Conduct Disorder and Psychosocial Outcomes at Age 30: Early Adult Psychopathology as a Potential Mediator

Conduct disorder (CD) is associated with a number of adverse psychosocial outcomes in adulthood. There is consistent evidence that CD is predictive of antisocial behavior, but mixed evidence that CD is predictive of other externalizing and internalizing disorders. Further, externalizing and internalizing disorders are often associated with similar psychosocial outcomes as CD. However, relatively little work has examined whether forms of psychopathology (e.g., externalizing and/or internalizing disorders) mediates the relationship between youth CD and adult psychosocial outcomes. The present study examined associations between youth CD and adult psychosocial outcomes and sought to identify forms of psychopathology that may potentially mediate this relationship. Participants completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. Analyses found that most domains of adult psychosocial functioning were associated with youth CD. Adult antisocial behavior was the only form of psychopathology predicted by CD. Adult antisocial behavior appeared to mediate the relationship between CD and marital status, life satisfaction, and being in jail and partially mediated the relationship between CD and family support and global functioning. These data suggest that reducing the progression to adult antisocial behavior may improve multiple psychosocial outcomes among those with a history of CD.     

Developmental relations between depressive symptoms, minor hassles, and major events from adolescence through age 30 years

Stress generation and stress exposure models of the relations among depressive symptoms, minor hassles, and major event stress were investigated among 815 community-dwelling participants. Autoregressive latent trajectory models were constructed to examine latent growth patterns from ages 15 years to 30 years and to test 1-year lagged, reciprocal paths between depressive symptoms and stress constructs. Results indicated significant cross-sectional and longitudinal associations between depressive symptoms and both stress constructs at the latent level. At the manifest level, lagged paths from hassles at 1 year to depressive symptoms at the next year were significant between ages 17 years and 24 years. Significant cross-sectional paths between major events and depressive symptoms were found between ages 24 years and 28 years, and modest support was found for lagged paths from depressive symptoms to major events 1 year later. Findings generally suggest a high degree of covariation in depressive symptoms and stress concurrently and over time. One-year lagged predictive effects net of the associations between individuals' latent trajectories appear to be weak, constrained to specific time periods, and most consistent with a stress exposure effect of hassles on depressive symptoms.     

Commentary: Response to Reviews of “Cultural Psychotherapy: Working with Culture in the Clinical Encounter”

Pastoral Psychology -     

Comorbidity of unipolar depression: I. Major depression with dysthymia

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n = 1,710) and adults (n = 2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had became depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY.     

An emotional processing writing intervention and heart rate variability: the role of emotional approach

Expressing and understanding one's own emotional responses to negative events, particularly those that challenge the attainment of important life goals, is thought to confer physiological benefit. Individual preferences and/or abilities in approaching emotions might condition the efficacy of interventions designed to encourage written emotional processing (EP). This study examines the physiological impact (as indexed by heart rate variability (HRV)) of an emotional processing writing (EPW) task as well as the moderating influence of a dispositional preference for coping through emotional approach (EP and emotional expression (EE)), in response to a laboratory stress task designed to challenge an important life goal. Participants (n?=?98) were randomly assigned to either EPW or fact control writing (FCW) following the stress task. Regression analyses revealed a significant dispositional EP by condition interaction, such that high EP participants in the EPW condition demonstrated higher HRV after writing compared to low EP participants. No significant main effects of condition or EE coping were observed. These findings suggest that EPW interventions may be best suited for those with preference or ability to process emotions related to a stressor or might require adaptation for those who less often cope through emotional approach.     

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.     

The Use of the Mirror Tracing Persistence Task as a Measure of Distress Tolerance in Generalized Anxiety Disorder

Behavioral tasks offer an objective index of processes associated with psychopathology. The mirror tracing persistence task (MTPT) has been used as a measure of distress tolerance, or the ability to endure negative internal states. In generalized anxiety disorder (GAD), a poor ability to tolerate aversive internal states may relate to the inability to adaptively regulate emotion. This study examined if those with GAD exhibit lower distress tolerance compared to controls as evidenced by length of time persisting on the MTPT. Participants underwent diagnostic interviews to determine the presence of absence of GAD and following group assignment, completed the MTPT. Results demonstrated that the groups differed significantly in time spent persisting on the task, with controls persisting longer than those with GAD, supporting the hypothesis that individuals with GAD exhibit lower distress tolerance than controls. These results provide support for the use of behavioral assessments as potential markers of distress tolerance.     

The symptomatic expression of major depressive disorder in adolescents and young adults

Data from the Oregon Adolescent Depression Project were used to examine the symptomatic expression of major depressive disorder (MDD) as a function of age and gender. The objective was to investigate the phenomenological nature of MDD among a cohort of adolescents as they progressed into early adulthood. The analyses were based on 564 participants who had experienced MDD in their lifetime. No systematic differences in the relative rate of occurrence of specific symptoms across episodes and only minor symptom differences between male and female participants were found. Age did not significantly influence the symptom picture. Stability of specific symptoms and episode severity across episodes was low. The results are discussed within the context of a stressor-symptom matching model.     

Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence

The authors examined whether adolescent major depressive disorder (MDD) was associated with difficulties in young adult functioning and whether differences would remain significant after accounting for nonmood disorder, MDD recurrence, functioning in adolescence, or current mood state. A total of 941 participants were assessed twice during adolescence and at age 24. In unadjusted analyses, adolescent MDD was associated with most young adult functioning measures. Associations were not due to interactions with adolescent comorbidity, but differences in global functioning and mental health treatment appeared as a result of MDD recurrence. Accounting for levels of functioning in adolescence or for current depression at age 24 eliminated the remaining associations. The implications of these findings for efforts to prevent MDD in adolescence are discussed.     

First onset versus recurrence of depression: differential processes of psychosocial risk.

Differential risk factors for the onset of depression were prospectively examined in a community-based sample of adolescents (N = 1,709), some of whom had a history of major depressive disorder (MDD; n = 286) and some of whom did not (n = 1,423). From the theories of J. Teasdale (1983, 1988) and R. Post (1992) concerning the etiology of initial versus recurrent episodes of depression, the authors hypothesized that (a) dysphoric mood and dysfunctional thinking styles would be correlated more highly among those with a previous history of MDD than among those without a history of MDD; (b) dysphoric mood or symptoms and dysfunctional thinking would be a stronger predictor of onset of recurrent episodes (n = 43) than of first onsets (n = 70); and (c) major life stress would be a stronger predictor of first onsets of MDD than of recurrent episodes. The results provide support for the 3 hypotheses and suggest that distinct processes are involved in the onset of first and recurrent episodes of MDD.