The relationship between stress and depression in first onsets versus recurrences: a meta-analytic review

S. M. Monroe and K. L. Harkness reviewed the empirical evidence supporting R. M. Post's kindling model, which suggests the 1st episode of depression is more likely to be preceded by major stressors than are subsequent episodes. Their review highlighted the diverse interpretations of Post's premise in the current literature and the changes in research methods that have contributed to this interpretive shift. The authors conducted a meta-analysis (N=13 studies) to test Post's premise that integrated early and recent research and examined potential moderators. A proportion difference effect size was used. Results indicated that 1st onsets of depression were more likely than recurrences to be preceded by severe life events, supporting Post's premise. The moderator analyses suggested that support may be most evident in patient samples and may vary according to age and gender, with less support for Post's premise evidenced in younger samples and in women. Although these results are preliminary, as the analysis included a small number of studies, they suggest that future research should further examine factors that influence the stress-depression relationship with successive recurrences.     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.     

Abrupt visual onsets and selective attention: evidence from visual search

The effect of temporal discontinuity on visual search was assessed by presenting a display in which one item had an abrupt onset, while other items were introduced by gradually removing line segments that camouflaged them. We hypothesized that an abrupt onset in a visual display would capture visual attention, giving this item a processing advantage over items lacking an abrupt leading edge. This prediction was confirmed in Experiment 1. We designed a second experiment to ensure that this finding was due to attentional factors rather than to sensory or perceptual ones. Experiment 3 replicated Experiment 1 and demonstrated that the procedure used to avoid abrupt onset--camouflage removal--did not require a gradual waveform. Implications of these findings for theories of attention are discussed.     

Abrupt visual onsets and selective attention: voluntary versus automatic allocation

The hypothesis that abrupt visual onsets capture attention automatically, as suggested by Yantis and Jonides (1984) was tested in four experiments. A centrally located cue directed attention to one of several stimulus positions in preparation for the identification of a target letter embedded in an array of distractor letters. In all experiments, one stimulus (either the target or one of the distractors) had an abrupt onset; the remaining letters did not. The effectiveness of the cue was manipulated (varying either its duration or its predictive validity) to test whether abrupt onsets capture attention even when subjects are in a highly focused attentional state. Results showed that onsets do not necessarily capture attention in violation of an observer's intentions. A mechanism for partially automatic attentional capture by abrupt onset is proposed, and the diagnosticity of the intentionality criterion for automaticity is discussed.     

Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events

The association between religiousness and depressive symptoms was examined with meta-analytic methods across 147 independent investigations (N = 98,975). Across all studies, the correlation between religiousness and depressive symptoms was -.096, indicating that greater religiousness is mildly associated with fewer symptoms. The results were not moderated by gender, age, or ethnicity, but the religiousness-depression association was stronger in studies involving people who were undergoing stress due to recent life events. The results were also moderated by the type of measure of religiousness used in the study, with extrinsic religious orientation and negative religious coping (e.g., avoiding difficulties through religious activities, blaming God for difficulties) associated with higher levels of depressive symptoms, the opposite direction of the overall findings.     

Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation

Background and Objectives: Stressful life events are known to contribute to development of depression; however, it is possible this link is bidirectional. The present study examined whether such stress generation effects are greater than the effects of stressful life events on depression, and whether stress generation is also evident with anxiety. Design: Participants were two large age cohorts (N = 732 aged 44 years; N = 705 aged 63 years) from the West of Scotland Twenty-07 study. Methods: Stressful life events, depression, and anxiety symptoms were measured twice five years apart. Cross-lagged panel analysis examined the mutual influences of stressful life events on depression and on anxiety over time. Results: Life events predicted later depressive symptomatology (p = .01), but the depression predicting life events relationship was less strong (p = .06), whereas earlier anxiety predicted life events five years later (p = .001). There was evidence of sex differences in the extent to which life events predicted later anxiety. Conclusions: This study provides evidence of stress causation for depression and weaker evidence for stress generation. In contrast, there was strong evidence of stress generation for anxiety but weaker evidence for stress causation, and that differed for men and women.     

The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression

This study examined the role of childhood abuse and neglect in sensitizing adolescents to the effects of proximal stressful life events in a cross-sectional sample of 103 depressed and nondepressed adolescents. Consistent with hypotheses, adolescents with a history of childhood abuse and/or neglect reported a lower level of threat of stressful life events prior to episode onset than that reported by those without. This effect was specific to those on their 1st episode of depression and was specific to independent events (i.e., stressors outside of adolescents' control). Further, this effect was robust when controlling for level of chronic difficulties, which was higher in those with childhood abuse and/or neglect. The authors suggest that childhood abuse and/or neglect may be an important risk factor that sensitizes individuals to the effects of acute independent life events.     

Age constraints on first versus second language acquisition: evidence for linguistic plasticity and epigenesis

Does age constrain the outcome of all language acquisition equally regardless of whether the language is a first or second one? To test this hypothesis, the English grammatical abilities of deaf and hearing adults who either did or did not have linguistic experience (spoken or signed) during early childhood were investigated with two tasks, timed grammatical judgement and untimed sentence to picture matching. Findings showed that adults who acquired a language in early life performed at near-native levels on a second language regardless of whether they were hearing or deaf or whether the early language was spoken or signed. By contrast, deaf adults who experienced little or no accessible language in early life performed poorly. These results indicate that the onset of language acquisition in early human development dramatically alters the capacity to learn language throughout life, independent of the sensory-motor form of the early experience.     

Attention capture by contour onsets and offsets: No special role for onsets

In five experiments, we investigated the power of targets defined by the onset or offset of one of an object’s parts (contour onsets and offsets) either to guide or to capture visual attention. In Experiment 1, search for a single contour onset target was compared with search for a single contour offset target against a static background of distractors; no difference was found between the efficiency with which each could be detected. In Experiment 2, onsets and offsets were compared for automatic attention capture, when both occurred simultaneously. Unlike in previous studies, the effects of overall luminance change, new-object creation, and number of onset and offset items were controlled. It was found that contour onset and offset items captured attention equally well. However, display size effects on both target types were also apparent. Such effects may have been due to competition for selection between multiple onset and offset stimuli. In Experiments 3 and 4, single onset and offset stimuli were presented simultaneously and pitted directly against one another among a background of static distractors. In Experiment 3, we examined “guided search,” for a target that was formed either from an onset or from an offset among static items. In Experiment 4, the onsets and offsets were uncorrelated with the target location. Similar results occurred in both experiments: target onsets and offsets were detected more efficiently than static stimuli which needed serial search; there remained effects of display size on performance; but there was still no advantage for onsets. In Experiment 5, we examined automatic attention capture by single onset and offset stimuli presented individually among static distractors. Again, there was no advantage for onset over offset targets and a display size effect was also present. These results suggest that, both in isolation and in competition, onsets that do not form new objects neither guide nor gain automatic attention more efficiently than offsets. In addition, in contrast to previous studies in which onsets formed new objects, contour onsets and offsets did not reliably capture attention automatically.     

Posthypnotic amnesia for a first romantic relationship: Forgetting the entire relationship versus forgetting selected events

This experiment investigated the impact of suggestion focus on posthypnotic amnesia (PHA) for memories of a first romantic relationship. During hypnosis, high and low hypnotisable participants recalled specific memories from this period in response to 10 cue phrases (Elicitation). They then received a PHA suggestion that targeted either the entire period or specific memories from that period. Participants' explicit memory was indexed by cued recall after PHA was administered (memories recalled to "old" and "new" cues; Recall 1) and after it was cancelled (Recall 2). A social judgement task indexed dissociations between implicit and explicit memory. PHA had the greatest impact on highs', but not lows', memory performance (in terms of memories recalled to old cues, recall latency, and qualitative memory ratings) when the suggestion targeted the entire period rather than specific events. We discuss these findings in terms of the parameters of PHA's influence on memory, its value for exploring the nature and structure of autobiographical memory, and its utility as a laboratory analogue of functional amnesia.     

Posthypnotic amnesia for a first romantic relationship: Forgetting the entire relationship versus forgetting selected events

This experiment investigated the impact of suggestion focus on posthypnotic amnesia (PHA) for memories of a first romantic relationship. During hypnosis, high and low hypnotisable participants recalled specific memories from this period in response to 10 cue phrases (Elicitation). They then received a PHA suggestion that targeted either the entire period or specific memories from that period. Participants' explicit memory was indexed by cued recall after PHA was administered (memories recalled to “old” and “new” cues; Recall 1) and after it was cancelled (Recall 2). A social judgement task indexed dissociations between implicit and explicit memory. PHA had the greatest impact on highs', but not lows', memory performance (in terms of memories recalled to old cues, recall latency, and qualitative memory ratings) when the suggestion targeted the entire period rather than specific events. We discuss these findings in terms of the parameters of PHA's influence on memory, its value for exploring the nature and structure of autobiographical memory, and its utility as a laboratory analogue of functional amnesia.     

Life events and depression in adolescence: relationship loss as a prospective risk factor for first onset of major depressive disorder

Although stressful life events have consistently been linked to the onset of major depressive disorder (MDD), most research has not distinguished 1st episodes from recurrences. In a large epidemiologic sample of older adolescents (N = 1,470) assessed at 2 time points, the risk conferred by a recent romantic break-up was examined as a predictor of 1st onset versus recurrence of MDD. Results indicated a heightened likelihood of 1st onset of MDD during adolescence if a recent break-up had been reported; in contrast, a recent break-up did not predict recurrence of depression. These results held for both genders and remained significant after controlling for gender. Additional analyses to determine the discriminant validity and specificity of these findings strongly supported the recent break-up as a significant risk factor for a 1st episode of MDD during adolescence. Implications of these findings and subsequent research directions are discussed.     

Desirable versus undesirable life events: their relationship to stress and mental distress.

The research of Holmes, Rahe, and their associates disclosing that life events and stress are related to the onset of physical illness is extended to the psychological domain in the present study. Using a modified version of their life events checklist, it is shown that an accumulation of life events is correlated with self-reported tension and distress, with emotional disturbances manifested by depression, paranoid thinking, suicidal proclivity, and anxiety, as well as with behavioral indications of stress such as drinking and traffic accidents. Most importantly, it is shown that these relationships do not hold for desirable life events but primarily for undesirable events. Thus, the authors suggest that the quality of the events in terms of their desirability is the crucial determinant of stress and the above-mentioned relationships rather than simply the life change produced by the events, as suggested in earlier studies. Methodological and theoretical implications for future research are discussed, emphasizing the importance of studying additional stress-relevant dimensions such as anticipation of the events and control over their outcome.     

Oculomotor consequences of abrupt object onsets and offsets: onsets dominate oculomotor capture

Previous research has shown that the appearance of an object (onset) and the disappearance of an object (offset) have the ability to influence the allocation of covert attention. To determine whether both onsets and offsets have the ability to influence eye movements, a series of experiments was conducted in which participants had to make goal-directed eye movements to a color singleton target in the presence of an irrelevant onset/offset. In accord with previous research, onsets had the ability to capture the eyes. The offset of an object demonstrated little or no ability to interrupt goal-directed eye movements to the target. Two experiments in which the effects of onsets and offsets on covert attention were examined suggest that offsets do not capture the eyes, because they have a lesser ability to capture covert attention than do onsets. A number of other studies that have shown strong effects of offsets on attention have used offsets that were uncorrelated with target position (i.e., nonpredictive), whereas we used onsets and offsets that never served as targets (i.e., antipredictive). The present results are consistent with a new-object theory of attentional capture in which onsets receive attentional priority over other types of changes in the visual environment.     

Faster target selection in preview visual search depends on luminance onsets: behavioral and electrophysiological evidence

To investigate how target detection in visual search is modulated when a subset of distractors is presented in advance (preview search), we measured search performance and the N2pc component as an electrophysiological marker of attentional target selection. Targets defined by a color/shape conjunction were detected faster and the N2pc emerged earlier in preview search relative to a condition in which all items were presented simultaneously. Behavioral and electrophysiological preview benefits disappeared when stimuli were equiluminant with their background, in spite of the fact that targets were feature singletons among the new items in preview search. The results demonstrate that previewing distractors expedites the spatial selection of targets at early sensory-perceptual stages, and that these preview benefits depend on rapid attentional capture by luminance onsets.     

Abrupt onsets capture attention independent of top-down control settings II: Additivity is no evidence for filtering

Is attentional capture contingent on top-down control settings or involuntarily driven by salient stimuli? Supporting the stimulus-driven attentional capture view, Schreij, Owens, and Theeuwes (2008) found that an onset distractor caused a response delay, in spite of participants’ having adopted an attentional set for a color feature. However, Folk, Remington, and Wu (2009) claimed that this delay reflects separate, nonspatial filtering costs instead, because the onset effects were additive with color-based capture effects, and capture should have caused underadditivity. The present Experiment 1 shows that contingent capture caused by additional color cues is also additive, just like the onset effect. This makes additivity a dubious diagnostic with regard to spatial capture. Experiment 2 demonstrates that it is possible to obtain underadditivity when attention-demanding distractors have sufficient capturing power. Experiment 3 shows that the abrupt onset interference turns into a benefit when the locations of the onset and the target coincide. Together, these results argue in favor of stimulus-driven attentional capture by abrupt onsets.     

Perceived stress,life events,dysfunctional attitudes,and depression in adolescent psychiatric inpatients

Hewitt, Flett, and Mosher (1992) examined the factor structure of the Perceived Stress Scale (PSS) and its relation to depression in adult psychiatric patients. This study sought to replicate and extend their findings, using a sample of 203 adolescent psychiatric inpatients. All patients admitted to the adolescent unit in a psychiatric hospital over a 3-year period were administered the PSS, as well as measures of depression, life events, dysfunctional attitudes, and intellectual abilities. Consistent with Hewittet al., two factors were found in the PSS, reflecting perceived distress and perceived coping ability. Regression analyses indicated that, for males, both factors account for independent variance in depression, whereas for females, only the distress factor is related to depression. In addition, for both male and female, dysfunctional attitudes account for significant variance in depression in addition to PSS, but negative life events do not. None of the variables were related to intellectual abilities. Implications for clinical assessment and intervention are discussed.     

Life events and depression: The plot thickens

Although we certainly agree with Beck's original ideas that depression results from people's negative interpretations of events, unlike Beck we believe that many of the interpretations are not necessarily distortions. Awful and difficult events happen to many people, and many depressions are preceded by truly negative life stressors. We propose that stressors result both from fate and from human agency. And maybe we will get as much mileage from studies of individual differences in stress generation and stress resolution as from a previous round of studies of individual differences in cognitions about stress. How do people create and manage their environments? Just as the study of depression has profited enormously from exploring its antecedent social context, we propose that even stressful events need to be studied in context—especially the interpersonal and family context. These processes shift over time and have mutual influences on each other. This leads to some very complex multigenerational, historical, transactional, and cognitive models, and that is what I meant when I titled this work “the plot thickens.”     

Aging and cardiovascular reactivity to stress: longitudinal evidence for changes in stress reactivity

Although age differences in cardiovascular function are well documented, little research has provided longitudinal evidence for age-related changes in cardiovascular reactivity to stress. In this study, the authors report such data from a follow-up of their prior work (B. N. Uchino, D. Uno, J. Holt-Lunstad, & J. B. Flinders, 1999) with participants between the ages of 30 to 70 (n=108, mean follow-up=10 months, range=7 to 16 months). Results revealed longitudinal evidence for an age-related increase in systolic blood-pressure reactivity and parasympathetic withdrawal to acute stress. The implications of these findings are discussed in light of the increased cardiovascular disease risk with age, as well as the links between aging, emotions, and physiology.