and early age of onset impair role functioning and coping capabilities, thereby contributing to stressful circumstances that predict severity of depressive reactions. Results of causal modeling analyses supported a model in which background factors were associated with severity of depressive outcomes as mediated by their effects on stress variables. Such a model implicates the self-perpetuating nature of clinical depression, both for the individual and across generations.
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Hammen C. Generation of stress in the course of unipolar depression. JOURNAL OF ABNORMAL PSYCHOLOGY 1991. [PMID: 1757669 DOI: 10.1037//0021-843x.100.4.555] [Citation(s) in RCA: 356] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. I examined event occurrence over 1 year in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression.
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