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.

Parent relationship quality buffers against the effect of peer stressors on depressive symptoms from middle childhood to adolescence.

During the transition to adolescence, several developmental trends converge to increase the importance of peer relationships, the likelihood of peer-related stressors, and the experience of depressive symptoms. Simultaneously, there are significant changes in parent-child relationships. The current study sought to evaluate whether positive relationship quality with parents continued to serve a protective effect by buffering the relationship between stressful life events, especially peer stress, and increases in depressive symptoms throughout the transition to adolescence. Participants in a large (N = 692) 2-site accelerated longitudinal study were recruited in 3rd, 6th, and 9th grade and followed every 3 months for 1 year. At baseline, parents and youth reported on parent-child relationship quality, and every 3 months thereafter reported on their levels of stressors and depressive symptoms. Parent relationship quality moderated the relationship of person-level fluctuations in peer stressors, such that there was a stronger association between peer stressors and increases in depressive symptoms in youth with lower levels of positive parental relationship quality. This effect was specific to peer stressors. These results suggest that low levels of parent relationship quality leave youth particularly vulnerable to the depressogenic effects of peer stressors from childhood through adolescence.

Effect of holding on co-regulation in preterm infants: a randomized controlled trial.

OBJECTIVE: To determine whether kangaroo holding of healthy preterm infants over the first eight weeks of an infant's life facilitates co-regulation of salivary cortisol between mother and infant. STUDY DESIGN: Randomized control trial. Infants were assigned to receive 1h of daily kangaroo (skin-to-skin contact on the chest of mother) or blanket holding (dressed and held in mother's arms). A registered nurse visited mothers weekly for eight weeks to encourage holding and provide information about infant development. A control group had no holding restrictions and received weekly brief social visits. SUBJECTS: The study included 79 preterm infants, born between 32 and 35weeks gestational age and were a mean of 15days (±5.7) at enrollment. OUTCOME MEASURES: Co-regulation was conceptualized as progressive reduction in the absolute difference between mother and infant cortisol levels across 60min of holding at each holding session. Mother and infant cortisol levels were measured before holding and at 30 and 60min after holding began during three holding sessions (baseline and at two and eight weeks after study initiation). Primary analyses were conducted using hierarchical linear models. RESULTS: There was much variability in cortisol levels. Levels of mother and infant cortisol decreased during holding. No significant co-regulation occurred in any group at any holding session or over time. CONCLUSIONS: Decreasing level of cortisol in both mothers and infants suggests that holding promoted the expected decline in stress hormone levels. However, supported holding methods did not differentially affect co-regulation compared to controls. Holding is pleasurable and stress may need to be present in order for mothers and infants to demonstrate co-regulation in cortisol levels.

A Trait-State-Error Model of Adult Hassles Over Two Years: Magnitude, Sources, and Predictors of Stress Continuity.

There are stable individual differences in exposure to stressful circumstances over time. The current study employed a latent trait-state model to estimate the magnitude of that stability and its sources. Adults (N = 327; age M = 43.9 years, SD = 6.15) provided reports of hassles and depressive symptoms every three months for two years. A Trait-State-Error model suggested that 60% of the variance in self-reports of hassles was attributable to stable, between-persons factors. Of the remaining variance, 20% was attributable to an autoregressive factor and 20% was attributable to either unique state factors or error. Moreover, average depressive symptoms, family income, and family conflict reported at baseline were significant predictors of the stable trait factor. These findings suggest that adults' self-reports of stressful experiences show marked stability over time, and that this stability may have significant implications for understanding the occurrence and impact of stress.

Cortisol secretion in depressed, and at-risk adults.

Distinct patterns of cortisol secretion have been associated with depression in past research, but it remains unclear whether individuals at-risk for depression may also have similar patterns of cortisol secretion. This is the first study to date of both naturalistic diurnal cortisol secretion and cortisol reactivity to a psychosocial laboratory stressor in depressed and at-risk adults. Cortisol secretion patterns were compared for 57 currently depressed, at-risk (based on trait-level positive and negative affect), and control participants over 5 days and in response to a laboratory stressor. After controlling for potentially confounding biobehavioral variables, the depressed group had a larger cortisol awakening response (CAR) and higher average diurnal cortisol compared to control participants. Individuals at-risk for depression also had significantly higher waking cortisol levels than control participants. Results for the psychosocial laboratory stressor did not show the predicted elevations in cortisol for depressed and at-risk participants compared to controls. The at-risk group recovered more quickly when compared to the depressed group both in levels of cortisol and concurrent measures of negative affect. The at-risk and depressed participants were similar on the diurnal cortisol measures, but differed on response to the laboratory social stressor, suggesting divergence in cortisol secretion patterns between currently depressed and temperamentally at-risk individuals. Further investigation of HPA functioning of individuals at-risk for depression may clarify the stress processes involved in risk for depression onset.

Negative attachment cognitions and emotional distress in mainland Chinese adolescents: a prospective multiwave test of vulnerability-stress and stress generation models.

The present study examined the relation between attachment cognitions, stressors, and emotional distress in a sample of Chinese adolescents. Specifically, it was examined whether negative attachment cognitions predicted depression and anxiety symptoms, and if a vulnerability-stress or stress generation model best explained the relation between negative attachment cognitions and internalizing symptoms. Participants included 558 adolescents (310 females and 248 males) from an urban school in Changsha and 592 adolescents (287 female, 305 male) from a rural school in Liuyang, both in Hunan province located in mainland China. Participants completed self-report measures of negative attachment cognitions at baseline, and self-report measures of negative events, depression symptoms, and anxiety symptoms at baseline and at regular 1-month intervals for an overall 6-month follow-up (i.e., six follow-up assessments). Higher levels of negative attachment cognitions predicted prospective depression and anxiety symptoms. Furthermore, support was found for a stress generation model that partially mediated this longitudinal association. No support was found for a vulnerability-stress model. Overall, these findings highlight new developmental pathways for development of depression and anxiety symptoms in mainland Chinese adolescents.

Chronic and acute stress, gender, and serotonin transporter gene-environment interactions predicting depression symptoms in youth.

BACKGROUND: Many recent studies of serotonin transporter gene by environment effects predicting depression have used stress assessments with undefined or poor psychometric methods, possibly contributing to wide variation in findings. The present study attempted to distinguish between effects of acute and chronic stress to predict depressive symptoms at age 20 among 346 youth varying in polymorphisms of the 5HTT gene who had been assessed at ages 15 and 20. METHODS: Interview measures assessed major acute life events between 15 and 19, and multiple interviews and questionnaires with youths and their parents at youth age 15 provided an index of chronic family stress. Lg alleles were reclassified as S. RESULTS: Chronic family stress at age 15 predicted higher depression scores at 20 among those with one or two S alleles, and the effects of genetic moderation were significant only for females. Gene-environment interactions with acute stress were nonsignificant. CONCLUSIONS: Careful measurement and separation of the effects of chronic and acute stress, and gender, are encouraged in the study of mechanisms of the stress-depression association.

Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization.

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n = 44) or standard care plus MFGT (n = 53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.

Predictors of body dissatisfaction in boys and girls with asthma.

BACKGROUND: Body satisfaction is an important issue for youth. Youth with more severe asthma may have experiences and emotions associated with less body satisfaction; however, this has not been studied. OBJECTIVE: To identify correlates of body dissatisfaction in youth with asthma. METHODS: Sixty-three females and 60 males, ages 8-18 years with asthma, completed measures of body dissatisfaction, anxiety, depression, asthma symptoms, and behaviors. Parents completed measures of asthma limitations; clinicians rated asthma severity. RESULTS: Anxiety, depression, and body mass index (BMI) accounted for 21 and 15% of the variance in body dissatisfaction for females and males, respectively. Physical activity added 13% variance to the above model for females. Asthma symptoms added 14% for males. Of note, neither parent ratings of asthma limitations nor clinician ratings of asthma severity contributed additional variance. CONCLUSION: This study increases our understanding of youth with asthma and provides future research directions.

Impact of multiple-family groups for outpatients with schizophrenia on caregivers' distress and resources.

OBJECTIVE: The objective of this study was to evaluate the effects of multiple-family group treatment on distress and psychosocial resources among family caregivers of persons with schizophrenia. METHODS: A total of 97 consumers with schizophrenia or another psychotic disorder and their caregivers were randomly assigned to receive multiple-family group treatment (N=53) or standard psychiatric outpatient care (N=44). Reliable and valid measures were used to assess caregivers' distress, caregivers' resources, and consumers' clinical status. RESULTS: After consumers' clinical status and baseline rates of caregivers' distress and caregivers' resources were controlled for, the caregivers of consumers who received multiple-family group treatment experienced greater reductions in distress but no increases in resources compared with caregivers of consumers who received standard psychiatric care. CONCLUSIONS: Multiple-family group treatment reduced caregivers' distress but did not increase caregivers' resources relative to standard psychiatric care.