Refining diathesis-stress models of depression or introducing ptolemaic epicycles? Commentary on Santor

Work guided by diathesis-stress models of depression has not been as productive or clinically relevant as hoped. Santor (this issue) suggests some promising refinements of these theories. He proposes more of a contextual focus and addresses temporal instability in presumed diatheses. However, if carelessly applied, the innovations he proposes risk being so accommodating of diverse findings as to be unfalsifiable. Santor also suggests that the selection of coping strategies may be the means by which personality mediates between life events and subsequent depression; though reasonable, this elaboration too can lead to formulations immune to data. Other issues are raised concerning the distinction between fluctuations and disturbances in mood, the role of a history of depression, and operationalization of life events. One immediate solution to some of the problems inherent in this research may be intensive study of more select samples.     

Negative life events and cognitive vulnerability to depression: Informant effects and sex differences in the prediction of depressive symptoms in middle childhood

While diathesis-stress models of cognitive vulnerability to depression (CVD) in childhood have been tested, few studies have included both parent- and child-reported negative life events, despite the fact that they provide unique information on events that may be relevant to depression risk in boys and girls. It was hypothesized that different types of stress may show moderation of CVD for boys and girls; specifically, we predicted that parent-reported stressors may moderate boys’ CVD, and that self-reported stress may play a more critical moderating role for girls. A community sample of 182 eight-year-olds completed measures of CVD at baseline, and child- and parent-reported measures of stress were collected at follow-up, one year later. Support for diathesis-stress models of CVD varied depending on child sex and the source of information on stress. Results highlight the importance of collecting multiple measures of stress in testing diathesis-stress models of CVD in middle childhood.     

The direct and interactive effects of neuroticism and life stress on the severity and longitudinal course of depressive symptoms

The direct and interactive effects of neuroticism and stressful life events (chronic and episodic stressors) on the severity and temporal course of depression symptoms were examined in 826 outpatients with mood and anxiety disorders, assessed on 3 occasions over a 1-year period (intake and 6- and 12-month follow-ups). Neuroticism, chronic stress, and episodic stress were uniquely associated with intake depression symptom severity. A significant interaction effect indicated that the strength of the effect of neuroticism on initial depression severity increased as chronic stress increased. Although neuroticism did not have a significant direct effect on the temporal course of depression symptoms, chronic stress significantly moderated this relationship such that neuroticism had an increasingly deleterious effect on depression symptom improvement as the level of chronic stress over follow-up increased. In addition, chronic stress (but not episodic stress) over follow-up was uniquely predictive of less depression symptom improvement. Consistent with a stress generation framework, however, initial depression symptom severity was positively associated with chronic stress during follow-up. The results are discussed in regard to diathesis-stress conceptual models of emotional disorders and the various roles of stressful life events in the onset, severity, and maintenance of depressive psychopathology.     

The Cognitive, Learned-Helplessness and Hopelessness Theories of Depression: A Review with Implications for Counsellors

Four theories of depression and the Attributional Style Questionnaire (ASQ) are described and their implications for counselling discussed. Recent research has focused upon the testing of the diathesis-stress component of the reformulated learned-helplessness theory of depression, and in particular upon the role which a hypothesised depressogenic causal attributional style towards events in general, and/or 'depressive attributions' towards specific events, play in the development of depression. It is suggested that the recently revised version of this theory — the hopelessness theory of depression — is both a more fruitful area of future research and of more interest to the counsellor, since it emphasises the role which attributions and other cognitive factors play in the maintenance and prevention of depression, rather than concentrating on a continued search for a cause.     

Vulnerability to depressive symptomatology: a prospective test of the diathesis-stress and causal mediation components of the hopelessness theory of depression.

The diathesis-stress and causal mediation components of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) were tested using a prospective methodology. Measures of the 3 vulnerability factors posited by the theory (cognitive diatheses about cause, consequences, and self) were completed by 152 Ss at Time (T) 1. Ss completed measures of depressive symptoms, anxious symptoms, and hopelessness at T1 and again at T2, 5 weeks later. Naturally occurring stressors were assessed at T2 (covering the T1-T2 interval). Consistent with the diathesis-stress component, each Cognitive Diathesis x Stress (CD x S) interaction predicted onset of depressive symptoms from T1 to T2. In contrast, the CD x S interactions predicted neither state nor trait anxiety. In addition, 2 of the 3 CD x S interactions (those involving cause and self, but not consequences) were partially mediated by hopelessness. Implications for future work on the hopelessness theory of depression are discussed.     

Overgeneral autobiographical memory and traumatic events: an evaluative review

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology.     

The relevance of recent developments in classical conditioning to understanding the etiology and maintenance of anxiety disorders

Current etiological models of anxiety disorders emphasize both internal diatheses, or risk factors, and external stressors as important in the development and maintenance of clinical anxiety. Although considerable evidence suggests personality, genetic, and environmental variables are important to these diathesis-stress interactions, this general approach could be greatly enriched by incorporating recent developments in experimental research on fear and anxiety learning. In this article, we attempt to integrate the experimental literature on fear/anxiety learning and the psychopathology literature on clinical anxiety, identify areas of inconsistency, and recommend directions for future research. First, we provide an overview of contemporary models of anxiety disorders involving fear/anxiety learning. Next, we review the literature on individual differences in associative learning among anxious and non-anxious individuals. We also examine additional possible sources of individual differences in the learning of both fear and anxiety, and indicate where possible parallels may be drawn. Finally, we discuss recent developments in basic experimental research on fear conditioning and anxiety, with particular attention to research on contextual learning, and indicate the relevance of these findings to anxiety disorders.     

Stress and stress management at the workplace

Anxiety sensitivity (AS), the fear of anxiety-related symptoms, is strongly implicated in the development of anxiety disorders and is associated with other types of psychopathology. Little is known, though, about the processes through which AS might precipitate distress. As a preliminary step in understanding mechanisms, the mediational role of stress perception was evaluated in a nonclinical sample using a cross sectional design. We conducted a comparison between trait anxiety (TA) and AS to test whether any observed relations were specific to fear of anxiety (AS) or whether associations could be explained by the more general construct. Perceived stress mediated the relation between AS, and specific AS components, and panic symptoms and depression; but not in analyses where TA was statistically controlled. Perceived stress was not found to mediate the relation between TA and panic symptoms or depression, although TA, perceived stress and depression were highly correlated. Although incremental validity was not demonstrated in the present study, stress perception may be an important process through which AS amplifies reactivity to demanding life circumstances and further study is warranted.     

Differences in negative life events between patients with anxiety disorders,depression and hypochondriasis

This study investigated whether some categories of adverse life events are differentially associated with specific types of emotional disorders. A life self-report measure of major life events was completed by 42 subjects with diagnoses of anxiety disorders, 46 subjects with major depression, 26 subjects with hypochondriasis and 73 nonclinical subjects (controls). As predicted, the onset of anxiety disorders, depression, and hypochondriasis appears to be differentially related with life stress of ‘threat’, ‘loss’, and ‘health’, respectively, previously experienced by the clinical subjects. Also, there were significant differences between clinical and nonclinical subjects on both perceived life stress and number of life events reported. Findings suggest a differential implication of psychosocial stress categories in particular emotional disorders (i.e., anxiety, depressive and hypochondriacal disorders). These results expand previous findings that have demonstrated an association between negative life events and psychopathology.     

Developmental differences in cognitive diatheses for child depression

We studied developmental changes in the relation between cognitive style (i.e., attributional style and cognitive errors) and depression in children. Subjects included 409 fourth-, sixth-, and eighth-grade school children. We hypothesized (1) that evidence congruent with a cognitive diathesis model of depression would emerge with development across middle childhood, (2) that Event × Cognitive Style × Age interactions would be specific to some domains of stressful events but not others, and (3) that interactions would be especially prominent in domains that children regarded as personally important. Hierarchical multiple regressions indicated that cognitive style moderated the relation between events and self-reported depressive symptoms only in later childhood, and that such interactions were specific to certain domains of stressful events and cognitions. The importance of distinguishing among types of stress and cognitions in future tests of diathesis-stress models of childhood depression are discussed. Implications of developmental differences in the psychopathology of child depression also emerge.     

Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n = 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.     

Diathesis-stress models of psychopathology: A quantitative genetic perspective

When genetics is considered in diathesis-stress models of psychopathology, it is often assumed that heredity provides the diathesis and environmental factors are responsible for the stressor. We discuss two quantitative genetic models relevant to the diathesis-stress construct. One model focuses on genotype-environment interaction, which is the usual way in which genetic influence is represented in diathesis-stress models. A second model—genotype-environment correlation—provides an alternative that represents both genetic and environmental influences relevant to the development of psychopathology. Implications of these models for clinical research are discussed.     

Temperament as a unifying basis for personality and psychopathology

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress).     

Corticotropin-Releasing Factor and the Psychobiology of Early-Life Stress

ABSTRACT— Trauma and neglect during childhood are increasingly appreciated as factors in the etiology of adult mood and anxiety disorders. Much has been learned about the role of stress biology in the persisting effects of early adverse experience on adult psychopathology. Here we present an overview of developmental trauma in the psychobiology of depression and anxiety. We emphasize the role of corticotropin-releasing factor in the pathophysiology of these disorders, focusing on the transduction of early life trauma into adult psychopathology.     

SCHIZOPHRENIA AS DIALOGUE AT THE ENDS OF ITS TETHER: THE RELATIONSHIP OF DISRUPTIONS IN IDENTITY WITH POSITIVE AND NEGATIVE SYMPTOMS

Changes to definitions and theories of psychopathology result less from scientific advances and more from changes in social and cultural values. Herein, the historical and contemporary diversity in definitions and theories of anorexia nervosa is used to illustrate this point. First, we offer a discussion of diachronic diversity (diversity over time) and synchronic diversity (diversity at a given point in time) in conceptions and theories of psychopathology in general. Second, we elaborate a social constructionist perspective on psychopathology in general. Third, to illustrate this perspective, we provide a diachronic and synchronic analysis of definitions and theories of anorexia nervosa. Fourth, we discuss the implications of this analysis for clinical practice. We conclude that whatever view eventually prevails will depend not on which one is better at rooting out some hidden truth about anorexia nervosa but, rather, on which one is viewed as more compatible with evolving social and cultural standards, views, and norms regarding health and illness in general and self-starvation in particular.     

Perfectionism,life events,and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.     

Perfectionism, life events, and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.     

Life stress, the "kindling" hypothesis, and the recurrence of depression: considerations from a life stress perspective

Major depression is frequently characterized by recurrent episodes over the life course. First lifetime episodes of depression, however, are typically more strongly associated with major life stress than are successive recurrences. A key theoretical issue involves how the role of major life stress changes from an initial episode over subsequent recurrences. The primary conceptual framework for research on life stress and recurrence of depression is the "kindling" hypothesis (R. M. Post, 1992). Despite the strengths of the kindling hypothesis, a review of the research literature reveals inconsistencies and confusion about life stress and its implications for the recurrence of depression. Adopting a life stress perspective, the authors introduce 3 major themes that resolve the inconsistencies in the current literature. They integrate these themes and extrapolate the ideas with available data to develop a preliminary framework for evaluating competing explanatory models and to guide research on life stress and the recurrence of depression.