Role of Parenting and Maltreatment Histories in Unipolar and Bipolar Mood Disorders: Mediation by Cognitive Vulnerability to Depression

Cognitive trio: relationship with major depression and clinical predictors in Han Chinese women

BACKGROUND

Previous studies support Beck's cognitive model of vulnerability to depression. However, the relationship between his cognitive triad and other clinical features and risk factors among those with major depression (MD) has rarely been systematically studied.

METHOD

The three key cognitive symptoms of worthlessness, hopelessness and helplessness were assessed during their lifetime worst episode in 1970 Han Chinese women with recurrent MD. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

Compared to patients who did not endorse the cognitive trio, those who did had a greater number of DSM-IV A criteria, more individual depressive symptoms, an earlier age at onset, a greater number of episodes, and were more likely to meet diagnostic criteria for melancholia, postnatal depression, dysthymia and anxiety disorders. Hopelessness was highly related to all the suicidal symptomatology, with ORs ranging from 5.92 to 6.51. Neuroticism, stressful life events (SLEs) and a protective parental rearing style were associated with these cognitive symptoms.

CONCLUSIONS

During the worst episode of MD in Han Chinese women, the endorsement of the cognitive trio was associated with a worse course of depression and an increased risk of suicide. Individuals with high levels of neuroticism, many SLEs and high parental protectiveness were at increased risk for these cognitive depressive symptoms. As in Western populations, symptoms of the cognitive trio appear to play a central role in the psychopathology of MD in Chinese women.

Cognitive vulnerability to depression during middle childhood: Stability and associations with maternal affective styles and parental depression

Theories of cognitive vulnerability to depression (CVD) imply that CVD is early-emerging and trait-like; however, little longitudinal work has tested this premise in middle childhood, or examined theoretically relevant predictors of child CVD. We examined test-retest correlations of self-referent encoding task performance and self-reported attributional styles and their associations with parental characteristics in 205 seven-year-olds. At baseline, child CVD was assessed, structured clinical interviews were conducted with parents, and ratings of observed maternal affective styles were made. Children's CVD was re-assessed approximately one and two years later. Both measures of children's CVD were prospectively and concurrently associated with children's depressive symptoms and showed modest stability. Multilevel modeling indicated that maternal criticism and paternal depression were related to children's CVD. Findings indicate that even early-emerging CVD is a valid marker of children's depression risk.

Stressful life events and depression symptoms: the effect of childhood emotional abuse on stress reactivity

OBJECTIVE

Stressful life events are associated with an increase in depressive symptoms and the onset of major depression. Importantly, research has shown that the role of stress changes over the course of depression. The present study extends the current literature by examining the effects of early life stress on emotional reactivity to current stressors.

METHOD

In a multiwave study (N = 281, mean age = 18.76; 68% female), we investigated the proximal changes that occur in depressive symptoms when individuals are faced with life stress and whether a history of childhood emotional abuse moderates this relationship.

RESULTS

Results support the stress sensitivity hypothesis for early emotional abuse history. Individuals with greater childhood emotional abuse severity experienced greater increases in depressive symptoms when confronted with current dependent stressors, controlling for childhood physical and sexual abuse.

CONCLUSIONS

This study highlights the importance of emotional abuse as an indicator for reactivity to stressful life events.

The impact of child sexual abuse on the course of bipolar disorder: a systematic review

OBJECTIVES

The aim of this review was to elucidate the impact of child sexual abuse on all clinical phenomena that occur after the onset of bipolar disorder, including associated clinical features that are not part of the diagnostic criteria for the disorder.

METHODS

Five databases were searched and supplemented with a hand search of reference lists from retrieved papers. Study quality was assessed using a validated quality assessment tool. Blind assessments of study eligibility and quality were conducted by two independent researchers to reduce bias, minimize errors, and enhance the reliability of findings. Disagreements were resolved by consensus.

RESULTS

Eighteen studies that included a total of 2996 adults and youths with bipolar disorder and met the minimum quality criteria necessary to ensure objectivity and not invalidate results were analyzed. Across studies, child sexual abuse was strongly (and perhaps directly) associated with posttraumatic stress disorder; whereas it was less strongly (and perhaps indirectly) related to suicide attempts, alcohol and/or drug abuse or dependence, psychotic symptoms, and an early age of illness onset. In regard to the association between child sexual abuse and other clinical variables concerning the course of bipolar disorder, evidence was scant or conflicting.

CONCLUSIONS

Child sexual abuse is associated (either directly or indirectly) with some clinical phenomena that represent a more severe form of bipolar disorder. Although such a traumatic experience may directly affect the development of posttraumatic stress disorder, the effects of early sexual abuse on later suicidal behavior, substance abuse, and psychotic symptoms may operate through the mediating influences of certain psychopathological or neurobiological variables.

Gender specific association of child abuse and adult cardiovascular disease in a sample of patients with basal cell carcinoma

OBJECTIVE

The aim of this study is to examine whether child abuse or neglect is more strongly associated with adult cardiovascular disease, and whether these associations differ by gender.

METHODS

A total of 116 participants (mean age 57.75 years) reported their experience of childhood maltreatment using the well-validated Childhood Experience of Care and Abuse Questionnaire. Cardiovascular disease was assessed using the Older Adults Resources Survey Multidimensional Functional Assessment Questionnaire.

RESULTS

Child abuse but not neglect was significantly associated with adult cardiovascular disease. The significant relationship between child abuse and cardiovascular disease was specific to women.

CONCLUSION

The results of this study indicate that being abused as a child is significantly associated with cardiovascular disease in adulthood, particularly among women.

Prevalence of child sexual abuse among adults and youths with bipolar disorder: a systematic review

To estimate the prevalence and social and demographic correlates of child sexual abuse among people with bipolar disorder, the findings of all the pertinent studies were qualitatively and semi-quantitatively analyzed. Five databases were searched. Blind assessments of study eligibility and quality were conducted by two independent researchers. Twenty studies, meeting minimum quality standards and including 3407 adults and youths with bipolar disorder across 10 countries and 3 continents, were examined. The prevalence of child sexual abuse was 24% (23% without outliers); however, such prevalence rate might be underestimated, because many studies restricted definitions to the most severe forms of abuse. Child sexual abuse was a common experience for both males and females, while it was more frequent for adults than for youths. Compared to healthy individuals, patients with bipolar disorder reported higher rates of child sexual abuse; compared to populations with other mental disorders, participants with bipolar disorder reported similar or lower rates of such abuse. Individuals with bipolar disorder are at risk of having a history of child sexual abuse, although such risk seems to be neither more specific to nor stronger for these individuals, compared to people with other psychiatric disorders.

Interaction of neuropeptide Y genotype and childhood emotional maltreatment on brain activity during emotional processing

Neuropeptide Y (NPY) has been associated with stress reactivity in affective disorders and is most densely expressed in the amygdala. An important stressor associated with affective disorders is the experience of childhood emotional maltreatment (CEM). We investigated whether the interaction of NPY risk genotype and CEM would affect brain activation. From The Netherlands Study of Depression and Anxiety, 33 healthy controls and 85 patients with affective disorders were scanned with functional magnetic resonance imaging while making gender decisions of emotional facial expressions. Results showed interactions between genotype and CEM, within carriers of the risk genotype, CEM was associated with higher amygdala activation, whereas CEM did not influence activation in non-risk carriers. In the posterior cingulate cortex (PCC), less activation was seen in those with CEM and the risk genotype, whereas genotype did not influence PCC activation in those without CEM. In addition, those carrying the risk genotype and with experience of CEM made a faster gender decision than those without CEM. Thus, the combined effect of carrying NPY risk genotype and a history of CEM affected amygdala and PCC reactivity, areas related to emotion, self-relevance processing and autobiographical memory. These results are consistent with the notion that the combination of risk genotype and CEM may cause hypervigilance.

Burden of maternal bipolar disorder on at-risk offspring: a controlled study on family planning and maternal care

INTRODUCTION

Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects.

OBJECTIVE

The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses.

MATERIALS AND METHODS

Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse.

RESULTS

BD mothers were less likely to have stable unions (45.5%; p<0.01) or to live with the biological father of their children (33.3%; p<0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p=0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse.

LIMITATIONS

Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments.

CONCLUSION

This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation.

Negative inferential style, emotional clarity, and life stress: integrating vulnerabilities to depression in adolescence

Negative inferential style and deficits in emotional clarity have been identified as vulnerability factors for depression in adolescence, particularly when individuals experience high levels of life stress. However, previous research has not integrated these characteristics when evaluating vulnerability to depression. In the present study, a racially diverse community sample of 256 early adolescents (ages 12 and 13) completed a baseline visit and a follow-up visit 9 months later. Inferential style, emotional clarity, and depressive symptoms were assessed at baseline, and intervening life events and depressive symptoms were assessed at follow-up. Hierarchical linear regressions indicated that there was a significant three-way interaction between adolescents' weakest-link negative inferential style, emotional clarity, and intervening life stress predicting depressive symptoms at follow-up, controlling for initial depressive symptoms. Adolescents with low emotional clarity and high negative inferential styles experienced the greatest increases in depressive symptoms following life stress. Emotional clarity buffered against the impact of life stress on depressive symptoms among adolescents with negative inferential styles. Similarly, negative inferential styles exacerbated the impact of life stress on depressive symptoms among adolescents with low emotional clarity. These results provide evidence of the utility of integrating inferential style and emotional clarity as constructs of vulnerability in combination with life stress in the identification of adolescents at risk for depression. They also suggest the enhancement of emotional clarity as a potential intervention technique to protect against the effects of negative inferential styles and life stress on depression in early adolescence.

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.

Epigenetic alterations related to early-life stressful events

Objective: Early stress events severely impact brain and behaviour. From a neurobiological point of view early stress influences neuroanatomical structures and is associated with a dysregulation of the hypothalamic-pituitary-adrenal axis. The objective of this article is to review the epigenetic alterations implicated in brain adaptation to early stress events.

Method: A review of empirical research of epigenetic alterations associated to early stress events was performed.

Results: Neuroanatomic and epigenetic alterations have been observed after early stress events. Epigenetics alterations include DNA methylation, histones modifications and microRNA (miRNA) expression. The most studied is largely the former, affecting genes involved in neuroendocrine, neurotransmission and neuroplasticity regulation after early stress exposition. It includes glucocorticoid receptor, FK506-binding protein 5, arginine vasopressin, oestrogen receptor alpha, 5-hydroxy-tryptamine transporter and brain-derived neurotrophic factor.

Conclusion: Epigenetic regulation is critical in the interplay between nature and nurture. Alterations in the DNA methylation as well as histones modifications and miRNA expression patterns could explain abnormal behaviours secondary to early stress events.

Disentangling the temporal relationship between parental depressive symptoms and early child behavior problems: a transactional framework

Despite the considerable amount of research demonstrating the relationship between parental depressive symptoms and child behavior problems, few studies have examined the direction of the relationship between these variables. Therefore, the purpose of this study was to examine transactional effects between parental depressive symptoms and child behavior problems. Participants were 209 parent-child dyads drawn from the Oregon Adolescent Depression Project who completed at least 2 of 4 annual questionnaire assessments between the child's age of 4 and 7 years. Structural equation modeling was used to examine the autoregressive paths from one year to the next year within each construct, as well as cross-lagged paths from one year to the next year between constructs. Findings indicated that parental depressive symptoms at each year predicted child behavior problems at the subsequent year and vice versa. No support was found for differential gender effects. These findings highlight the reciprocal relationship between parental depressive symptoms and child behavior problems and suggest intervention programs for young children should assess for and target parental depression when appropriate. Future research should examine these relationships across a broader developmental spectrum and in more diverse, heterogeneous samples.

Future directions in vulnerability to depression among youth: integrating risk factors and processes across multiple levels of analysis

Depression is a developmental phenomenon. Considerable progress has been made in describing the syndrome, establishing its prevalence and features, providing clues as to its etiology, and developing evidence-based treatment and prevention options. Despite considerable headway in distinct lines of vulnerability research, there is an explanatory gap in the field's ability to more comprehensively explain and predict who is likely to become depressed, when, and why. Still, despite clear success in predicting moderate variance for future depression, especially with empirically rigorous methods and designs, the heterogeneous and multi-determined nature of depression suggests that additional etiologies need to be included to advance knowledge on developmental pathways to depression. This paper advocates for a multiple levels of analysis approach to investigating vulnerability to depression across the lifespan and providing a more comprehensive understanding of its etiology. One example of a multiple levels of analysis model of vulnerabilities to depression is provided that integrates the most accessible, observable factors (e.g., cognitive and temperament risks), intermediate processes and endophenotypes (e.g., information-processing biases, biological stress physiology, and neural activation and connectivity), and genetic influences (e.g., candidate genes and epigenetics). Evidence for each of these factors as well as their cross-level integration is provided. Methodological and conceptual considerations important for conducting integrative, multiple levels of depression vulnerability research are discussed. Finally, translational implications for how a multiple levels of analysis perspective may confer additional leverage to reduce the global burden of depression and improve care are considered.

Do child abuse and maltreatment increase risk of schizophrenia?

INTRODUCTION

Although childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues.

METHODS

Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results.

RESULTS

An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated.

CONCLUSION

Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.

Number of childhood abuse perpetrators and the occurrence of depressive episodes in adulthood

OBJECTIVE

Although past research has documented a link between adverse childhood experiences - particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA) - and depression, relatively few studies have examined the unique impact of each of these highly co-occurring abuse types. Moreover, relatively little is known about the specific aspects of abuse experiences that increase risk for depression (e.g., number of perpetrators). The current study provides a conservative test of the association between the number of CEA, CPA, and CSA perpetrators, and depressive episodes in adulthood.

METHOD

Two hundred and ninety-nine participants were followed longitudinally for 2.5 years. CEA, CPA, and CSA were measured using the Lifetime Experiences Questionnaire, and depressive episodes were assessed with diagnostic interviews administered every 6 weeks.

RESULTS

After statistically controlling for the influence of cognitive risk for depression, baseline depressive symptoms, past history of clinical depression, and total number of different types of CEA, CSA, and CPA events, the number of CEA and CSA, but not CPA, perpetrators were uniquely associated with the number of depressive episodes experienced over the prospective follow-up.

CONCLUSIONS

These results indicate that experiencing CEA and CSA from multiple perpetrators increased risk for clinical depression beyond what is accounted for by the total number of types of abuse experiences. This study highlights the need for future research to assess the specific qualities of childhood abuse experiences that uniquely confer risk for clinical depression, as well as possible mechanisms through which they exert their deleterious effect.

Childhood maltreatment and social anxiety disorder: implications for symptom severity and response to pharmacotherapy

BACKGROUND

Childhood maltreatment has been associated with symptom severity, reduced quality of life, and impaired functioning in adults with social anxiety disorder (SAD). No study has investigated how childhood maltreatment impacts pharmacotherapy outcomes in this population, despite evidence for such a link in depression. The current study replicates previous work on childhood maltreatment within SAD and examines its impact on response to pharmacotherapy.

METHODS

One hundred and fifty six individuals seeking treatment for SAD completed the Childhood Trauma Questionnaire, which measures various types of abuse and neglect, along with the measures of symptom severity, quality of life, and disability. Data from a subset of patients enrolled in a paroxetine trial (N = 127) were analyzed to gauge the impact of childhood maltreatment on attrition and treatment response.

RESULTS

All types of maltreatment except for sexual abuse and physical abuse were related to greater symptom severity. Emotional abuse and neglect were related to greater disability, and emotional abuse, emotional neglect, and physical abuse were related to decreased quality of life. Emotional abuse significantly predicted attrition. A time by emotional abuse interaction suggests that for those who stayed the course, the impact of emotional abuse on severity of social anxiety weakened significantly over time.

CONCLUSIONS

Emotional maltreatment was most strongly linked to dysfunction in SAD, despite a tendency in the anxiety literature to focus on the effects of sexual and physical abuse. Additionally, individuals reporting emotional abuse were more likely to dropout from pharmacotherapy, but those who stayed the course displayed similar outcomes to those without such a history.

Exploratory and Confirmatory Factor Analysis of a Short-Form of the EMBU among Chinese Adolescents

The present study used a sample of Chinese adolescents and validated a short-form of the Egna Minnen Beträffande Uppfostran: One's Memories of Upbringing (s-EMBU) assessing perceived parental rearing styles. A Chinese revision of the s-EMBU by the authors was administered to a total of 779 high school students, ages 11 to 19 years. Exploratory factor analysis with half of the sample yielded a three-factor solution of Rejection, Emotional Warmth, and Overprotection, accounting for 47.1% of the total variance on the father form and 48.8% of the total variance on the mother form. Then, confirmatory factor analysis indicated a good fit of the three-factor model to the data in the other half of the sample. The three subscales consisted of 6, 6, and 7 items, respectively. Scores on these subscales had Cronbach alphas ranging from .71 to .81, indicating adequate internal consistency. These psychometric properties suggest its applicability for research with Chinese adolescents.

The Mediating Role of Early Maladaptive Schemas in the Relation between Quality of Attachment Relationships and Symptoms of Depression in Adolescents

Background:Quality of attachment relations between adolescents and their parents and peers may be related to early maladaptive schemas as well as to symptoms of depression.Aims:The aim of the current study was to assess whether schema domains and maladaptive schemas mediate the relation between indices of quality of attachment relationships with parents and peers and symptoms of depression in non-clinical adolescents (N= 222).Method:A battery of questionnaires was completed, including measures of quality of attachment relations, maladaptive schemas, and depression.Results:The schema domains of disconnection and rejection and other-directedness mediated the relation between quality of attachment relationships and symptoms of depression. More precisely, the schemas’ mistrust/abuse and social isolation mediated the relation between trust in parents and depressive symptoms, whereas the schemas’ social isolation and self-sacrifice mediated the relation between alienation from peers and symptoms of depression.Conclusions:The mediation analyses suggest that treatment of adolescent depression could be focused on both attachment bonds and on changing maladaptive schemas.

Childhood adversity and chronicity of mood disorders

To evaluate the potential impact of early childhood problems on the chronicity of mood disorders. A representative cohort from the population was prospectively studied from ages 19/20 to 39/40. Unipolar (UP) and bipolar disorders (BP) were operationally defined applying broad Zurich criteria for bipolarity. Chronicity required the presence of symptoms for more days than not over 2 years prior to an interview, or almost daily occurrence for 1 year. A family history and a history of childhood problems were taken at ages 27/28 and 29/30. Data include the first of multiple self-assessments with the Symptom-Checklist-90 R at age 19/20, and mastery and self-esteem assessed 1 year later. A factor analysis of childhood problems yielded two factors: family problems and conduct problems. Sexual trauma, which did not load on either factor, and conduct problems were unrelated to chronicity of UP or BP or both together. In contrast, childhood family problems increased the risk of chronicity by a factor of 1.7. An anxious personality in childhood and low self-esteem and mastery in early adulthood were also associated with chronicity. Childhood family problems are strong risk factors for the chronicity of mood disorders (UP and BP). The risk may be mediated partly by anxious personality traits, poor coping and low self-esteem.

Intrusions of autobiographical memories in individuals reporting childhood emotional maltreatment

BACKGROUND

During childhood emotional maltreatment (CEM) negative attitudes are provided to the child (e.g., "you are worthless"). These negative attitudes may result in emotion inhibition strategies in order to avoid thinking of memories of CEM, such as thought suppression. However, thought suppression may paradoxically enhance occurrences (i.e., intrusions) of these memories, which may occur immediately or sometime after active suppression of these memories.

OBJECTIVE

Until now, studies that examined suppressive coping styles in individuals reporting CEM have utilized self-report questionnaires. Therefore, it is unclear what the consequences will be of emotion inhibition styles on the intrusion of autobiographical memories in individuals reporting CEM.

METHOD

Using a thought suppression task, this study aimed to investigate the experience of intrusions during suppression of, and when no longer instructed to actively suppress, positive and negative autobiographical memories in individuals reporting Low, Moderate, and Severe CEM compared to No Abuse (total N=83).

RESULTS

We found no group differences during active suppression of negative and positive autobiographical memories. However, when individuals reporting Severe CEM were no longer instructed to suppress thinking about the memory, individuals reporting No Abuse, Low CEM, or Moderate CEM reported fewer intrusions of both positive and negative autobiographical memories than individuals reporting Severe CEM. Finally, we found that intrusions of negative memories are strongly related with psychiatric distress.

CONCLUSIONS

The present study results provide initial insights into the cognitive mechanisms that may underlie the consequences of childhood emotional maltreatment and suggests avenues for successful interventions.

Parental depressive feelings, parental support, and the serotonin transporter gene as predictors of adolescent depressive feelings: a latent growth curve analysis

Parental support and parental depressive feelings are found to be associated with depressive feelings in adolescent boys and girls, but results are inconsistent. In addition, the 5-HTTLPR genotype has been found to interact with environmental stressors in predicting adolescents' depressive feelings, but this has not been examined longitudinally. Therefore, the present study examined the relationships between parental support, parental depressive feelings, and adolescent depressive feelings. In addition, the relationships between the 5-HTTLPR genotype and adolescent depressive feelings were explored, as well as gene-environment interactions. Adolescents (N = 306; Girls = 53.3%; M (age T1) = 13.4) filled out questionnaires at five annual waves and provided saliva samples for DNA. Latent growth curve modelling (LGCM) was used to examine the baseline level and the change in depressive feelings over time. Maternal support was related to baseline levels of depressive feelings in girls, whereas paternal support was related to baseline levels in boys. Paternal depressive feelings were only related to boys' depressive feelings at baseline, and maternal depressive feelings were not related to any outcome measures. Furthermore, no associations were found between 5-HTTLPR genotype and adolescent depressive feelings, and no gene-environment interactions emerged. Limitations of the study and implications of the findings are discussed.

Child sexual abuse in the etiology of depression: A systematic review of reviews

BACKGROUND

Despite a large amount of research, there is considerable controversy about the role that child sexual abuse plays in the etiology of depression. To prevent interpretative difficulties, mistaken beliefs, or confusion among professionals who turn to this literature for guidance, this article addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the issue.

METHODS

Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus.

RESULTS

Four reviews, including about 60,000 subjects from 160 studies and having no limitations that could invalidate their results, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for depression. The relationship ranges from small-to-medium in magnitude and is moderated by sample source. Additional variables may either act independently to promote depression in people with a history of sexual abuse or interact with such traumatic experience to increase the likelihood of depression in child abuse survivors.

CONCLUSIONS

For all victims of abuse, programs should focus not only on treating symptoms, but also on reducing additional risk factors. Depressed adults who seek psychiatric treatment should be enquired about early abuse within admission procedures.

Loneliness in adolescence: gene x environment interactions involving the serotonin transporter gene

BACKGROUND

Loneliness is assumed to peak in early adolescence and to decrease throughout middle and late adolescence, but longitudinal confirmation of this tendency is lacking. Behavioral genetic studies with twin designs have found a significant genetic component for loneliness in children and adults, but no molecular genetic studies have been conducted to reveal the functional polymorphisms involved.

METHODS

Associations among the serotonin transporter gene (5-HTTLPR), sex, parental support, and loneliness were examined in a longitudinal study spanning five annual waves (N = 306).

RESULTS

Using latent growth curve modeling (LGCM), loneliness was found to be highest in early adolescence and slowly declined throughout adolescence. The 5-HTTLPR genotype was related to the development of loneliness, in that short allele carriers remained stable in loneliness over time, whereas adolescents with the long-long genotype decreased in loneliness. Interactions were found between maternal support and 5-HTTLPR genotype, showing that adolescents who perceived little support from their mothers and carried a short allele were at increased risk for developing loneliness.

CONCLUSIONS

Our study is the first to chart adolescent loneliness longitudinally and to examine the genetic underpinnings of loneliness. Our results contribute to a further understanding of the environmental and genetic basis of loneliness. Replication of our results is needed in both population-based and clinical samples.

Early life stressors and genetic influences on the development of bipolar disorder: the roles of childhood abuse and brain-derived neurotrophic factor

OBJECTIVES

Although there is increasing research exploring the psychosocial influences and biological underpinnings of bipolar disorder, relatively few studies have specifically examined the interplay between these factors in the development of this illness. Social-biological models within a developmental psychopathology perspective are necessary to advance our understanding of the processes involved in the onset and course of bipolar disorder. This article presents a review of the empirical literature linking childhood abuse to bipolar disorder, the research to date on the possible role of brain-derived neurotrophic factor (BDNF) in the development of this disorder, followed by a discussion of how childhood abuse may interact with BDNF.

METHODS

A literature search was conducted using Psycinfo to identify relevant articles on childhood abuse, BDNF, and bipolar disorder.

RESULTS

The extant research implicates both childhood abuse and BDNF in the etiology of bipolar disorder. Specifically, there is growing evidence associating early abuse to the development of bipolar disorder. Similarly, the BDNF Val66 allele has been linked with increased susceptibility to bipolar disorder. Based on existing research, a genetic diathesis-transactional stress model is proposed incorporating childhood abuse and the BDNF gene in the pathogenesis of bipolar disorder.

CONCLUSIONS

Although there is some support for this model, the relatively modest amount of relevant literature highlights the need for further research. An integrative theoretical framework including both social and biological processes in bipolar disorder is important for the development of effective prevention and treatment strategies for this disorder.

Perceived social competence, negative social interactions, and negative cognitive style predict depressive symptoms during adolescence

The current study examined whether negative interactions with parents and peers would mediate the longitudinal association between perceived social competence and depressive symptoms and whether a negative cognitive style would moderate the longitudinal association between negative interactions with parents and increases in depressive symptoms. Youth (N = 350; 6th-10th graders) completed self-report measures of perceived social competence, negative interactions with parents and peers, negative cognitive style, and depressive symptoms at three time points. Results indicated that the relationship between perceived social competence and depressive symptoms was partially mediated by negative interactions with parents but not peers. Further, baseline negative cognitive style interacted with greater negative parent interactions to predict later depressive symptoms.

Developmental origins of cognitive vulnerabilities to depression: review of processes contributing to stability and change across time

Cognitive theories of depression have been shown to be potent predictors of future increases in depressive symptoms and disorder in children, adolescents, and adults. This article focuses on potential developmental origins of the main cognitive vulnerabilities, including dysfunctional attitudes, negative cognitive style, and rumination. We selectively review processes and factors that have been hypothesized to contribute to the emergence and stabilization of these cognitive risk factors. This review focuses on genetic factors, temperament, parents and peers as salient interpersonal influences, and stressful life events. We end with suggestions for future theory development and research. In particular, we emphasize the need for additional conceptual and empirical work integrating these disparate processes together into a coherent, developmental psychopathological model, and we highlight the coexistence of both stability and change in the development of cognitive vulnerabilities to depression across the lifespan.

Suicide risk factors and mediators between childhood sexual abuse and suicide ideation among male and female suicide attempters

The current study examined the manner in which childhood sexual abuse (CSA) history relates to risk factors for suicidal behavior among recent suicide attempters (n = 166). Men who recently attempted suicide and endorsed a CSA history had higher scores on measures of hopelessness and suicide ideation than men without a CSA history. Men with a CSA history were also more likely to have made multiple suicide attempts and meet diagnostic criteria for posttraumatic stress disorder and borderline personality disorder. In contrast, there were fewer group differences as a function of CSA history among the female suicide attempters. Hopelessness was a significant mediator between CSA history and suicide ideation in both men and women.

Longitudinal Predictors of Bipolar Spectrum Disorders: A Behavioral Approach System (BAS) Perspective

We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal - distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System sensitivity) predictors. We then present a theoretical model, the Behavioral Approach System (BAS) dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.

Family processes in the development of youth depression: translating the evidence to treatment

There is strong evidence that family factors play a role in the development, maintenance and course of youth depression. However, to date few clinical trials of psychotherapy for youth depression employ family therapy interventions or target the known family risk factors. This is surprising given recent meta-analytic findings showing only modest effect sizes for psychotherapy for youth depression, and that cognitive therapies do not outperform non-cognitive therapies. The aim of this review is to 1) use a developmental systems approach to review empirical evidence on family risk factors for youth depression to identify potential targets for treatment, 2) examine the extent to which these family risk factors have been targeted in clinical trials for youth depression, and 3) provide a road map for the development of empirically validated family-based interventions for youth depression. Strong evidence was found supporting a relationship between family factors at multiple system levels and depressive symptoms or disorders. Support for several different hypothesized causal mechanisms as well as bidirectional effects was found. A comparison of the identified risk factors and psychotherapy trials for youth depression indicated that few RCT's target family factors; among those that do, only a few of the family risk factors are targeted. Recommendations for translation of empirical knowledge of family risk factors and mechanisms to develop empirically valid family-based interventions to enhance existing treatments for youth depression are provided.

A pilot study of self-esteem as a mediator between family factors and depressive symptoms in young adult university students

The aim of this study was to examine whether self-esteem mediates the relationship between family factors and depressive symptoms in young adults. Participants completed self-report questionnaires about overall family environment, conflict with mother or father, parental rearing, self esteem, and depressive symptoms. Self-esteem was found to mediate the relationship between the combined family factors and depressive symptoms. When examined simultaneously, none of the individual family variables uniquely predicted depressive symptoms or self-esteem. However, separate analysis of each of the three family factors provided evidence for self-esteem mediating the relationship between parental conflict and depressive symptoms, and the relationship between parental care and depressive symptoms. Self-esteem may play a role in the mechanism underlying the link between parent-offspring relationship factors and depressive symptoms.

Early adversity in chronic depression: clinical correlates and response to pharmacotherapy

BACKGROUND

There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD.

METHODS

Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks.

RESULTS

A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission.

CONCLUSIONS

These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy.

Emotional maltreatment and depression: prospective prediction of depressive episodes

BACKGROUND

Most research to date on the role of maltreatment experiences in depression has focused on physical and sexual maltreatment. However, several researchers have theorized that emotional maltreatment may be more strongly linked to depression. Furthermore, prospective studies in this area are lacking. This study addressed these issues by examining whether experiences of current emotional maltreatment predicted the development of new prospective episodes of major (MD) or minor depression (MiD), and the subtype of hopelessness depression (HD) in young adults. It also assessed whether current emotional maltreatment from peers and from authority figures separately predicted the occurrence of depressive episodes.

METHOD

One hundred and sixty-five participants from the Cognitive Vulnerability to Depression Project were followed prospectively for 2.5 years. Current emotional maltreatment and new depressive episodes were assessed with life event and diagnostic interviews administered every 6 weeks.

RESULTS

Greater overall emotional maltreatment predicted shorter time to onset of new MD, MiD, and HD episodes. Peer- and authority-perpetrated emotional maltreatment separately predicted shorter time to development of new HD episodes.

CONCLUSIONS

Greater emotional maltreatment in young adults prospectively predicts onset of depression, particularly HD. These findings highlight the importance of adult emotional maltreatment experiences in determining targets for prevention and treatment.

A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression

OBJECTIVES

To investigate the differential profile of early family life events associated with lifetime anorexia nervosa (AN), bulimia nervosa (BN), and major depression (MD).

METHOD

Only data from the monozygotic twins (n = 622) were examined from a community sample of female twins who had participated in three waves of data collection. Eating disorder and MD diagnoses were ascertained from the Eating Disorder Examination at Wave 3 and interview at Wave 2 respectively. Early family events were ascertained from self-report measures at Waves 1 and 3. Two case control designs were used, including a comparison of women: (1) who had lifetime AN, BN, MD, and controls, and (2) twin pairs discordant for either AN, BN, or MD (where the unaffected cotwin formed the control group).

RESULTS

Across the two types of designs, compared to controls, both AN and BN were associated with more comments from the family about weight and shape when growing up. AN was uniquely associated with higher levels of paternal protection while BN was associated with higher levels of parental expectations.

CONCLUSION

While some overlap among early life events was indicated, especially related to parental conflict and criticism, there was evidence to support some degree of nonoverlap among life events associated with AN, BN, and MD.

A cognitive vulnerability-stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context

Why is adolescence an "age of risk" for onset of bipolar spectrum disorders? We discuss three clinical phenomena of bipolar disorder associated with adolescence (adolescent age of onset, gender differences, and specific symptom presentation) that provide the point of departure for this article. We present the cognitive vulnerability-transactional stress model of unipolar depression, evidence for this model, and its extension to bipolar spectrum disorders. Next, we review evidence that life events, cognitive vulnerability, the cognitive vulnerability-stress combination, and certain developmental experiences (poor parenting and maltreatment) featured in the cognitive vulnerability-stress model play a role in the onset and course of bipolar disorders. We then discuss how an application of the cognitive vulnerability-stress model can explain the adolescent age of onset, gender differences, and adolescent phenomenology of bipolar disorder. Finally, we further elaborate the cognitive vulnerability-stress model by embedding it in the contexts of normative adolescent cognitive (executive functioning) and brain development, normative adolescent development of the stress-emotion system, and genetic vulnerability. We suggest that increased brain maturation and accompanying increases in executive functioning along with augmented neural and behavioral stress-sensitivity during adolescence combine with the cognitive vulnerability-stress model to explain the high-risk period for onset of bipolar disorder, gender differences, and unique features of symptom presentation during adolescence.