Transdiagnostic and disorder-specific models of intergenerational transmission of internalizing pathology.

BACKGROUND: Numerous studies have supported an association between maternal depression and child psychiatric outcomes, but few have controlled for the confounding effects of both maternal and offspring co-morbidity. Thus, it remains unclear whether the correspondence between maternal and offspring depressive and anxiety disorders is better explained by associations between shared features of maternal and offspring internalizing disorders or by specific effects exerted by unique aspects of individual disorders. METHOD: Pairs of mothers and offspring overselected for maternal depression (n = 815) were assessed at offspring age 15 years for anxiety and depressive disorders; 705 completed a follow-up at offspring age 20 years. For both mothers and offspring, structural equation modeling was used to distinguish transdiagnostic internalizing pathology--representing the overlap among all depressive and anxiety disorders--from diagnosis-specific forms of pathology. To discriminate between general versus specific pathways of intergenerational transmission of psychopathology, we examined (a) the general association between the maternal and offspring internalizing factors and (b) the correlations between maternal and offspring diagnosis-specific pathology for each disorder. RESULTS: For mothers and offspring, a unidimensional latent variable model provided the best fit to the correlations among depressive and anxiety disorders. The maternal transdiagnostic internalizing factor strongly predicted the corresponding factor among offspring. In addition, the unique component of post-traumatic stress disorder among offspring was significantly related to the analogous unique component among mothers, but specific components of other maternal disorders, including depression, did not predict corresponding offspring pathology. CONCLUSIONS: Results suggest that intergenerational transmission of internalizing disorders is largely non-specific.

Bipolar depression and antidepressant-induced mania: a naturalistic study.

BACKGROUND: The likelihood and character of antidepressant-induced mania remain important but poorly understood factors in the treatment of bipolar depression. METHOD: We examined the response to naturalistic treatment of 29 bipolar I patients who experienced a total of 79 depressive episodes. Treatment consisted primarily of mood stabilizers used alone (N = 31) or in combination with antidepressants (N = 48). Intensity of baseline mood stabilizer therapy, adequacy of added antidepressant therapy, intensity of ensuing mania or hypomania, and course of illness prior to study were measured, and selected comparisons were made between treatment groups. RESULTS: Postdepressive mood elevations (i.e., switches) that occurred during or up to 2 months after each depressive episode were present in 28% (22/79) and judged to be severely disruptive in only 10% (8/79) of episodes. Examining only the first episode per patient, a history of a greater number of past manic episodes was associated with a higher risk of switching (p < .023). Antidepressant treatment combined with mood stabilizer therapy was not associated with higher rates of postdepressive mood elevation than mood stabilizer therapy alone. At a descriptive level, subjects treated with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were associated with a higher switch rate than those treated with fluoxetine; TCAs were also associated with more intense switches. CONCLUSION: The frequency and severity of postdepressive mood elevation associated with acute or continuation antidepressant therapy may be reduced by mood stabilizers. Such elevations may be more likely in patients with a strong history of mania.

Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms.

Empirical tests of the diathesis-stress component of A. T. Beck's (1976; A. T. Beck, A. J. Rush, B. F. Shaw, & G. Emery, 1979) cognitive theory of depression have generally not yielded positive results. The resulting focus on conceptual and methodological concerns has diverted attention from the more fundamental issue of how validly vulnerability is measured. The present investigation uses the Dysfunctional Attitude Scale (DAS; A. N. Weissman, 1979; A. N. Weissman & Beck, 1978), the most commonly used measure of vulnerability in this area, but adopts a more in-depth approach by examining DAS factors in addition to the typical total score. This study involved a sample of undergraduates who had never before taken a college-level examination. The dimension of the DAS measured by the Perfectionistic Achievement factor had the strongest relationship to increased depressive symptoms in response to poorer-than-expected performance on the examination. Implications for future research in this area are discussed.

Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress.

The authors tested a cognitive-interpersonal hypothesis of depression by examining the role of interpersonal cognitions in the prediction of depression associated with interpersonal stressors. A measure of adult attachment assessed interpersonal cognitions about ability to be close to others and to depend on others and anxiety about rejection and abandonment. Participants were women who had recently graduated from high school; they were followed for 1 year with extensive interview evaluation of life events, depression, and other symptomatology. Generally, cognitions, interpersonal events, and their interactions contributed to the prediction of interview-assessed depressive symptoms, but the effects were not specific to depression and predicted general symptomatology measured by diagnostic interviews as well, and results also varied by attachment subscale. Results were discussed in terms of a developmental psychopathology approach to disorders in young women.

Psychosocial outcomes of children of unipolar depressed, bipolar, medically ill, and normal women: a longitudinal study.

The psychosocial functioning of children of unipolar depressed, bipolar, medically ill, and psychiatrically normal women was studied over a 2-year period. Ninety-six children aged 8-16 years were assessed at 6-month intervals on Child Behavior Checklist behavior problems, social competence, internalizing and externalizing behaviors, academic performance, and school behavior. The children of unipolar mothers showed significantly poorer functioning on all measures as compared with the other 3 groups of children, including bipolar offspring. A greater proportion of children in the unipolar group also had relatively chronic, clinically significant problems in psychosocial functioning. Children of bipolar women did not differ from children of psychiatrically normal women. Results are discussed in terms of the consequences of children's continuing exposure to maternal depression and attendant stressors, as well as the contribution of social and academic difficulties to a vicious cycle of maladjustment.

Perceptions of stressful life events and depression: a test of attributional models.

A brief review of tests of the attributional model of depression suggests that there is only weak or inconsistent support for the predicted causal ascriptions by depressed persons for negative events. Moreover, in very few studies have researchers actually tested the causal predictions of the model. Finally, because many of the studies were conducted with normal college students, the generality of the model as applied to different populations needs to be investigated. We addressed three questions: (a) the validity of the hypothesized independent and direction relation between each of the dimensions of internality, stability, controllability, intentionality, and globality and depression; (b) the causal relation between attributions and depression in a 2-month prospective study; and (c) evaluation of the model on two disparate samples: normal college students and elderly depressed outpatients ascribing causes for their personally stressful events. Causal modeling statistical procedures were applied to both the question of concurrent relations and causal relations between cognitions and depression. The results suggest minimal support for the attributional model: The dimensions were not each independently and directly associated with depression in the manner predicted by Abramson, Seligman, and Teasdale (1978), and the model that best fit the data was generally congruent for both the normal and clinical samples. In terms of direction of causality, the data were more consistent in indicating that depression causes cognitions than in indicating the reverse.