Children of depressed mothers: maternal strain and symptom predictors of dysfunction

Prenatal paternal stress predicts infant parasympathetic functioning above and beyond maternal prenatal stress

BACKGROUND

Paternal stress is often assessed by maternal report and is posited to influence infant development indirectly by contributing to a mother's stress and experiences during pregnancy. Far less is known about how direct effects of prenatal paternal stress, as described by fathers themselves, are related to an infant's physiological functioning. We assessed fathers' own experiences of stress and examined its direct impact on infant respiratory sinus arrhythmia (RSA), a biological index of self-regulation, at seven-month postpartum.

METHOD

During the third trimester of pregnancy, the UCLA Life Stress Interview was conducted to assess chronic stress in mothers and fathers (N = 90). Infant baseline RSA and RSA reactivity in response to the Still-Face paradigm were assessed at seven-month postpartum.

RESULTS

Infants of fathers with high prenatal stress showed lower baseline RSA, possibly reflective of poor infant psychophysiological regulation. The predictive role of paternal stress remained significant after controlling for maternal stress.

CONCLUSIONS

Our findings provide emerging empirical evidence to support the influence of prenatal paternal stress on infant RSA, highlighting the important role of fathers for child development.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

Prenatal maternal transdiagnostic, RDoC-informed predictors of newborn neurobehavior: Differences by sex

We examined whether Research Domain Criteria (RDoC)-informed measures of prenatal stress predicted newborn neurobehavior and whether these effects differed by newborn sex. Multilevel, prenatal markers of prenatal stress were obtained from 162 pregnant women. Markers of the Negative Valence System included physiological functioning (respiratory sinus arrhythmia [RSA] and electrodermal [EDA] reactivity to a speech task, hair cortisol), self-reported stress (state anxiety, pregnancy-specific anxiety, daily stress, childhood trauma, economic hardship, and family resources), and interviewer-rated stress (episodic stress, chronic stress). Markers of the Arousal/Regulatory System included physiological functioning (baseline RSA, RSA, and EDA responses to infant cries) and self-reported affect intensity, urgency, emotion regulation strategies, and dispositional mindfulness. Newborns' arousal and attention were assessed via the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. Path analyses showed that high maternal episodic and daily stress, low economic hardship, few emotion regulation strategies, and high baseline RSA predicted female newborns' low attention; maternal mindfulness predicted female newborns' high arousal. As for male newborns, high episodic stress predicted low arousal, and high pregnancy-specific anxiety predicted high attention. Findings suggest that RDoC-informed markers of prenatal stress could aid detection of variance in newborn neurobehavioral outcomes within hours after birth. Implications for intergenerational transmission of risk for psychopathology are discussed.

Prenatal maternal hair cortisol concentrations are related to maternal prenatal emotion dysregulation but not neurodevelopmental or birth outcomes

Hair cortisol concentrations measured during pregnancy have emerged as a novel biomarker for prenatal stress exposure. However, associations between prenatal stress and distress, broadly defined, and hair cortisol concentrations during pregnancy are inconsistent. We examined relations among hair cortisol concentrations during the third trimester with (a) emotion dysregulation and (b) detailed measures of maternal prenatal stress. We also examined the predictive validity of maternal hair cortisol during pregnancy for adverse newborn health outcomes. Cortisol concentrations were derived from 6 cm of hair during the third trimester of pregnancy. Mothers reported on their emotion dysregulation and stress at this time. A standardized newborn neurobehavioral exam was conducted shortly after birth and newborn birth weight and gestational age were assessed from medical records. All hypotheses were preregistered on the Open Science Framework (osf.io/279ng). High levels of emotion dysregulation, but not stress, were predictive of high hair cortisol concentrations. Maternal prenatal BMI mediated the relation between maternal prenatal emotion dysregulation and hair cortisol concentrations. There was no association between hair cortisol and infant birth outcomes. This research supports the notion that transdiagnostic markers of psychopathology are important correlates of hair cortisol concentrations during pregnancy.

Intergenerational transmission of emotion dysregulation: Part II. Developmental origins of newborn neurobehavior

We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors-arousal and attention-via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.

Positive Affect as a Buffer between Chronic Stress and Symptom Severity of Emotional Disorders

Research has demonstrated that stressors play a critical role in the development of generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD). Separately, deficits in positive affect (PA) have been identified in GAD, SAD, and MDD. While previous research has linked the buffering effects of PA in chronic illness, such effects have yet to be investigated for chronic stressors and emotional disorder-related symptom severity. The purpose of the present study was to examine PA as a moderator of chronic interpersonal and non-interpersonal stress on GAD, SAD, and MDD symptom severity. Using a multilevel statistical approach with a sample of adolescents and young adults (N=463), PA was found to significantly moderate the relationship between chronic interpersonal stress and symptom severity for MDD and SAD. Findings suggest that in times of chronic interpersonal stress, higher PA may serve as a buffer from development of SAD and MDD symptoms.

Chronic Stress in Vocational and Intimate Partner Domains as Predictors of Depressive Symptoms After Breast Cancer Diagnosis

BACKGROUND

After cancer diagnosis, depressive symptoms are elevated on average and decline over time, but substantial variability is apparent. Few studies have examined to what extent chronic stress in distinct life domains affects depressive symptoms.

PURPOSE

Chronic stress in vocational and intimate partner life domains, and their interaction, were tested as predictors of depressive symptoms after breast cancer diagnosis.

METHODS

Women (N = 460) completed validated interviews regarding chronic stress in specific life domains shortly after diagnosis and a measure of depressive symptoms every 6 weeks for 6 months.

RESULTS

In latent growth curve modeling analyses, greater chronic stress in work (b = 2.90; p < .001) and intimate partner domains (b = 1.38, p = .02) was associated with higher depressive symptoms at study entry (intercept), and greater work stress predicted faster recovery from depressive symptoms over time (b = -0.10; p = .01). The two domains of chronic stress also interacted significantly on depressive symptoms at study entry (b = -1.54; p < .02) and over time (b = 0.14; p < .001). Greater work stress was associated with higher depressive symptoms at study entry regardless of intimate partner stress, but greater intimate partner stress was associated with higher depressive symptoms when work stress was low. The decline over 6 months in initially elevated depressive symptoms predicted by high work stress was significantly steeper when intimate partner stress was low.

CONCLUSIONS

Targeting interventions to recently diagnosed breast cancer patients living with chronically stressful vocational and intimate partner life circumstances could be worthwhile.

Experiences of HIV-related discrimination and consequences for internalised stigma, depression and alcohol use

Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity. Design: 199 participants were recruited from an HIV clinic in the southeastern United States. Main study measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test. Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma. Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.

Identification of and Support for Children of Mentally Ill Parents: A 5 Year Follow-Up Study of Adult Mental Health Services

Background: Children of parents with mental disorders are more likely to develop mental difficulties during their childhood and adulthood. Based on this knowledge, the Norwegian health legislation has been amended to better identify and protect children of parents with a mental illness. In this project, two interventions were implemented in a regional clinic for adult mental health services. These interventions were (i) Assessment Form and (ii) Child Talks. Both interventions aimed to support healthcare professionals in identifying and providing support for children of patients within adult mental health services. The process of changing relevant practice to become more family-focused was evaluated in 2010 and 2013, and the results showed some changes slowly materializing in the adult mental health services. The purpose of the current study was to investigate long-term effects of the interventions at 5 year follow-up (2015). The main aim was to investigate whether the workforce perceived that their clinical practice had changed as a result of the legislative change and the implemented interventions. Method: This longitudinal study consists of a pre-test, post-test and follow-up test. The sample (N = 219 at pre-test, N = 185 by post-test and N = 108 on follow-up test) included healthcare staff from a participating hospital, responding to an online survey about their routines for identifying children of patients, their attitudes, as well as concerns and expectations related to having a child perspective in their clinical work. Employee experiences with family conversations were also investigated, as well as their knowledge about the consequences parents' mental disorders may have for children. Results: Our findings showed a significant increase in participants identifying children of patients between pre- and post-measurement but a minor, non-significant increase at follow-up measurement. There was no significant increase of participants who reported that they had a lot of experience with family conversations. From post-test to follow-up, there was no increase in the workforce' reported positive attitudes, knowledge or expectations about the effects of the interventions. Conclusion: There have been some changes in clinical practice, but it seems that the changes required by law are a very time consuming process. It is necessary to increase the pace of the implementation process.

Preschoolers' Psychopathology and Temperament Predict Mothers' Later Mood Disorders

Considerable research exists documenting the relationship between maternal mood disorders, primarily major depressive disorder (MDD), and a variety of negative child outcomes. By contrast, research exploring the reverse pathway whereby child traits are associated with later maternal mood disorders is much more limited. We examined whether young children's temperament and psychopathology predicted maternal mood disorders approximately 6 years later. Child temperament and symptoms were assessed at age three using semi-structured diagnostic interviews and parent-report inventories. Maternal psychopathology was assessed with semi-structured interviews when children were 3 and 9 years old. Mothers also reported on their marital satisfaction when children were 3 and 6 years old. Child temperamental negative affectivity (NA), depressive symptoms, and externalizing behavior problems significantly predicted maternal mood disorders over and above prior maternal mood, anxiety, and substance disorders. The link between children's early externalizing symptoms and maternal mood disorders 6 years later was mediated by maternal marital satisfaction 3 years after the initial assessment. These findings suggest that early child temperament and psychopathology contribute to risk for later maternal mood disorders both directly and through their impact on the marital system. Research indicates that effective treatment of maternal depression is associated with positive outcomes for children; however, this study suggests that treating early child problems may mitigate the risk of later maternal psychopathology.

Additive genetic risk from five serotonin system polymorphisms interacts with interpersonal stress to predict depression

Behavioral genetic research supports polygenic models of depression in which many genetic variations each contribute a small amount of risk, and prevailing diathesis-stress models suggest gene-environment interactions (G×E). Multilocus profile scores of additive risk offer an approach that is consistent with polygenic models of depression risk. In a first demonstration of this approach in a G×E predicting depression, we created an additive multilocus profile score from 5 serotonin system polymorphisms (1 each in the genes HTR1A, HTR2A, HTR2C, and 2 in TPH2). Analyses focused on 2 forms of interpersonal stress as environmental risk factors. Using 5 years of longitudinal diagnostic and life stress interviews from 387 emerging young adults in the Youth Emotion Project, survival analyses show that this multilocus profile score interacts with major interpersonal stressful life events to predict major depressive episode onsets (hazard ratio [HR] = 1.815, p = .007). Simultaneously, there was a significant protective effect of the profile score without a recent event (HR = 0.83, p = .030). The G×E effect with interpersonal chronic stress was not significant (HR = 1.15, p = .165). Finally, effect sizes for genetic factors examined ignoring stress suggested such an approach could lead to overlooking or misinterpreting genetic effects. Both the G×E effect and the protective simple main effect were replicated in a sample of early adolescent girls (N = 105). We discuss potential benefits of the multilocus genetic profile score approach and caveats for future research.

The Effects of Childhood and Adolescent Adversity on Substance Use Disorders and Poor Health in Early Adulthood

Childhood and adolescent adversity have been shown to predict later mental and physical health outcomes. Understanding which aspects and developmental timings of adversity are important, and the mechanisms by which they have their impact may help guide intervention approaches. A large subset of adolescents (N = 457; Female 68.9 %) from the 10-year longitudinal Youth Emotion Project was examined to better understand the associations among childhood/adolescent adversity, substance use disorder, and later health quality. Adolescent (but not childhood) adversities were associated with poorer health in late adolescence/early adulthood, adolescent adversities were associated with subsequent onset of substance use disorder, and adolescent adversities continued to be associated with poorer health in late adolescence/early adulthood after accounting for the variance explained by substance use disorder onset. These associations were observed after statistically accounting for emotional disorders and socioeconomic status. Specific domains of adversity uniquely predicted substance use disorder and poorer health outcomes. In contrast with current recent research, our findings suggest the association between childhood/adolescent adversity and poorer health outcomes in late adolescence and emerging adulthood are not entirely accounted for by substance use disorder, suggesting efforts to curtail family-based adolescent adversity may have downstream health benefits.

Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset

Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

Sensitizing effect of early adversity on depressive reactions to later proximal stress: Moderation by polymorphisms in serotonin transporter and corticotropin releasing hormone receptor genes in a 20-year longitudinal study

Previous research supports gene-environment interactions for polymorphisms in the corticotropin hormone receptor 1 gene (CRHR1) and the serotonin transporter gene linked polymorphic region (5-HTTLPR) in predicting depression, but it has rarely considered genetic influences on stress sensitization processes, whereby early adversities (EA) increase depressive reactivity to proximal stressors later in life. The current study tested a gene-environment-environment interaction (G × E × E; specifically, gene-EA-proximal stress interaction) model of depression in a 20-year longitudinal study. Participants were assessed prospectively for EA up to age 5 and recent chronic stress and depressive symptoms at age 20 and genotyped for CRHR1 single nucleotide polymorphism rs110402 and 5-HTTLPR. EA predicted stronger associations between recent chronic stress and depression, and the effect was moderated by genes. CRHR1 A alleles and 5-HTTLPR short alleles were associated with greater stress sensitization (i.e., greater depressive reactivity to chronic stress for those also exposed to high levels of EA). The results are consistent with the notion that EA exposure results in neurobiological and cognitive-emotional consequences (e.g., altered hypothalamic-pituitary-adrenal axis functioning), leading to emotional distress in the face of recent stressors among those with certain genetic characteristics, although further research is needed to explore explanatory mechanisms.

Genetic moderation of the association between adolescent romantic involvement and depression: Contributions of serotonin transporter gene polymorphism, chronic stress, and family discord

Studies support a link between adolescent romantic involvement and depression. Adolescent romantic relationships may increase depression risk by introducing chronic stress, and genetic vulnerability to stress reactivity/emotion dysregulation may moderate these associations. We tested genetic moderation of longitudinal associations between adolescent romantic involvement and later depressive symptoms by a polymorphism in the serotonin transporter linked polymorphic region gene (5-HTTLPR) and examined contributory roles of chronic stress and family discord. Three hundred eighty-one youth participated at ages 15 and 20. The results indicated that 5-HTTLPR moderated the association between age 15 romantic involvement and age 20 depressive symptoms, with strongest effects for short homozygotes. Conditional process analysis revealed that chronic stress functioned as a moderated mediator of this association, fully accounting for the romantic involvement-depression link among short/short genotypes. Also, romantic involvement predicted later depressive symptoms most strongly among short-allele carriers with high family discord. The results have important implications for understanding the romantic involvement-depression link and the behavioral and emotional correlates of the 5-HTTLPR genotype.

Normal personality traits, rumination and stress generation among early adolescent girls

This study examined associations between personality and stress generation. Expanding upon prior work, we examined (a) the role of Positive Emotionality (PE), Negative Emotionality (NE), and Constraint (CON), and their lower-order facets, as predictors of acute and chronic interpersonal stress generation; (b) whether personality moderated effects of rumination on stress generation; and (c) whether personality increased exposure to independent (uncontrollable) stress. These questions were examined in a one-year study of 126 adolescent girls (M age = 12.39 years) using contextual stress interviews. NE predicted increases in acute and chronic interpersonal stress generation, but not independent stress. NE, CON and affiliative PE each moderated the effect of rumination on chronic interpersonal stress generation. These effects were driven by particular lower-order traits.

Marital Processes, Neuroticism, and Stress as Risk Factors for Internalizing Symptoms

OBJECTIVE

Marital discord has a robust association with depression, yet it is rarely considered within broader etiological frameworks of psychopathology. Further, little is known about the particular aspects of relationships that have the greatest impact on psychopathology. The purpose of the present study was to test a novel conceptual framework including neuroticism, specific relationship processes (conflict management, partner support, emotional intimacy, and distribution of power and control), and stress as predictors of internalizing symptoms (depression and anxiety).

METHOD

Questionnaire and interview data were collected from 103 husbands and wives 5 times over the first 7 years of marriage.

RESULTS

Results suggest that neuroticism (an expression of the underlying vulnerability for internalizing disorders) contributes to symptoms primarily through high levels of non-marital stress, an imbalance of power/control in one's marriage, and poor partner support for husbands, and through greater emotional disengagement for wives.

CONCLUSIONS

Marital processes, neuroticism, and stress work together to significantly predict internalizing symptoms, demonstrating the need to routinely consider dyadic processes in etiological models of individual psychopathology. Specific recommendations for adapting and implementing couple interventions to prevent and treat individual psychopathology are discussed.

Refining the Candidate Environment: Interpersonal Stress, the Serotonin Transporter Polymorphism, and Gene-Environment Interactions in Major Depression

Meta-analytic evidence supports a gene-environment (G×E) interaction between life stress and the serotonin transporter polymorphism (5-HTTLPR) on depression, but few studies have examined factors that influence detection of this effect, despite years of inconsistent results. We propose that the "candidate environment" (akin to a candidate gene) is key. Theory and evidence implicate major stressful life events (SLEs)-particularly major interpersonal SLEs-as well as chronic family stress. Participants (N = 400) from the Youth Emotion Project (which began with 627 high school juniors oversampled for high neuroticism) completed up to five annual diagnostic and life stress interviews and provided DNA samples. A significant G×E effect for major SLEs and S-carrier genotype was accounted for significantly by major interpersonal SLEs but not significantly by major non-interpersonal SLEs. S-carrier genotype and chronic family stress also significantly interacted. Identifying such candidate environments may facilitate future G×E research in depression and psychopathology more broadly.

Positively biased appraisals in everyday life: when do they benefit mental health and when do they harm it?

To promote optimal mental health, is it best to evaluate negative experiences accurately or in a positively biased manner? In an attempt to reconcile inconsistent prior research addressing this question, we predicted that the tendency to form positively biased appraisals of negative experiences may reduce the motive to address those experiences and thereby lead to poorer mental health in the context of negative experiences that are controllable and severe but lead to better mental health in the context of controllable negative experiences that are less severe by promoting positive feelings without invoking serious consequences from unaddressed problems. In 2 longitudinal studies, individuals in new marriages were interviewed separately about their ongoing stressful experiences, and their own appraisals of those experiences were compared with those of the interviewers. Across studies, spouses' tendencies to form positively biased appraisals of their stressful experiences predicted fewer depressive symptoms over the subsequent 4 years among individuals judged to be facing relatively mild experiences but more depressive symptoms among individuals judged to be facing relatively severe experiences. Furthermore, in Study 2, these effects were mediated by changes in those experiences, such that the interaction between the tendency to form positively biased appraisals of stressful experiences and the objectively rated severity of initial levels of those experiences directly predicted changes in those experiences, which in turn accounted for changes in depressive symptoms. These findings suggest that cognitive biases are not inherently positive or negative; their implications for mental health depend on the context in which they occur.

Prospective Predictors of Suicidal Ideation during Depressive Episodes among Older Adolescents and Young Adults

Suicide is a leading cause of death among older adolescents and young adults; however, few studies have prospectively examined risk for suicidal ideation. The present study in older adolescents and young adults investigated whether two personality traits previously implicated in risk for suicidal ideation, neuroticism and extraversion, as well as certain aspects of interpersonal functioning, prospectively predicted endorsement of suicidal ideation during depressive episodes. Participants (n=117) are a subset of the Northwestern-UCLA Youth Emotion Project sample, which started with a group of high school juniors oversampled for high neuroticism. Baseline interpersonal functioning was measured using the Life Stress Interview. Baseline personality trait composite scores were created from multiple inventories. Depressive disorders and suicidal ideation were assessed at the baseline and three annual follow-up interviews using the SCID. Cox regression was employed to predict suicidal ideation during depressive episodes diagnosed at any follow-up interview. Results showed that baseline extraversion inversely predicts suicidal ideation in males only, and that baseline interpersonal problems in one's social circle, regardless of gender, predict suicidal ideation during depressive episodes.

What I like about you: the association between adolescent attachment security and emotional behavior in a relationship promoting context

Because the ability to flexibly experience and appropriately express emotions across a range of developmentally relevant contexts is crucial to adaptive functioning, we examined how adolescent attachment security may be related to more functional emotional behavior during a relationship promoting interaction task. Data were collected from 74 early adolescent girls (Mean age 13.45 years; SD = 0.68; 89% Caucasian) and their primary caregiver. Results indicated that, regardless of the parent's interaction behavior and the level of stress in the parent-adolescent relationship, greater adolescent security was associated with more positive and less negative behavioral displays, including greater positivity, greater coherence of verbal content and affect, less embarrassment, and less emotional dysregulation in response to a situational demand for establishing intimacy with the parent. Implications for encouraging and fostering adolescents' capacity to respond to interpersonal contexts in ways that promote the relationship are discussed.

Mediators of aggression among young adult offspring of depressed mothers

The current article explores the connection between maternal depression and offspring aggression during the transition to adulthood, expanding the scope of prior research on this topic. Both family-level factors (including parent-child relationship quality and maternal romantic relationship quality) and youth factors (including depression history and social functioning in midadolescence) were tested as potential mediators in a longitudinal community sample of 710 youth at ages 15 and 20. The results suggest that maternal depression confers a risk for higher levels of aggressive behavior by offspring at age 20. Structural equation models suggested that the association between maternal depression and youth aggression is fully mediated by youth history of depression by midadolescence, even when accounting for the stability of aggression between ages 15 and 20. Parent-child relationship quality, youth social functioning, and maternal relationship quality were not unique mediators of this association. Limitations and implications are discussed.

A prospective study of stress autonomy versus stress sensitization in adolescents at varied risk for depression

This longitudinal study investigated the stress autonomy, stress sensitization, and depression vulnerability hypotheses in adolescents across 6 years (i.e., Grades 6 through 12). Participants were 240 children (Time 1 mean age = 11.86, SD = 0.57) who varied in risk for depression on the basis of their mother's history of mood disorders. All analyses were conducted as multilevel models to account for nesting in the data. Results were consistent with the stress sensitization hypothesis. The within-subject relation of stress levels to depressive symptoms strengthened with increasing numbers of prior depressive episodes. In addition, evidence consistent with the vulnerability hypothesis was found. The relation of stress levels to depressive symptoms was stronger for adolescents who were at risk for depression on the basis of maternal depression history and for those who had experienced more depressive episodes through Grade 12. These findings suggest that onsets of depression in adolescents may be predicted by both relatively stable and dynamic transactions between stressful life events and vulnerabilities such as maternal depression and youths' own history of depressive episodes.

The role of neuroticism and extraversion in the stress-anxiety and stress-depression relationships

Though there is a considerable amount of research supporting the association between stressful life events and major depression, there is a paucity of research concerning a range of other life stress constructs, non-depressive disorders, the role of stable personality traits, and gender differences. This study addresses these deficits by: (a) focusing on the association between interpersonal and non-interpersonal chronic life stress (CLS) and both depressive and anxiety disorders; (b) examining the roles of neuroticism and low extraversion in these associations; and (c) assessing gender differences. Participants were 603 adolescents from a study examining risk factors for emotional disorders. Depression and social phobia were associated with interpersonal CLS (IP-CLS), with neuroticism partially accounting for these associations. Low extraversion partially accounted for the association between social phobia and IP-CLS. Depression was also associated with non-interpersonal CLS (NI-CLS), but only in females. This study provides preliminary evidence for the importance of personality variables in explaining shared associations between stress and depression. Additionally, the stress-social phobia relationship is highlighted with no evidence supporting an association between other anxiety disorders and CLS.

A longitudinal investigation of the impact of life stress on HIV treatment adherence

Suboptimal antiretroviral adherence is associated with poorer HIV outcomes. Psychosocial factors, including life stress, depression and coping, may influence adherence behavior. This prospective investigation sought to examine the impact of life stress (acute life events, chronic stress, and perceived stress), depression, and coping style on adherence to HIV treatment regimes over time. Participants were 87 treatment-seeking HIV-infected individuals recruited from an urban HIV clinic. They completed clinician-administered interviews and self-report questionnaires at baseline and 3-month follow-up. Acute life events and chronic stress prospectively predicted decreases in treatment adherence more strongly among individuals in a major depressive episode (n = 21) compared to non-depressed individuals (n = 66). Coping style did not appear to be the mechanism by which life stress influenced adherence among depressed HIV-infected individuals. These findings demonstrate that life stress has toxic effects for depressed individuals and suggest that treatment adherence interventions with depressed individuals could be enhanced via development of stress management skills.

Maternal depression, maternal expressed emotion, and youth psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors-maternal depression within the child's lifetime and maternal EE-in a study of children at risk for depression. One hundred and seventy-one youth, ages 8-12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist-Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children's own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers' reports of children's Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers' reports of children's Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children's depression diagnoses.

A prospective study of the cognitive-stress model of depressive symptoms in adolescents

This prospective study investigated a cognitive diathesis-stress model of depression in adolescents across the transition from 6th to 7th grade using individual, additive, weakest link, and keystone approaches to operationalizing the cognitive vulnerability. Participants were 240 young adolescents (mean age = 11.87 years, SD = 0.57) who differed in risk for mood disorders based on their mother's history of depression. Results of the hierarchical multiple regression analyses indicated some support for the individual, additive, weakest link, and keystone diatheses. In particular, the weakest link diathesis interacted with stress and gender to predict increases in depressive symptoms in 7th grade; the form of this interaction was consistent with the cognitive diathesis-stress model for boys, whereas for girls the pattern of relations reflected more of a dual-vulnerability model. That is, high levels of depressive symptoms were found for all girls except those with more positive cognitive styles and low stress levels. These findings highlight the utility of examining different approaches to combining measures of cognitive vulnerability in conjunction with stress in predicting depressive symptoms, and the importance of exploring gender differences with regard to the cognitive diathesis-stress model.

Patterns of adolescent depression to age 20: the role of maternal depression and youth interpersonal dysfunction

Considerable research has focused on youth depression, but further information is needed to characterize different patterns of onset and recurrence during adolescence. Four outcome groups by age 20 were defined (early onset-recurrent, early-onset-desisting, later-onset, never depressed) and compared on three variables predictive of youth depression: gender, maternal depression, and interpersonal functioning. Further, it was hypothesized that the association between maternal depression and youth depression between 15 and 20 is mediated by early-onset depression and interpersonal dysfunction by age 15. Eight hundred sixteen community youth selected for depression risk by history (or absence) of maternal depression were interviewed at age 15, and 699 were included in the 5-year follow-up. Controlling for gender, early onset and interpersonal dysfunction mediated the link between maternal depression and late adolescent major depression. Different patterns for males and females were observed. For males maternal depression's effect was mediated by early onset but not interpersonal difficulties, while for females maternal depression's effect was mediated by interpersonal difficulties but not early onset. Maternal depression did not predict first onset of major depression after age 15. The results suggest the need for targeting the impact of maternal depression's gender-specific effects on early youth outcomes, and also highlight the different patterns of major depression in youth and their likely implications for future course of depression.

Relationship between maternal clinical factors and mother-reported child problems

Maternal depression has been associated with mothers' elevated reports of child problems. However, it is unclear the extent to which elevations in mother ratings reflect having a depression diagnosis, having any mental illness diagnosis, or having a diagnosis vs. symptom levels. As part of a NIMH-funded, longitudinal study of mothers with serious mental illness (N=379), we examined the relationship between mother-reported adolescent behavior problems (N=78) and maternal depression vs. other diagnoses, as well as the effects of depression diagnosis vs. symptom levels. Mothers were recruited from the public mental health system in an urban area, and are primarily African-American and low income. We found that maternal psychiatric symptoms made a unique and significant contribution to explaining the variance in mother-reported child problems, independent of controls (e.g., teacher reports and child demographics), while maternal diagnosis did not. Implications of findings are discussed.

Early adversity and the prospective prediction of depressive and anxiety disorders in adolescents

The current study was a prospective exploration of the specificity of early childhood adversities as predictors of anxiety and depressive disorders in adolescents. Participants were 816 adolescents (414 males, 402 females) with diagnostic information collected at age 15; information on early adversities had been collected from the mothers during pregnancy, at birth, age 6 months, and age 5 years for a related study. Adolescents with "pure" anxiety disorders were compared with adolescents with "pure" depressive disorders (major depressive disorder, dysthymia), and these groups were compared to never-ill controls. Analyses controlled for gender and maternal depression and anxiety disorders. Results indicated that adolescents with anxiety disorders were more likely than depressed youth to have been exposed to various early stressors, such as maternal prenatal stress, multiple maternal partner changes, and more total adversities, whereas few early childhood variables predicted depressive disorders. Even when current family stressors at age 15 were controlled, early adversity variables again significantly predicted anxiety disorders. Results suggest that anxiety disorders may be more strongly related to early stress exposure, while depressive disorders may be related to more proximal stressors or to early stressors not assessed in the current study.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Maternal depression and child behaviour problems: a meta-analysis

Children of depressed mothers are not only at risk for the development of psychopathology, but also for behaviour problems. A meta-analysis of 33 studies was conducted to determine the magnitude of the relationship between maternal depression and behaviour problems in children 1 year of age and older. Substantive, methodological, and miscellaneous variables were extracted and coded by both the researcher and a research assistant. The initial inter-rater agreement reached in coding these variables ranged from 85% to 100%. Effect sizes were calculated in three ways: unweighted, weighted by sample size, and weighted by quality index score. The mean effect size for the r index ranged from 0.29 when weighted by sample size to 0.35 when unweighted, indicating a moderate relationship between maternal depression and child behaviour problems. Children between the ages of 1-18 whose mothers were depressed displayed more conduct behaviour problems than children whose mothers were not depressed. The magnitude of this relationship covaried significantly with the predictors of sample size and quality index scores. Implications for future research are addressed.

Prevalence and correlates of depressive symptoms in mothers of young children

Mothers of young children are at risk for depressive symptoms due to their gender and status as parents. The primary purposes of this study were (1) to assess the prevalence of depressive symptoms in a sample of mothers with young children, (2) to identify sociodemographic correlates of depressive symptoms among the women, and (3) to determine if chronic stress is associated with depressive symptoms independent of other risk factors. In-home interviews were conducted with 196 mothers of 5- and 6-year-old children using the Center for Epidemiologic Studies--Depression (CES-D) Scale and the Everyday Stressors Index (ESI). High depressive symptoms (CES-D greater than or equal to 16) were reported by 49% of the mothers. They were highest among those who had never married, had less than a high school education, were under 25 years of age, were black, and had a low income. The ESI was a strong predictor of high depressive symptoms, controlling for sociodemographic characteristics. In comparison to mothers reporting a low level of everyday stressors (score = 5), those scoring 15 were 3 times more likely to have high depressive symptoms; those scoring 35 were more than 30 times as likely to have high CES-D scores. The results suggest the importance of chronic daily stressors as correlates of depressive symptoms in mothers of young children and also point to the need for multivariate models when examining predictors of those symptoms.