Assessment of life stress in adolescents: self-report versus interview methods

Caregiver Report of Children's Exposure to Adverse Life Events: Concordance Between Questionnaire and Interview Approaches

Assessment practices for measuring adverse life events (ALEs) are often characterized by considerable variability, which is associated with inconsistency and reproducibility issues when conducting research on children with ALE exposure. One aspect of assessment variability for caregiver report of children's ALE history that has received minimal attention is assessment format. To address this issue, the current study evaluated concordance between two main ALE assessment formats: interviews and questionnaires. This involved examining overall endorsement of ALEs and concordance among multiple characteristics of ALE exposure, including type, polyvictimization, frequency, severity, and age of onset. Fifty-eight caregivers (Mage = 33.72; 60% Black; 55% below the federal poverty line) of preschool and school-age children were administered an ALE assessment in both a questionnaire and interview format across two sessions. The sum scores and concordance rates between format responses were compared based on ALE type, polyvictimization, frequency, severity, and age of onset of exposure. Results indicated that most total or sum scores were similar between formats, with the exception of ALE severity scores. However, there was most often low-to-moderate concordance across the 50 types of ALEs examined in the current study, suggesting that a different constellation of events comprised each sum or total score. This was also the case across all characteristics of the ALEs and most notably for the severity of ALE. Based on these findings, the format of assessment may be associated with inconsistent reporting of children's ALE exposure across multiple characteristics of ALE. Researchers may need to utilize multiple types of ALE assessments when relying on caregiver report of a child's ALEs.

Associations between pre-pandemic authoritative parenting, pandemic stressors, and children's depression and anxiety at the initial stage of the COVID-19 pandemic

Large-scale changes due to the Novel Coronavirus (COVID-19) pandemic negatively affected children's mental health. Prior research suggests that children's mental health problems during the pandemic may have been concurrently attenuated by an authoritative parenting style and exacerbated by family stress. However, there is a gap in the literature investigating these mechanisms and whether pre-pandemic authoritative parenting had a lasting positive influence on children's mental health while they were exposed to pandemic-related family stressors. The current study begins to fill this gap by investigating these unique relationships in a sample of 106 4-8 year old children (51% female). Before the pandemic, caregivers completed questionnaires on their parenting style and their children's depression and anxiety symptoms. Shortly after the onset of COVID-19's stay-at-home mandate, parents answered questionnaires about their children's depression and anxiety symptoms and pandemic-related family stressors. Child depression and anxiety symptom severity increased. Higher levels of pandemic-related family stress were associated with increases only in child anxiety scores. Further, greater endorsement of a pre-pandemic authoritative parenting style was associated with smaller changes only in child depression scores. Study findings elucidate unique and complex associations between young children's anxiety and depression symptoms severity and pre-pandemic parenting and pandemic-related family stressors.

Patterns of life stress and the development of ruminative brooding in adolescence: A person-centered approach

Research links life stressors, including acute, chronic, and early life stress, to the development of ruminative brooding. However, singular forms of life stress rarely occur in isolation, as adolescents typically encounter stressors that vary on important dimensions (e.g., types, timings, quantities) across development. The current study employs latent profile analysis (LPA) to identify natural clusters of life stress that, over time, may be differently associated with ruminative brooding. Evaluations of episodic, chronic, and early life stress were conducted with community-recruited mid-adolescents (N = 241, Mage = 15.90 years, 53% female) and their parents using the UCLA Life Stress Interview and lifetime adversity portions of the Youth Life Stress Interview. Analyses identified four distinct patterns: low stress, high peer stress, moderate home / family stress, and multifaceted / high school stress. Adolescents in the high peer stress and moderate home / family stress profiles were at highest risk for developing a brooding style over time. Despite high overall levels of stress, teens in the multifaceted / high school stress profile were at not at elevated risk for developing a brooding style. Findings demonstrate the utility of person-centered approaches to identify patterns of stress exposure that heighten risk for brooding over time.

Two or more significant life-events in 6-months are associated with lower rates of HIV treatment and virologic suppression among youth with HIV in Uganda and Kenya

Youth living with HIV in sub-Saharan Africa have poor HIV care outcomes. We determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15-24 years living with HIV in rural Kenya and Uganda. This was a cross-sectional analysis of 995 youth enrolled in the SEARCH Youth study. At baseline, providers assessed recent (within 6 months) life-events, defined as changes in schooling/employment, residence, partnerships, sickness, incarceration status, family strife or death, and birth/pregnancy, self-reported alcohol use, being a parent, and HIV-status disclosure. We examined the frequencies of events and their association with ART status and HIV viral suppression (<400 copies/ul). Recent significant life-events were prevalent (57.7%). Having >2 significant life-events (aOR = 0.61, 95% CI:0.45-0.85) and consuming alcohol (aOR = 0.61, 95% CI:0.43-0.87) were associated with a lower odds of HIV viral suppression, while disclosure of HIV-status to partner (aOR = 2.39, 95% CI:1.6-3.5) or to family (aOR = 1.86, 95% CI:1.3-2.7), being a parent (aOR = 1.8, 95% CI:1.2-2.5), and being single (aOR = 1.6, 95% CI:1.3-2.1) had a higher odds. This suggest that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa.Trial registration: ClinicalTrials.gov identifier: NCT03848728..

Exposure to family stressful life events in autistic children: Longitudinal associations with mental health and the moderating role of cognitive flexibility

Mental health problems are prevalent in autistic youth, but the underpinning mechanisms are not well explored. In neurotypical youth, stressful life events are an established risk factor for mental health problems. This study tested longitudinal bidirectional associations between family-level stressful life events and mental health problems and whether these were moderated by cognitive flexibility, in a cohort of autistic children (N = 247). Family-stressful life events, assessed using the parent-reported Family Inventory of Life Events and Changes, and mental health problems, assessed using the teacher-reported Child Behavior Checklist Internalizing and Externalizing Symptoms subscales, were measured at multiple points between 7 and 11 years. Analyses showed no significant pathways from internalizing or externalizing symptoms to family-stressful life events or from family-stressful life events to internalizing or externalizing symptoms. There was some evidence of moderation by cognitive flexibility; the family-stressful life events to internalizing symptoms pathway was non-significant in the group with typical shifting ability but significant in the group with clinically significant shifting problems. Information about family-level stressful life event exposure and cognitive flexibility may be helpful in identifying autistic youth who may be at higher risk of developing mental health problems. Established risk factors for mental health problems in neurotypical populations are relevant for understanding mental health in autistic youth.

The experience of life events and body composition in middle childhood: a population-based study

While studies suggest potential influences of childhood adversities on obesity development in adulthood, less is known about the short-term association in children. We examined the association between a wide range of life events experienced in the first ten years of life (including maltreatment and milder adversities) and body composition in 5333 ten-year old Dutch children. In structured interviews, mothers retrospectively reported on their children’s experience of 24 events. BMI was calculated, and fat mass index and fat free mass index were determined by dual-x-ray absorptiometry scanning. Linear regressions showed that, unadjusted, a higher number of life events was associated with higher BMI and body composition. However, associations attenuated to non-significance after adjustment for covariates. Similar findings were observed for maltreatment and milder life events. Thus, the number of experienced life events was not associated with body composition in middle childhood. Rather, other factors, like socioeconomic conditions, accounted for the relationship between life events and weight development in children.

The relationship between stressful events, emotion dysregulation, and anxiety symptoms among youth: longitudinal support for stress causation but not stress generation

INTRODUCTION

There is a clear bi-directional link between stressful events and depressive symptoms in adolescence, but the directionality of this link for anxiety symptoms remains underexamined. We critically evaluate the longitudinal relationship between stressors and anxiety among youth. Specifically, we examine whether stressors predict anxiety symptoms over a 1.5-year period (stress causation), and whether anxiety symptoms predict stressors over this period (stress generation). We examine potential influencing factors, including stressor type (independent vs. dependent) and emotion dysregulation (nonacceptance; goal-directed difficulty).

METHODS

Social, separation, and physical anxiety symptoms, and frequency and stressor type, were assessed every 3 months for 1.5 years among community youth (n = 528, ages 8-17). Baseline emotion dysregulation was assessed. Time-lagged analyses evaluated the bi-directional relationship of stress and anxiety over time, controlling for previous anxiety and depression.

RESULTS

Interpersonal stressors predicted subsequent physical and social anxiety symptoms, but anxiety did not predict subsequent stressors. Both nonacceptance and goal-directed difficulties predicted subsequent anxiety symptoms and stressors, but did not moderate the relationship.

CONCLUSION

The findings supported the stress causation model for youth anxiety, but not the stress generation model. Nonacceptance and goal-directed difficulty predicted greater subsequent anxiety symptoms and stressors. We discuss implications for prevention and intervention.

Special Issue: Race and Mental Health Among Older Adults: Do Depressive Symptoms Shape Blacks' Perceptions of Stress Over Time?

Background and Objectives

Previous studies have linked stress to multiple negative mental health outcomes, including depression. This established stress–depression association is typically examined in one direction and cross-sectionally. This study examined the bidirectional relationships between depressive symptoms and changes in perceived stress over time in Blacks.

Research Design and Methods

The present study uses a community-dwelling sample of 450 Black adults, aged 51–96 years old, who participated in the Baltimore Study of Black Aging—Patterns of Cognitive Aging. Perceived stress—measured by the Perceived Stress Scale—and depressive symptoms—measured using the Center for Epidemiologic Studies Depression scale—were both assessed at baseline and follow-up 33 months later. Ordinary least squares regression was used to examine 2 bidirectional longitudinal relationships between (1) stress–depression and (2) depression–stress, and whether these associations are modified by age.

Results

Initial analyses testing the typical stress–depression relationship showed an effect in the expected direction, that is stress leading to more depressive symptoms over time, adjusting for model covariates, but the effect was not statistically significant (b = 0.014, p = .642). After accounting for baseline perceived stress level, age, sex, education, and chronic health conditions, depressive symptoms were positively associated with follow-up stress (b = 0.210, p < .000). The depression–stress association further varied by age group such that the impact of baseline depression on changes in perceived stress was greatest in Blacks in their 60s versus those in their 50s (b = 0.267, p = .001), controlling for model covariates.

Discussion and Implications

Contrary to previous work, the results suggest that an individual’s mental health shapes his/her perception of stressful events and this relationship varies by age group. While the typical finding (stress impacting depression) was not significant, the findings reported here highlight the importance of considering the possible bidirectional nature of the relationships between psychosocial measures of stress and mental health in later life among Blacks.

Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression

BACKGROUND

Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed.

OBJECTIVE

The objective of our study was to test CLEAR's reliability, validity, and association with depression.

METHODS

CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression.

RESULTS

CLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90).

CONCLUSIONS

CLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders.

Recent Stressful Life Events (SLE) and Adolescent Mental Health: Initial Validation of the LEIA, a New Checklist for SLE Assessment According to Their Severity, Interpersonal, and Dependent Nature

The main aim of the present study was to develop and validate a checklist for adolescents, the Life Events Inventory for Adolescents (LEIA), for screening stressful life events (SLEs) of different nature (major-minor, dependent-independent, and personal-interpersonal). The LEIA was administered together with another SLE checklist (Escala de Acontecimientos Vitales [Life Events Scale], EAV), and with measures of life satisfaction and externalizing and internalizing symptoms. The results showed that the kappa and the percentage agreement reliability indices were adequate. Regarding validity evidences, the correlations found between the LEIA and the EAV ranged from .65 to .69, and between the LEIA and the psychopathological symptoms ranged from .26 to .38. Specifically, major dependent noninterpersonal SLEs were the best predictors of externalizing psychopathology; while major independent noninterpersonal SLEs were the best predictors of internalizing symptoms and low life satisfaction. To conclude, the LEIA could be considered an adequate checklist to screen for SLEs in adolescents.

Caregiver Self-Reports and Reporting of Their Preschoolers' Trauma Exposure: Discordance Across Assessment Methods

Nearly half of preschool-aged children from low-income families in the United States have been exposed to potentially traumatic events (PTEs), yet few are identified or receive trauma-focused mental health care. Given the critical need to accurately and efficiently identify PTE-exposed individuals, the current study examined discordant caregiver self-reporting of PTE exposure and caregiver reporting of child PTE exposure across two assessment methods: checklist and interview. Research has demonstrated significant cross-method discrepancies among adults reporting stressful life experiences, but examinations of caregiver reporting for their young children have not been conducted. Further, given their possible impact on reporting patterns, caregiver and child characteristics were examined in relation to discordant caregiver reporting by trauma type. Participants were 64 low-income, racially and ethnically diverse caregivers and their preschool-aged children from a Northeastern US city. Caregivers reported self and child PTE exposure via checklist and semi-structured interview. Cross-method discordance for caregiver and child exposure by trauma type ranged from 10.9% to 46.9% (Cohen's kappa =.06-.70). Caregiver race and education were associated with discordant reporting, as were caregiver and child psychopathology. Lower levels of caregiver psychopathology were associated with discordant caregiver reporting of their own exposure, whereas higher levels were associated with discordant caregiver reporting of child exposure. Discordant caregiver reporting of PTE exposure varies by assessment format and trauma type and is differentially related to caregiver demographics and caregiver and child psychopathology. Associations between assessment methods, individual characteristics, and reporting should be considered when assessing PTE exposure to support service engagement and targeted treatment.

Review of Tools for Measuring Exposure to Adversity in Children and Adolescents

Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools.

Mental health service use, depression, panic disorder and life events among Swedish young adults in 2000 and 2010: a repeated cross-sectional population study in Stockholm County, Sweden

AIMS

The use of specialised psychiatric services for depression and anxiety has increased steadily among young people in Sweden during recent years. It is not known to what extent this service use is due to an increase in psychiatric morbidity, or whether other adversities explain these trends. The aim of this study is to examine if there is increased use of psychiatric services among young adults in Sweden between 2000 and 2010, and if so, to what extent this increase is associated with differences in depression, anxiety and negative life events.

METHODS

This is a repeated cross-sectional study of 20-30-year old men and women in Stockholm County in 2000 and 2010 (n = 2590 and n = 1120). Log-binomial regression analyses were conducted to compare the prevalence of service use, depression and panic disorder between the two cohorts. Self-reported life events were entered individually and as a summary index, and entered as potential mediators. Different effects of life events on service use were examined through interaction analysis. We report prevalence proportion ratios (PPR) with 95% confidence intervals.

RESULTS

Specialised psychiatric service use, but also depression and panic disorder was more common in the younger cohort (current service use 2.4 and 5.0%). The younger cohort did not report more life events overall or among those with depression or anxiety. Neither depression, panic disorder nor life events could explain the increased use of psychiatric services in the younger cohort (Fully adjusted model PPR = 1.70, 1.20-2.40 95% CI). There was no significant interaction between cohort and life events in predicting psychiatric service use.

CONCLUSION

This study provides initial support for an increase in service use among young adults compared with 10 years earlier. The increased service use cannot be explained with increasing worse life situations.

Gene-environment interactions between stress and 5-HTTLPR in depression: A meta-analytic update

BACKGROUND

Meta-analyses have yielded contradictory findings concerning the role of 5-HTTLPR in interaction with stress (GxE) in depression. The current meta-analysis investigates if these contradictory findings are a result of differences between studies in methodological approaches towards the assessment of stress and depression.

METHODS

After performing a systematic database search (February to December 2016), first, a meta-analysis was used to investigate the total effect size and publication bias. Second, stratified meta-analyses were used to investigate the potential moderating influence of different methodological approaches on heterogeneity of study findings. Third, a meta-regression was used to investigate the combined influence of the methodological approaches on the overall effect size.

RESULTS

Results showed a small but significant effect of 5-HTTLPR in interaction with stress in the prediction of depression (OR[95%CI] = 1.18[1.09; 1.28], n = 48 effect sizes from 51 studies, totaling 51,449 participants). There was no evidence of publication bias. Heterogeneity of effect sizes was a result of outliers and not due to different methodological approaches towards the assessment of stress and depression. Yet, there was some evidence that studies adopting a categorical and interview approach to the assessment of stress report higher GxE effects, but further replication of this finding is needed.

LIMITATIONS

A large amount of heterogeneity (i.e., 46%) was not explained by the methodological factors included in the study and there was a low response rate of invited studies.

CONCLUSIONS

The current meta-analysis provides new evidence for the robustness of the interaction between stress and 5-HTTLPR in depression.

Depressive symptoms and negative life events: What psycho-social factors protect or harm left-behind children in China?

BACKGROUND

In China, children under 18 years old who are left at rural residences for at least 6 months by either one or both of their parents migrating to work in cities are called "left-behind children (LBC)". Due to restricted family support, they are at a greater risk of developing depressive symptoms than non-left-behind children (NLBC). The objective of this study is to explore how depressive symptoms and stress induced by negative life events such as interpersonal conflicts, punishment and loss, as well as their relationships vary for LBC with different left-behind-related characteristics.

METHODS

Using data from a large school-based survey conducted in Chongqing between December 2012 and June 2013, we first identified the differences in depressive symptoms and negative-event-induced stress between LBC and NLBC, and then analyzed the variances among LBC with different left-behind-related characteristics. The data was analyzed with Chi-square test, MANCOVA, ANCOVA, ANOVA, T-test and hierarchical multiple regression analyses.

RESULTS

We found that LBC were more stressed when experiencing negative events and had more depressive symptoms than NLBC. Children left behind by both parents were most depressed. Negative-event-induced stress and communication on life difficulties with migrant parents were risk factors for depressive symptoms, whereas adequate communication on academic performance or children's feelings was a protective factor against depressive symptoms. Communication duration and frequency, communication by visiting, communication on academic performance, life difficulties and children's feelings moderated the relationship between stress and depressive symptoms, respectively. Duration of separation, communication duration and frequency, communication on academic performance, learning difficulties and children's feelings moderated the relation between the type of parental migration and depressive symptoms, respectively.

CONCLUSIONS

Our findings suggest that children left behind by both parents should be the focus of public attention for their higher susceptibility to stress-related depression. To help LBC stay mentally healthy, governments need to formulate regulations contributing to LBC's family reunion, communities need to involve more residents to attend LBC as "surrogate parents" and teach migrant parents to communicate with LBC properly, and schools need to teach LBC how to deal with stress and communicate with migrant parents.

Between- and within-person associations between negative life events and alcohol outcomes in adolescents with ADHD

Escalations in alcohol use during adolescence may be linked with exposure to negative life events, but most of this research has focused on between-person associations. Moreover, adolescents with attention-deficit hyperactivity disorder (ADHD) may be an especially vulnerable population, reporting more life events and alcohol involvement and may even be more sensitive to the effects of life events on alcohol outcomes compared with those without ADHD. We tested the between- and within-person effects of the number and perceptions of negative life events on the development of alcohol use outcomes from age 14 to 17 years in 259 adolescents with and without ADHD using generalized estimating equations. Between-person differences in exposure to negative life events across adolescence, but not the perception of those events, were associated with a higher likelihood of alcohol use and drunkenness at age 17 years. Within-person differences in life events were associated with alcohol use above and beyond that predicted by an adolescents' typical trajectory over time. Parent- and teacher-reported ADHD symptoms were associated with more negative perceptions of life events and with greater alcohol use and drunkenness at age 17 years, but symptoms did not moderate the life event-alcohol association. Interventions should consider the variables that produce vulnerability to life events as well as the immediate impact of life events. That the accumulation of life events, rather than their perceived negativity, was associated with alcohol outcomes indicates that interventions targeting the reduction of negative events, rather than emotional response, may be more protective against alcohol use in adolescence. (PsycINFO Database Record

Associations of stressful life events with coping strategies of 12-15-year-old Norwegian adolescents

Successful adaptation to the environment requires strategies to cope with stressful situations. The aim of this study was to examine the role of stressful life events in coping strategies during early adolescence. A representative sample of 2464 adolescents in Norway were assessed at two time-points, one year apart (i.e., at T1, mean age 13.7 years, and at T2, mean age 14.9 years), with identical questionnaires. The participation rate was 88.3% at T1. Stressful life events and daily hassles were measured by questionnaires constructed for this study. Coping with stress was measured by a modified version of the Coping Inventory for Stressful Situations (CISS), which measures three coping dimensions: emotional, task and avoidance coping. Depressive symptoms were assessed by the Mood and Feelings Questionnaire (MFQ). Standard multiple linear regression methods were applied. Different domains of stressful life events were associated with the coping strategies, and these relationships differed at various time-points by gender. In sum, school stress and stressful life events in one's network (network stress) was associated with coping strategies more strongly among girls, while family and miscellaneous stress showed a stronger association among boys. These relationships were partly mediated by depressive symptom levels, more strongly in cross-sectional than in longitudinal analyses. However, daily hassles seemed to represent smaller events of no importance in coping strategies. In preventive work, reducing stressful events, treating depression and teaching healthier coping strategies are important.

Differences in frontal and limbic brain activation in a small sample of monozygotic twin pairs discordant for severe stressful life events

Monozygotic twin pairs provide a valuable opportunity to control for genetic and shared environmental influences while studying the effects of nonshared environmental influences. The question we address with this design is whether monozygotic twins selected for discordance in exposure to severe stressful life events during development (before age 18) demonstrate differences in brain activation during performance of an emotional word-face Stroop task. In this study, functional magnetic resonance imaging was used to assess brain activation in eighteen young adult twins who were discordant in exposure to severe stress such that one twin had two or more severe events compared to their control co-twin who had no severe events. Twins who experienced higher levels of stress during development, compared to their control co-twins with lower stress, exhibited significant clusters of greater activation in the ventrolateral and medial prefrontal cortex, basal ganglia, and limbic regions. The control co-twins showed only the more typical recruitment of frontoparietal regions thought to be important for executive control of attention and maintenance of task goals. Behavioral performance was not significantly different between twins within pairs, suggesting the twins with stress recruited additional neural resources associated with affective processing and updating working memory when performing at the same level. This study provides a powerful glimpse at the potential effects of stress during development while accounting for shared genetic and environmental influences.

Self-Reported Stressful Life Events During Adolescence and Subsequent Asthma: A Longitudinal Study

BACKGROUND

Although exposure to stressful life events in adolescence has been associated with poor health as measured by number of physicians' visits and symptom scores, little is known regarding stress in adolescence and either concurrent or subsequent asthma.

OBJECTIVE

The objective of this study was to explore whether life events in adolescence are associated with either concurrent or new active asthma.

METHODS

The Tucson Children's Respiratory Study, a prospective population-based birth cohort, surveyed participants at 10 ages between 6 and 29 years regarding respiratory health. Asthma was defined as a physician-diagnosis of asthma with symptoms during the previous year. At age 16, participants (n = 318) were queried regarding stressful life events using the 67-item Life Events Questionnaire for Adolescents (LEQA). LEQA scores were examined in relation to both concurrent and new active asthma. Estimates were obtained with logistic regression and mixed models.

RESULTS

There was no relation between asthma prevalence at age 16 and LEQA scores in the overall sample, although males with high LEQA scores had higher prevalence of asthma compared with males with low scores (relative risk [RR]: 3.03; 95% confidence interval [CI]: 1.37, 6.69; P = .006). Among adolescents with no asthma through age 16, risk of new asthma was greater for those with high LEQA scores (adjRR: 4.07; 95% CI: 1.33, 12.43; P = .014), after adjustment for potential confounders including smoking. Emotional support from family and friends slightly diminished the relation of stress to new asthma.

CONCLUSIONS

Stressful life events during adolescence are associated with subsequent new asthma. Additional biological and psychological measures of stress would complement these findings.

In Their Own Words: Rural Adolescent Stressors and Relationship to Depressive Symptoms

This study evaluated qualitative reports of stressful life events from young rural adolescents and examined the relationship between stressor themes and depressive symptoms. A phenomenological approach guided content analysis of qualitative data. Number of themes within each response was tabulated, and association with depressive symptoms was then examined. Stressors were categorized into four thematic domains: family, peers, academics, and intrapersonal. Individual themes within each domain varied, but the themes of conflict and loss were predominant in most domains. Higher number of themes were associated with elevated depressive symptoms ( p = .045). Study findings provide insight into the lived experience of adolescent stressors and provide additional empirical evidence regarding the association between stressors and depressive symptoms. The ubiquitous themes of conflict and loss, and the implications of these themes for adolescents' mental health provide insight for nurses as they advocate for quality mental and physical health care for adolescents and their families.

Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study

AIMS/HYPOTHESIS

The aim of this study was to prospectively investigate whether psychological stress during childhood may be a risk factor for manifest type 1 diabetes.

METHODS

The All Babies In Southeast Sweden (ABIS) study invited all families with babies born between 1 October 1997 and 30 September 1999 in southeast Sweden to participate. Our study subsample includes 10,495 participants in at least one of the data collections at 2-3, 5-6, 8 and 10-13 years of age not yet diagnosed with type 1 diabetes at inclusion; 58 children were subsequently diagnosed. Age at diagnosis was obtained from the national register SweDiabKids in 2012. Family psychological stress was measured via questionnaires given to the parents assessing serious life events, parenting stress, parental worries and the parent's social support.

RESULTS

Childhood experience of a serious life event was associated with a higher risk of future diagnosis of type 1 diabetes (HR 3.0 [95% CI 1.6, 5.6], p = 0.001) after adjusting for heredity of type 1 diabetes and age at entry into the study. The result was still valid when controlling for heredity of type 2 diabetes, size for gestational age, the parents' education level and whether the mother worked at least 50% of full time before the child's birth (HR 2.8 [95% CI 1.5, 5.4], p = 0.002), and also when childhood BMI was added to the model (HR 5.0 [95% CI 2.3, 10.7], p < 0.001).

CONCLUSIONS/INTERPRETATION

This first prospective study concluded that experience of a serious life event in childhood may be a risk factor for manifest type 1 diabetes.

Ventral striatum reactivity to reward and recent life stress interact to predict positive affect

BACKGROUND

Stressful life events are among the most reliable precipitants of major depressive disorder; yet, not everyone exposed to stress develops depression. It has been hypothesized that robust neural reactivity to reward and associated stable levels of positive affect (PA) may protect against major depressive disorder in the context of environmental adversity. However, little empirical data exist to confirm this postulation. Here, we test the hypothesis that individuals with relatively low ventral striatum (VS) reactivity to reward will show low PA levels in the context of recent life stress, while those with relatively high VS reactivity will be protected against these potentially depressogenic effects.

METHODS

Differential VS reactivity to positive feedback was assessed using blood oxygen level-dependent functional magnetic resonance imaging in a sample of 200 nonpatient young adults. Recent life stress, current depressive symptoms, and PA were assessed via self-report. Linear regression models were used to investigate the moderating effects of VS reactivity on the relationship between recent stress and state PA across participants.

RESULTS

Recent life stress interacted with VS reactivity to predict self-reported state PA, such that higher levels of life stress were associated with lower PA for participants with relatively low, but not for those with high, VS reactivity. These effects were independent of age, gender, race/ethnicity, trait PA, and early childhood trauma.

CONCLUSIONS

The current results provide empirical evidence for the potentially protective role of robust reward-related neural responsiveness against reductions in PA that may occur in the wake of life stress and possibly vulnerability to depression precipitated by stressful life events.

Epidemiological approaches to measure childhood stress

The prevalence of childhood stress has repeatedly been shown to be high, with 'parental separation' and 'being bullied at school' as the most frequently reported stressors in the child's everyday life. This is quite alarming as children are most vulnerable to the adverse psychological and physiological health consequences of chronic stress exposure. Despite growing research interest in this field over the last years, literature falls short in providing an overview of methods to adequately assess stress in elementary school children (6-12 years old). This review describes questionnaires and interviews, as well as laboratory measurements of cortisol in biological samples (serum, urine, saliva and hair) as stress assessment methods in children, with the emphasis on epidemiological research settings. Major characteristics, strengths and limitations of these methods are established, examples of child-specific stressor questionnaires and interviews are provided and specific recommendations with respect to epidemiological research are formulated. In addition, hair cortisol as a potential biomarker for chronic stress (in children) is discussed more thoroughly. This review is meant to serve as a preliminary guide for health researchers new to this research area by reflecting on theoretical and methodological aspects in childhood stress assessment.

Does comorbid depression predict subsequent adverse life events in youth with attention-deficit/hyperactivity disorders?

OBJECTIVES

Studies have primarily focused on adverse life events (ALEs) as potential causes rather than as outcomes of pediatric depression. The current study prospectively examines ALEs in a sample of youth with attention-deficit/hyperactivity disorders (ADHD) to determine whether having a major depressive disorder (MDD) at baseline (T1) predicts counts of child-dependent or child-independent ALEs at a second assessment (T2) ≈ 8 months later.

METHODS

Subjects with ADHD 11-18 years old were drawn mostly from a tertiary mental health clinic and evaluated with semi-structured diagnostic interviews, and parent and teacher questionnaires of ADHD severity. Eighteen with and 61 without initial MDD at T1 were compared at T2 regarding counts of subsequent overall, child-dependent, and child-independent ALEs reported on life events questionnaires by the child or parent.

RESULTS

The group initially with MDD had higher overall ALEs (p=0.01) and child-dependent ALEs (p ≤ 0.001) but not child-independent ALEs (p=0.12) at T2 relative to the nondepressed group, although only 3 of 18 continued to meet full criteria for MDD. The group initially with MDD also had a higher baseline ADHD severity (p=0.04) and proportion of oppositional or conduct disorders (p=0.004). In multivariate analyses, the group initially having MDD had a higher adjusted mean at T2 of child-dependent ALEs (p=0.02), but not of overall ALEs (p=0.06), after controlling for other T1 variables, including ALEs of the same type, ADHD severity, externalizing disorders, and the interaction of externalizing disorders with MDD.

CONCLUSIONS

These findings suggest that child-dependent ALEs are potentially an important outcome after youth with ADHD have an episode of MDD. Youth with ADHD who develop comorbid MDD should be closely monitored and offered interventions to address the potential burden of child-dependent ALEs lingering after a depressive episode.

What contributes to perceived stress in later life? A recursive partitioning approach

One possible explanation for the individual differences in outcomes of stress is the diversity of inputs that produce perceptions of being stressed. The current study examines how combinations of contextual features (e.g., social isolation, neighborhood quality, health problems, age discrimination, financial concerns, and recent life events) of later life contribute to overall feelings of stress. Recursive partitioning techniques (regression trees and random forests) were used to examine unique interrelations between predictors of perceived stress in a sample of 282 community-dwelling adults. Trees provided possible examples of equifinality (i.e., subsets of people with similar levels of perceived stress but different predictors) as well as identification both of contextual combinations that separated participants with very high and very low perceived stress. Random forest analyses aggregated across many trees based on permuted versions of the data and predictors; loneliness, financial strain, neighborhood strain, ageism, and to some extent life events emerged as important predictors. Interviews with a subsample of participants provided both thick description of the complex relationships identified in the trees, as well as additional risks not appearing in the survey results. Together, the analyses highlight what may be missed when stress is used as a simple unidimensional construct and can guide differential intervention efforts.

Nature, nurture and socioeconomic policy-what can we learn from molecular genetics?

Many countries use public resources to compensate individuals with genetic disorders, identified by behaviors/symptoms such as chronic diseases and disabilities. This paper draws attention to molecular genetic research which may provide a new dimension to our understanding of how socioeconomic outcomes are generated. We provide an overview of the recently emerging evidence of gene-environment interaction effects. This literature points out specific areas where policies may compensate groups of individuals carrying genetic risks, without the need to identify anyone's genetic endowments. Moreover, epigenetics studies, which concern heritable changes in gene functions that occur independently of the DNA sequence, have shown that environments may affect heritable traits across generations. It means that policies which neutralize adverse environments may also increase intergenerational mobility, given that genetic and/or environmental risk factors are more common in socially disadvantaged groups.

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.

Sociodemographic and psychosocial factors associated with continuous subcutaneous insulin infusion in adolescents with type 1 diabetes

OBJECTIVE

To examine the role of sociodemographic factors and psychosocial adjustment in continuous subcutaneous insulin infusion (CSII) use among adolescents with type 1 diabetes.

METHODS

A total of 150 adolescents with type 1 diabetes and their caregivers completed measures of general psychological functioning, diabetes functioning, and stressful life events. Blood glucose monitoring (BGM) frequency and glycemic control were also assessed. Logistic regression was used to determine associations between CSII use and sociodemograpic and psychosocial factors.

RESULTS

All logistic regression models were significant, indicating a large proportion of the variance in CSII use was associated with sociodemographic, diabetes-specific and psychosocial variables. Final models showed higher frequency of BGM and having private insurance as significant correlates of CSII use. CSII use was also associated with adolescent and caregiver reports of sharing of responsibilities around diabetes management and negative affect regarding BGM.

CONCLUSIONS

Adolescents currently prescribed CSII therapy evidenced key differences from their counterparts using multiple daily injections (MDI) in insurance status, diabetes management behavior, and family functioning related to diabetes. Efforts to understand the role of family factors in the maintenance of CSII therapy with clinical indicators of CSII use may inform treatment effectiveness.

The moderation by the serotonin transporter gene of environmental adversity in the etiology of depression: 2009 update

An updated review of 34 human observational studies indicates that the length polymorphism of the serotonin transporter gene moderates the effect of environmental adversity in the development of depression. This finding depends on the use of contextual or objective methods to assess environmental adversity and is attenuated when self-report instruments are used. Inconsistent findings in male adolescents suggest a developmental stage and sex-specific protective mechanism. These systematic relationships between method and results should be followed up to specify causal mechanisms leading to depression.

Negative life events in children and adolescents with bipolar disorder

OBJECTIVE

To study the relationship between negative life events and demographic and clinical variables in youth with bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified (NOS), as well as to compare the rates of life events in youth with bipolar disorder, depressive and/or anxiety disorders (DEP-ANX), and healthy controls.

METHOD

Subjects included 446 youth, aged 7 to 17 years, meeting DSM-IV criteria for bipolar I, bipolar II, or an operationalized definition of bipolar disorder NOS, and were enrolled in the Course and Outcome of Bipolar Illness in Youth study. Subjects completed the Life Events Checklist. Sixty-five DEP-ANX and 65 healthy youth were obtained from previous studies using similar methodology. The study was conducted from October 2000 to July 2006.

RESULTS

Older age, lower socioeconomic status, living with nonintact family, non-Caucasian race, anxiety, and disruptive disorders were associated with greater number of total negative life events. Specifically, increased independent, dependent, and uncertain negative life events were associated with lower socioeconomic status, nonintact family, and comorbid disruptive disorders. Increased independent negative life events were additionally associated with non-Caucasian race and comorbid anxiety disorders. Increased dependent and uncertain negative life events were also associated with older age. DEP-ANX youth reported a similar rate of negative life events as bipolar youth, and both groups had more negative life events than the healthy controls. Bipolar youth reported fewer total and dependent positive life events compared to DEP-ANX and healthy youths.

CONCLUSIONS

Similar to DEP-ANX youth, bipolar youth are exposed to excessive negative independent and dependent life events, which may have implications in the long-term outcome and negative consequences associated with this disorder.

Chronic stress and obesity in adolescents: scientific evidence and methodological issues for epidemiological research

AIMS

This review describes the role of chronic stress in the development of obesity and available methodologies for the assessment of chronic stress in humans, in particular adolescents, with the aim of developing a feasible methodology to implement in an epidemiological study.

DATA SYNTHESIS

Chronic stress seems to be associated with the aetiology of obesity by interacting with both mechanisms of energy intake (increase of appetite and energy intake) and expenditure (decrease of physical activity) and by stimulating visceral fat accumulation in favour of abdominal obesity. However, more research is necessary to unravel the underlying mechanisms of the obesity-inducing effects of chronic stress, especially in adolescents. In addition to experimental research, epidemiological observational studies, in particular cohort studies, are appropriate given their non-intervening character, lower budgetary costs and natural setting. In practice, stress can be assessed by means of either a subjective approach using stressor checklists or interviews, or an objective approach measuring biomarkers of stress. In epidemiological research in adolescents, a combination of both strategies is recommended, with a preference for a general stressor checklist for adolescents and measurement of salivary cortisol, one of the most used and well-characterized biomarkers of stress.

CONCLUSION

This review provides basic evidence for the positive association between chronic stress and obesity, but also points out the need for more research in adolescents to further elucidate the role of chronic stress in the aetiology of obesity in this crucial life period. Good, well-standardized epidemiological surveys could be of great benefit in this research area.

Does the Hopelessness Theory Account for Sex Differences in Depressive Symptoms Among Young Adults?

The present study examined whether the sex difference in depression could be accounted for within the framework of the hopelessness theory of depression. Specifically, we tested whether young adults' negative inferential styles mediated the sex difference in depressive symptoms or whether sex moderated the cognitive vulnerability-stress effects on depressive symptoms in a multi-wave longitudinal study. In doing so, we examined the different forms of negative inferential styles separately (causes, consequences, self-characteristics, composite, weakest link). Results did not support the mediation hypothesis. In terms of the moderation hypothesis, we found significant sex 9 inferential style 9 stress interactions predicting depressive symptoms across the follow-up, with the vulnerability-stress effects significant for men but not women. Among women, negative inferential styles and life events were independent predictors of depressive symptoms. In these moderation analyses, each of the inferential styles exhibited similar predictive validity.

Interpersonal predictors of stress generation

Hammen (1991) provided evidence for a stress generation process in which individuals with a history of depression contributed to the occurrence of stressors, especially interpersonal and conflict events. However, few studies have examined the factors contributing to stress generation. This study examines aspects of individuals' interpersonal style, operationalized as attachment, dependency, and reassurance seeking, as predictors of conflict stress generation within romantic relationships. These effects were examined both prospectively over a 4-week period and cross-sectionally using a 14-day daily diary in a sample of female college students. Overall, there was significant evidence that interpersonal style contributes to the occurrence of interpersonal stressors. Specifically, anxious attachment and reassurance seeking prospectively predicted romantic conflict stress over a 4-week period, and a variety of interpersonal behaviors were associated with romantic conflict stressors on a daily basis. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.

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.

Modern approaches to conceptualizing and measuring human life stress

The idea that adverse life circumstances and negative life events contribute to disorder and disease has long been held. Advances in conceptualizing and defining these conditions under the common label of life stress have led to progress in measuring both the environmental and individual response characteristics that may promote disorder and disease. In general, a substantial and growing research literature supports the basic premise that life stress plays an important role in the development of many psychological and physical problems. Recent research, too, strongly suggests that interest in life stress in relation to health and disease will accelerate over the coming years. Yet debates and controversies remain concerning how to best conceptualize and measure life stress, which presents distinctive challenges for advancing the field. The present review examines the major issues pertaining to these debates, controversies, and challenges, for they will be crucial to resolve if progress is to be made in understanding ways in which life stress may or may not contribute to psychological and physical disorders.

Stress generation in adolescent depression: the moderating role of child abuse and neglect

The present study examined the role of childhood abuse and neglect and depression recurrence in moderating the generation of stressful life events in adolescent depression. Maltreatment history and stressful life events were assessed using two rigorous contextual interviews and rating systems. In a sample of 59 community depressed adolescents we found significantly higher rates of interpersonal events in the 3-month period immediately following depression episode onset versus the 3-month period immediately preceding onset in adolescents with a history of childhood maltreatment. By contrast, rates of events remained constant over a matched period in a control group of non-maltreated adolescents. Furthermore, the generation of interpersonal events only held among those on a first onset of depression. These results suggest that a history of childhood abuse and neglect exacerbates the psychosocial dysfunction associated with the onset of depression, particularly in the very first episode.

Understanding the impact of prior depression on stress generation: examining the roles of current depressive symptoms and interpersonal behaviours

Stress generation is a process in which individuals contribute to stressful life events. While research has supported an association between current depression and stress generation, it has been noted that individuals with prior depression tend to contribute to stressors even when they are no longer experiencing a depressive episode. The aim of the study is to elucidate the pathways through which prior major depression predicts interpersonal stress generation in women. Specifically, we examined current subsyndromal depressive symptoms and problematic interpersonal behaviours as potential mediators. Fifty-one college women were followed prospectively for 6 weeks. Participants were interviewed to assess current and past depression as well as stressful life events they experienced over the 6-week period. The findings suggest that prior major depression continues to have an impact even after the episode has ended, as the disorder continues to contribute to stress generation through residual depressive symptoms.

Life events and juvenile bipolar disorder: conceptual issues and early findings

There is increasing interest in the psychosocial variables that might predict the course of child and adolescent bipolar disorder. In the literature on adult bipolar disorder, life events have been shown to be a major predictor of symptoms. In this review, we focus on studies of how life events influence the course of child and adolescent bipolar disorder. To begin, we review methodological considerations in life events research, and briefly summarize the findings regarding life events in adult bipolar disorder. Then, we discuss available studies on life events as a predictor of the course of juvenile bipolar disorder. We conclude with suggested directions for future research.

Inventorying stressful life events as risk factors for psychopathology: Toward resolution of the problem of intracategory variability

An explosion of research on life events has occurred since the publication of the Holmes and Rahe checklist in 1967. Despite criticism, especially of their use in research on psychopathology, such economical inventories have remained dominant. Most of the problems of reliability and validity with traditional inventories can be traced to the intracategory variability of actual events reported in their broad checklist categories. The purposes of this review are, first, to examine how this problem has been addressed within the tradition of economical checklist approaches; second, to determine how it has been dealt with by far less widely used and far less economical labor-intensive interview and narrative-rating approaches; and, third, to assess the prospects for relatively economical, as well as reliable and valid, solutions.

Differential exposure and reactivity to interpersonal stress predict sex differences in adolescent depression

This study tested the hypothesis that higher rates of depression in adolescent girls are explained by their greater exposure and reactivity to stress in the interpersonal domain in a large sample of 15-year-olds. Findings indicate that adolescent girls experienced higher levels of total and interpersonal episodic stress, whereas boys experienced higher levels of chronic stress (academic and close friendship domains). Higher rates of depression in girls were explained by their greater exposure to total stress, particularly interpersonal episodic stress. Adolescent girls were also more reactive (more likely to become depressed) to both total and interpersonal episodic stress. The findings suggest that girls experience higher levels of episodic stress and are more reactive to these stressors, increasing their likelihood of becoming depressed compared to boys. Results were discussed in terms of girls' greater interpersonal focus and implications for understanding sex differences in depression.

Toward guidelines for evidence-based assessment of depression in children and adolescents

We aim to provide a starting point toward the development of an evidence-based assessment of depression in children and adolescents. We begin by discussing issues relevant to the diagnosis and classification of child and adolescent depression. Next, we review the prevalence, selected clinical correlates, course, and treatment of juvenile depression. Along with some general considerations in assessment, we discuss specific approaches to assessing depression in youth (i.e., interviews, rating scales) and briefly summarize evidence on the reliability and validity of a few selected instruments. In addition, we touch on the assessment of several other constructs that are important in a comprehensive evaluation of depression (i.e., social functioning, life stress, and family history of psychopathology). Last, we highlight areas in which further research is necessary and conclude with some broad recommendations for clinical practice given the current state of the knowledge.

Family and psychosocial risk factors in a longitudinal epidemiological study of adolescents

OBJECTIVE

To study the association of family and social risk factors with psychopathology in a longitudinal study of adolescents.

METHOD

From 1986 to 1988, 3,419 seventh through ninth graders were screened with the Center for Epidemiologic Studies Depression Scale. The top decile scorers and a random sample of the remainder were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (n = 581). Follow-up interviews were completed 6 years later (mean age = 18.65; n = 490). Baseline variables are associated with baseline and follow-up diagnoses. Diagnoses are grouped by affective, disruptive, and anxiety disorders.

RESULTS

The frequency of psychiatric diagnosis decreased from 19.9% (baseline) to 5.7% (follow-up). In multivariable logistic regression analyses controlling for race, gender, and socioeconomic status, baseline undesirable life events and low family cohesion are associated with any disorder and affective disorder at baseline. Not living with both biological parents at baseline increases the odds ratio (OR) for affective disorder at baseline (OR 3.45; 95% confidence interval [CI] = 1.68-7.08) and follow-up (OR 4.40; CI = 1.26-15.40). At baseline and follow-up, anxiety and affective disorders are associated with being white and anxiety disorder with being female.

CONCLUSIONS

Family structure and cohesion and stressful life events are associated with affective disorders in adolescents.