Pathways to childhood depressive symptoms: the role of social, cognitive, and genetic risk factors

Childhood depressive conditions have been explored from multiple theoretical approaches but with few empirical attempts to address the interrelationships among these different domains and their combined effects. In the present study, the authors examined different pathways through which social, cognitive, and genetic risk factors may be expressed to influence depressive symptoms in 300 pairs of child twins from a longitudinal study. Path analysis supported several indirect routes. First, risks associated with living in a step- or single-parent family and punitive parenting did not directly influence depressive outcome but were instead mediated through maternal depressive symptoms and child negative attributional style. Second, the effects of negative attributional style on depressive outcome were greatly exacerbated in the presence of precipitating negative life events. Third, independent of these social and cognitive risk mechanisms, modest genetic effects were also implicated in symptoms, with some indication that these risks are expressed through exposure to negative stressors. Together, these routes accounted for approximately 13% of total phenotypic variance in depressive symptoms. Theoretical and analytical implications of these results are discussed in the context of several design-related caveats.     

Greek women's attitudes toward pregnancy,labor, and infant: Their significance for intervention

Greek women's needs, attitudes, and experiences during the months immediately prior to and subsequent to the birth of their infants were evaluated. Themes considered were women's feelings and attitudes toward pregnancy, labor and the expected infant; breast feeding; emotional and practical needs; experiences from perinatal care and relationships with medical care personnel and with the family; perceptions of physical and emotional stress; and their relationships with infant and partner. Findings showed, among others, that women emphasized a desire for more personal care — more time, continuity of care, information about their pregnancy, and less distance from the doctor. Moreover, they expressed their need for emotional support. Anxiety was found to be a central feature of women's feelings during labor and delivery. The same anxiety was related to efforts to deal with infant crying, attempts to console the infant, and concern for picking the baby up. Understanding maternal attitudes provides guidelines for designing an intervention program that would integrate emotional and cognitive factors.     

Specific Life Events and Chronic Experiences Differentially Associated with Depression and Anxiety in Young Twins

Behavioral genetic analyses indicate that environmental influences associated with depression and anxiety are specific to each symptom type; however, this has not been tested specifically in children. Sixty-one (61) child twin pairs in which at least one twin had a very high anxiety or depression score, and 29 nonanxious, nondepressed pairs were interviewed about life events and chronic stressors in the previous 12 months. Loss events, schoolwork stressors, family relationship problems, and friendship problems were all significantly associated with depression but not anxiety. Threat events were significantly associated with anxiety but not depression. Loss events and schoolwork stressors appeared to act as shared environment influences in that they made twin pairs resemble one another. Threat events, friendship problems, and family relationship problems were individual specific and accounted for differences within the pairs. These results clarify the associations between life events and depressive and anxious symptoms in children and adolescents and reveal specific associations previously unidentified in this age range.     

Behavioral Genetics as a Tool for Developmental Psychology: Anxiety and Depression in Children and Adolescents

Over the past decade there has been a huge increase in the number of behavioral genetic studies looking into anxiety and depression in children and adolescents. There are now enough data in this area to make a review of the results useful. This paper begins with an outline of the methods used in such research and moves on to review the results in extant studies. Overall, these studies indicate modest to moderate genetic influence on both anxiety and depression. However, behavioral genetic methods are also paramount for exploring environmental influences in addition to genetic influences. Shared environment (that which makes family members resemble one another) is rarely identified in adult studies of personality or psychopathology and does not appear to be a significant influence for depression but it is for anxiety. Nonshared environment, which makes family members differ from one another, is found to be a significant influence for both anxiety and depression. Patterns within these results due to rater effects, age effects, sex effects, the precise phenotype measured, and the study design are explored.     

Genetic Influences on Anxiety in Children: What we’ve Learned and Where we’re Heading

Anxiety is a common problem, typically beginning early in life. This article explores reasons for individual differences in levels of anxiety among children, by reviewing the genetic literature. The plethora of research to date has demonstrated clearly that both genes and environmental influences play important roles in explaining differences in levels of anxiety of various types among children. This has encouraged researchers to search for specific genes and environmental influences upon anxiety. Despite important progress in identifying links between anxiety and specific genes—including associations between serotonin and dopamine genes and different symptoms of anxiety—overall, progress has been slow because multiple genes of small effect size are likely to influence anxiety. This article explains how the hunt for genes involved in anxiety is likely to benefit from genetically sensitive research, which examines the co-occurrence of symptoms; includes measures of the environment; and examines endophenotypes and risk pathways.     

Longitudinal genetic analysis of anxiety sensitivity

Anxiety sensitivity is associated with both anxiety and depression and has been shown to be heritable. Little, however, is known about the role of genetic influence on continuity and change of symptoms over time. The authors' aim was to examine the stability of anxiety sensitivity during adolescence. By using a genetically sensitive design, the authors were also able to investigate the extent to which genetic and environmental factors influence anxiety sensitivity over time. Self-reports of anxiety sensitivity were obtained for over 1,300 twin and sibling pairs at 3 time points. Data were analyzed using multivariate genetic models. Anxiety sensitivity was moderately heritable at all time points with substantial nonshared environmental contributions. Time 1 genetic factors accounted for continuity of symptoms at Times 2 and 3. New genetic factors at Time 2 also influenced Time 3 symptoms. New nonshared environmental influences emerged at each time point. Analysis of a latent factor of trait anxiety sensitivity revealed some stable nonshared environmental influences. Genetic effects were generally stable over time, with new genetic influences emerging in late adolescence. Environmental influences on anxiety sensitivity were, on the whole, more time specific; however, some stable environmental influences were also found.     

Truly intensive clinical ethics immersion at the Washington Hospital Center

Opportunities for practical, hospital-based training in those skills demanded by clinical ethics consultation (CEC) have been limited. Given the number of individuals who provide part-time CEC, greater access to condensed, practical training such as the clinical ethics immersion course offered by the Washington Hospital Center, is necessary. Two participants in the initial cohort evaluate their CE training at a busy, urban referral center, exploring prior expectations, perceptions of its utility and suggestions for improvement. Such training will prove valuable not only for bioethicists who lack practical CEC experience "at the bedside" but also for ethics consultants whose ethics services have a low consult volume who wish to sharpen their skills.     

The role of children’s negative attributions on depressive symptoms: an inherited characteristic or a product of the early environment?

Negative attributional style has been associated with depressive symptoms in children. Yet, it is unclear whether these cognitive biases reflect inherited characteristics of the broader depressive phenotype or are a product of children's environments. While existing data in adolescents show that negative attributions reflect a genetic predisposition, elevating depressive responses to stress, other data suggest that negative attributions in children are more likely to reflect early environmental experiences on symptoms. Here, we assess the degree to which negative attributional style and depressive symptoms arise from common genetic, shared and non-shared environmental influences in childhood. Monozygotic and dizygotic twins reported on attributional style and depressive symptoms at age 8 (n = 300 pairs) and at age 10 (n = 250 pairs). Two multivariate models with varying assumptions on the nature of the relationship between negative attributions and depressive symptoms within and across time were fit to the data. The Common Pathway model provided better fit than the Cholesky decomposition. A common, latent factor influenced both attributional style and depressive symptoms at both time-points in children. The only significant influences on this factor were shared and non-shared aspects of the environment. Placing the present findings with those of adolescents suggests possible developmental differences in the relationship between attributional style and depressive symptoms.     

Heart-beat perception, panic/somatic symptoms and anxiety sensitivity in children

There is considerable evidence implicating heart-beat perception (HBP) accuracy and anxiety sensitivity (AS) in the development of panic in adults. However, to date there have been no studies exploring the association between HBP, AS and childhood panic/somatic symptoms. Seventy-nine children aged 8 to 11 years completed a mental tracking paradigm (Psychophysiology 18 (1981) 483) to assess HBP, the Children's Anxiety Sensitivity Index (J Clin Chil Psychol 20 (1991) 162) and the Screen for Childhood Anxiety Related Emotional Disorders (J Am Acad Child Adoles Psych 38 (1999) 1230). Those with good HBP (n = 7, 9%) had significantly higher panic/somatic symptoms (t = -1.71, P < 0.05), and AS (t = -2.16, P < 0.02) than those with poor HBP. There were no effects of age, sex or BMI on HBP. Those with high levels of panic/somatic symptoms were seven times more likely to have good HBP and had AS scores 1 S.D. higher than the remainder of the sample. Multivariate analyses revealed that these two phenotypes had independent associations with high panic/somatic symptoms. These results extend the literature on HBP and panic and suggest that in children, as in adults, increased panic/somatic symptoms are associated with enhanced ability to perceive internal physiological cues, and fear of such sensations.