On the Use of Mixed Markov Models for Intensive Longitudinal Data.

Markov modeling presents an attractive analytical framework for researchers who are interested in state-switching processes occurring within a person, dyad, family, group, or other system over time. Markov modeling is flexible and can be used with various types of data to study observed or latent state-switching processes, and can include subject-specific random effects to account for heterogeneity. We focus on the application of mixed Markov models to intensive longitudinal data sets in psychology, which are becoming ever more common and provide a rich description of each subject's process. We examine how specifications of a Markov model change when continuous random effect distributions are included, and how mixed Markov models can be used in the intensive longitudinal research context. Advantages of Bayesian estimation are discussed and the approach is illustrated by two empirical applications.

Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials.

BACKGROUND: Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD: Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS: A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS: Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

Family processes in adolescent depression.

A developing body of research points to the role of family relationships and interactions as factors relevant to understanding unipolar depressive symptomatology and disorder in adolescents. This paper is focused on examining mechanisms by which adverse family processes may operate to increase adolescents' vulnerability to depression. The review is organized into a description and evaluation of four potential mechanisms by which families may influence adolescents' risk: (a) Stress/Support, (b) Social Interactional, (c) Cognitive, and (d) Affect Regulation. The presentation of the individual mechanisms is followed by a brief discussion of how they could be integrated to develop a fuller understanding of familial processes relevant to the etiology and maintenance of depressive conditions. Finally, we conclude with a discussion of overall limitations in the literature and recommendations for future research.

Adolescent responses to depressive parental behaviors in problem-solving interactions: implications for depressive symptoms.

The purpose of this study was to explore the relations between child responses to interparental depressive behavior and subsequent child depressive symptomatology. Data were collected on 156 two-parent families. Families completed questionnaire data and participated in problem-solving interactions, which were coded using a microsocial observational system. Three potential child responses to interparental depressive behavior were examined: facilitative, aggressive, and depressive. Results indicated that for female adolescents the displays of facilitative and depressive behavior as well as the suppression of aggressive behavior in response to interparental depressive behavior were related to increases in depressive symptomatology. For males, on the other hand, the display of aggressive and depressive behavior in response to interparental depressive behavior was related to increases in depression. Results provide preliminary support both for the examination of child responses to conflictual marital behavior and for expanding the conceptualization of conflictual marital behaviors to include depressive as well as the more traditionally examined aggressive behaviors, in order to better understand the link between conflictual marital behavior and child depressive symptomatology.

Regulation of negative affect during mother-child problem-solving interactions: adolescent depressive status and family processes.

Despite recent suggestions that depression can be conceptualized as a disorder of affect regulation, relatively little research has focused on affect regulation skills in depressed individuals. This paper investigated whether depressed adolescents (N = 25) differ from nondepressed adolescents (N = 25) on two indices of affect regulation (i.e., duration of negative affective states and reciprocity of maternal negative affect) as well as whether these indices are related to microsocial family interactional processes. Analyses revealed that depressed teens differed from their nondepressed peers with regard to duration of negative affective states but not in their likelihood of reciprocating negative affect. Additionally, indices of adolescent affect regulation were related to family interactional processes. Duration of depressive affect was positively associated with maternal display of facilitative behavior contingent on adolescent depressive behavior. Duration of aggressive behavior was inversely related to maternal problem-solving responses to aggressive behavior. Finally, adolescent reciprocity of maternal depressive and aggressive behaviors was strongly associated with mothers' reciprocity of adolescents' negative affective behavior.

Family relationships of depressed adolescents: a multimethod assessment.

Conducted a multimethod assessment consisting of behavioral observations as well as mother- and adolescent-report measures to compare the family environments of depressed adolescents to those of healthy, nondistressed adolescents. Each group consisted of 17 girls and 9 boys. Depressed adolescents and their mothers described their families as being less supportive and more conflictual than did their counterparts in comparison families. Depressed adolescents also demonstrated less problem-solving behavior, and both they and their mothers demonstrated less facilitative and more depressive behavior during observed problem-solving interactions. In contrast, neither depressed adolescents nor their mothers demonstrated higher rates of aggressive behavior relative to their counterparts in the families of healthy adolescents. The multimethod assessment allowed us to draw firm conclusions regarding the role of supportive family interactions. Hypotheses regarding the inconsistency between self-report and observational data with regard to family conflict are addressed.

Family rigidity, adolescent problem-solving deficits, and suicidal ideation: a mediational model.

Family rigidity and adolescent problem-solving deficits have each been linked to adolescent suicidal behaviors. The objective of the present study was to evaluate the hypothesis that family rigidity has primarily an indirect effect on adolescent suicidal ideation through its effect on adolescent problem-solving deficits. College students and their parents completed the Family Adaptability and Cohesion Evaluation Scale II. Students also completed the Problem-Solving Inventory and the Adult Suicidal ideation Questionnaire. Structural equation models confirmed that family rigidity has an indirect effect on adolescent suicidal ideation through its effect on adolescent problem-solving deficits. Directions for treatment efforts are discussed.

Interactional processes in families with depressed and non-depressed adolescents: reinforcement of depressive behavior.

Problem-solving interactions were observed in 86 families of depressed adolescents and 408 families of non-depressed adolescents. Sequential analyses indicated that mothers of depressed adolescents were more likely than mothers of non-depressed adolescents to increase facilitative behavior in response to adolescent depressive behavior. Additionally, fathers of depressed adolescents were more likely than their counterparts in families of non-depressed adolescents to decrease aggressive behavior subsequent to adolescent depressive behavior. These analyses suggest that parents of depressed adolescents may be inadvertently reinforcing depressive behavior. Decreases in adolescent depressive symptomatology from year 1 to year 2 were not accompanied by changes in family interaction patterns.

Family support and conflict: prospective relations to adolescent depression.

The relations between family support, family conflict, and adolescent depressive symptomatology were examined longitudinally in a sample of 231 female and 189 male adolescents and their mothers. Structural equation models revealed that less supportive and more conflictual family environments were associated with greater depressive symptomatology both concurrently and prospectively over a 1-year period. Conversely, adolescent depressive symptomatology did not predict deterioration in family relationships. Depressive symptomatology and, to a greater extent, family characteristics showed high levels of stability over the 1-year period. Counter to our expectations, the relations between family variable and depressive symptomatology were similar for boys and girls. The results suggest that the quality of family interactions is relevant for understanding the development of depressive symptoms in adolescents.

Data analytic techniques for treatment outcome studies with pretest/posttest measurements: an extensive primer.

This paper discusses several data analytic technique, for examining treatment efficacy in pretest-posttest control group designs. The following approaches are described: ANOVA on post scores, ANOVA on difference scores, split-plot repeated measures ANOVA, profile analysis, and ANOCOVA with prescore as the co-variate. Guidelines for choosing between available techniques are provided; the primary focus here is on the nature of the null hypothesis, the assumptions underlying the approach, and the power of the procedure. The importance of examining the characteristics of the data set in selecting an analytic technique is illustrated.

Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.

OBJECTIVES: This investigation attempted to prevent unipolar depressive episodes in a sample of high school adolescents with an elevated risk of depressive disorder. METHOD: Adolescents at risk for future depressive disorder by virtue of having elevated depressive symptomatology were selected with a two-stage case-finding procedure. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to 1,652 students; adolescents with elevated CES-D scores were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Subjects with current affective diagnoses were referred to nonexperimental services. The remaining 150 consenting subjects were considered at risk for future depression and randomized to either a 15-session cognitive group prevention intervention or an "usual care" control condition. Subjects were reassessed for DSM-III-R diagnostic status after the intervention and at 6- and 12-month follow-up points. RESULTS: Survival analyses indicated a significant 12-month advantage for the prevention program, with affective disorder total incidence rates of 14.5% for the active intervention, versus 25.7% for the control condition. No differences were detected for nonaffective disorders across the study period. CONCLUSION: Depressive disorder can be successfully prevented among adolescents with an elevated future risk.

Applicability of the Impact on Family Scale for assessing families with behaviorally difficult children.

The present paper reports a series of studies on the potential usefulness of the Stein and Riessman Impact on Family Scale for assessing the effects of behaviorally difficult children on their families. Subjects were parents of 54 clinic and 76 nonclinic children who completed a child behavior or child temperament questionnaire in addition to the Impact on Family Scale. Findings suggest that, while the scale was developed for assessing the influence of a physically ill child on the family, this general assessment approach may also have value in assessing family-related changes associated with having a child who is difficult to look after.

Child temperament, maternal adjustment, and changes in family life style.

Child temperament has been implicated as a relevant factor in understanding parental adjustment. In a study of 77 mothers of 3- and 4-year-old children, difficult child temperament was found to be directly related to maternal distress, discomfort in the role of parent, poor spousal relationships, and negative changes in way of life. Quality and intensity of the child's mood were most predictive of these difficulties.