Every year, almost ten million adults seek treatment for depression (National Institute of Mental Health, 1).  Each person who experiences an episode of Major Depressive Disorder (MDD) has an increased risk of suicidal behavior, substance abuse, bipolar disorder and poor psychosocial functioning (Birmaher et al., 1996), all of which potentially impact their friends, family and co-workers in negative ways.  Etiological theories, including Beck’s cognitive diathesis-stress model (1978), Nolen-Hoeksema’s rumination theory (1991), Abramson, Metalsky and Alloy’s hopelessness theory (1989), and Hankin and Abramson’s cognitive vulnerability-transactional stress theory (2001) include negative affect as a common element contributing to the onset of depressive episodes.  Watson and Walker (1996) established that, in young adults, trait measures of negative affect remain relatively stable across time spans of six to seven years and retain their power to predict future levels of depression.  Because of this potentially enduring nature of negative affect, the question of what factors might interact with negative affect to trigger the onset and relapse of MDD and its associated outcomes is important to both those with the disease and society at large. 

           

Cognitive Theory

Several etiological theories identify the interaction between dysfunctional cognitions and negative life events as the source of depressive episodes.  The cognitive diathesis-stress theory (Kovacs et al., 1978) identifies a person’s thought process, in conjunction with negative life events, as the source of major depression.  A stressful life event can activate a pre-existing negative schema (a functional unit that organizes thoughts, e.g., “I am worthless”) by the affect it induces; this schema then reinforces depressive thought patterns.  According to Kovacs et al., people respond to events according to these cognitive schemas.  Beck refers to these thought patterns as a “negative cognitive set,” which he defines as negative views of experience, the future and the self.  These thought patterns, when reinforced by a schema activated by negative affect, contribute to the onset of MDD.   

            The negative cognitive set resembles what Sacco related to Beck in a communication, namely, that depressed individuals tend to attribute failure to internal, stable and global attributions (Beck, 1987).  A pessimistic attributional style has been subsequently linked to a higher risk of future depression when associated with low levels of stress (Lewinsohn, Joiner & Rohde, 2001), regardless of the number of negative life events experienced (Spence, Sheffield & Donovan, 2002). 

Another model of depressive etiology, the information-processing theory (Teasdale, 1983), also takes negative life events into account.  Instead of positing the existence of negative schema, this theory suggests that the ease with which a depressed person accesses negative cognitions increases as a function of depressed mood.  Events that evoke a certain negative affect trigger self-defeating thoughts previously associated with that affect and make it easier for an individual to slip into an episode of MDD when he or she encounters subsequent stressors (Teasdale, 1983). 

 

Hopelessness Theory

The hopelessness theory (Abramson et al., 1988) also links stressful life events (e.g. the failure to achieve a goal) and depression.  The hopelessness results from the depression-prone individual’s negative cognitive set.  Rholes, Riskind, and Neville (1985) discovered that, in an undergraduate population, initial levels of hopelessness predicted depression severity six weeks later more accurately than initial levels of depression.  They hypothesized that hopelessness acts as a diathesis that, when combined with negative events, increases vulnerability to a depressive episode. Results of a study of college undergraduates by Needles & Abramson (1990) indicate that the interaction between a global, stable attributional style and negative events contribute to the level of hopelessness and subsequent depression severity six weeks later.  Conversely, a global, stable attributional style interacts with positive life events to reduce depressive symptoms.  This emphasizes the importance of hopelessness in maintaining the depressed state.  Lastly, Abramson et al.’s (1998) 30-month study of undergraduates at high- and low-cognitive risk for suicide identified hopelessness as a mediator between the vulnerability (e.g., high cognitive risk) and the potential for suicidal thoughts and behavior.

 

Other Diathesis-Stress Models

Other studies have identified different diatheses and mediators that contribute to the onset of a depressive episode.  A study of young adolescents by Spence, Sheffield and Donovan (2002) found that a negative problem solving orientation, the way that an individual views and approaches a difficult task, operated as a diathesis: when combined with higher numbers of stressful life events, it increased chances of more severe depression in the future.  Lewinsohn et al. (2001) identified a mid-range level of dysfunctional thinking (e.g., “My life is wasted unless I am a success”) as measured by the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978) as being related to depressive onset in adolescents.  Abela & D’Alessandro (2002) also pinpointed dysfunctional attitudes, mediated by a negative view of the future, as a diathesis that predicted depressive mood in high school students.  Vazquez, Jimenez, Suara and Avia (2001) identified a different mediator of future depressive mood, namely, the importance that the adolescent places on the stressful event’s outcome. 

Another study identified a potential limitation of the diathesis-stress model.  Lewinsohn, Allen, Seeley and Gotlib (1999) differentiated between adolescents with and without a history of depression and discovered that stressful life events only predicted first episodes of MDD.  For those who had experienced an earlier depressive episode, the likelihood of recurrence did not increase as a function of stressful life events but rather as a function of dysphoric mood severity.

           

Interpersonal Theories

Hammen’s (1991) stress generation hypothesis offers an explanation of the relationship between stress and depression that differs from the diathesis-stress model discussed above.  Hammen studied stress generation in depressed individuals and discovered that the interpersonal deficits caused by depressive affect and behaviors generated new sources of stress that, in turn, fueled the depression.  In support of Hammen’s theory, Hokanson, Rubert, Welker, Hollander and Hedeen (1989) discovered over an eight-month study that the roommates of clinically depressed college students reported more aggressive feelings toward their roommate and less enjoyment of their company.  Further, Siegel and Alloy (1990) reported that dysphoric students and their roommates tended to have more negative relationships than two non-depressed individuals.  A subsequent study of women by Harkness et al. (2001) examined the link between dysthymia, anxiety and dependent stressful life events, and reported that the combined presence of dysthymia and anxiety increased the threat of events like interpersonal difficulties.  These difficulties strain the depressed individual’s relationships and subsequently deepen and maintain the depressed emotions.

            A 1995 study of college students by Potthoff, Holahan, and Joiner integrated the stress generation hypothesis (Hammen, 1991) with Coyne’s (1976) interpersonal theory of depression.  The interpersonal theory asserts that individuals with a reassurance-seeking style of interpersonal communication will experience more interpersonal difficulties and, as a result, an increase in depressive symptoms.  Negative affect can cause individuals to engage in reassurance seeking behaviors that strain relationships and subsequently deepen and maintain the depressed emotions.  Potthoff et al. (1995) discovered a positive correlation between reassurance-seeking and depressive symptoms; they proposed that stress generation mediates between the reassurance-seeking behavior and the depression that potentially results, highlighting the importance of interpersonal factors in depression’s development. 

 

 Rumination Theory

Nolen-Hoeksema’s (1991) rumination theory proposes that individuals who cope by focusing on their negative emotions instead of distracting themselves have an increased chance of experiencing a longer, more severe depressive episode, regardless of stressful life events or social support.  As reported by Nolen-Hoeksema, Morrow, and Fredrickson (1993), people tend to cope with stressors in a consistent manner.  Therefore, an unhealthy coping style can persist and worsen depression as the individual encounters frustrations.  A prospective study of college students by Just & Alloy (1997) reports that ruminative response styles increased the chances of a nondepressed individual experiencing a depressive episode over 18 months after recruitment, and that rumination increased the severity of the episode.  Other studies of undergraduates indicate that individuals with moderate levels of depression tend to cope by ruminating and subsequently experience more stress (Arthur, 1998; Forsythe & Compas, 1987).  Rumination has since been associated with cognitive inflexibility that might contribute to the perseverance of the negative affect (Davis & Nolen-Hoeksema, 2000).  Although rumination is proposed as a maintenance rather than etiological theory, it is possible that a person experiencing mid-range levels of dysphoria who ruminates instead of actively coping will be at greater risk of experiencing an escalation to a full-blown depressive episode. 

           

Cognitive Vulnerability-Transactional Stress Theory: An Integration

Hankin et al.’s (2001) cognitive vulnerability-transactional stress theory combines several of these existing etiological models into a more cohesive form.  It begins with the idea that negative affect caused by stressful life events will only persist in those with pre-existing vulnerabilities.  Based on this, Hankin et al.’s theory takes the cognitive diathesis-stress model (Kovacs et al., 1978) and adds negative affect as a mediating factor between the stressor and the cognition.  In order to include other factors that might interact with the negative affect to increase depression, it incorporates a ruminative response style (Nolen-Hoeksema, 1991) and other non-depression specific cognitive vulnerabilities.  Also, as suggested by Potthoff et al. (1995), Hammen (1991) and Coyne (1976), this theory allows for the possibility that depressed individuals might create stressful interpersonal situations that exacerbate their condition (Hankin et al., 2001).

            According to the literature reviewed above, the following have been proposed as risk factors for depression onset: negative attributional style, stressful life events, interpersonal deficits, dysfunctional attitudes and coping style.  However, no prospective study has been conducted that examines a non-clinical population with elevated negative affect to determine what factors interact with that affect to predict onset of a full depressive episode.  I plan to administer measures evaluating the above factors to male and female college students with mid-range levels of dysphoria.  After two months have passed, I will re-administer the measures and determine which students experienced a depressive episode during the elapsed time.  By comparing the scores of participants who had an episode of MDD with those who did not, I can determine what factors, if any, contributed to students with elevated negative affect experiencing depression. 

Method

Participants

            Participants consisted of 100 male and female undergraduates ages 18-23 fulfilling an experimentation requirement for an introductory psychology course at the University of Texas at Austin.  To qualify for the study, participants had to demonstrate mid-range levels of negative affect by scoring in the middle third of possible scores on the Positive and Negative Affect Schedule Revised (PANAS-X; Watson, Clark & Tellegen, 1988).  Those currently receiving treatment for depression were excluded.

Measures

             A questionnaire including all of the following measures were used at Time 1 (T1) to assess cognitive, social and environmental factors that might contribute to the onset of a depressive episode.  Those measures that assess current depressive mood were re-administered at Time 2 (T2).

Negative Affect.  The Positive and Negative Affect Schedule Revised (PANAS-X; Watson et al., 1988) was used to measure potential participants’ negative affect.  Participants rated the frequency of certain mood states (e.g., lonely, anxious, jittery) over the last few weeks using a scale from 1-5, with 1 meaning “very slightly or not at all” and 5 meaning “extremely.”  The PANAS-X was administered prior to T1 as a tool to recruit dysphoric participants and again at Time 2 (T2) as an indicator of current depression levels.

Depression.  Participants’ current depression was assessed using the Beck Depression Inventory (BDI; Beck et al., 1961).  The BDI is a 21-item questionnaire that asks participants to rate depressive symptomatology (e.g., “I don’t cry any more than usual”) on a scale of 0 to 3, with 0 being rarely and 3 being frequently.  This measure has high internal consistency and test-retest reliability (Beck et al., 1988) and was administered at both T1 and T2. 

Demographics. Participants responded to questions about their age, sex and race at T1.

Prior history of depression.  Participants responded to questions about personal and family history of mood disorders at T1.

Social Support.  To assess the amount of support participants received from friends and parents, the researchers used the Network of Relationships Inventory (NRI; Furman & Buhrmester, 1985).  Participants rated 12 statements such as, “I shared private feelings with my parent(s),” on a scale from 1 (strongly disagree) to 5 (strongly agree).  The NRI was administered at T1. 

Dysfunctional Attitudes.  Participants’ dysfunctional attitudes were assessed using an abbreviated 9-item version of the Dysfunctional Attitudes Scale (DAS-A; Weissman et al., 1978).  The DAS-A is a 9-item scale that measures maladaptive attitudes (e.g., “I should be happy all the time”), which Beck postulated contribute to the onset of depressive episodes.  Its correlation with the original 20-item version of the test is .93 (Lewinsohn et al., 2001) and it has shown good test-retest reliability over eight-week periods (Hamilton & Abramson, 1983).  The DAS was administered at T1.

Attributional Style.  To measure participants’ attributional style, the researchers used a shortened version of the Attributional Style Questionnaire (ASQ; Peterson, Semmel, Von Baeyer, Abramson, Metalsky, and Seligman, 1982).  Participants were given three hypothetical negative events (e.g., “Your boyfriend/girlfriend breaks up with you, but you still want to stay together”) and asked four questions (e.g., “Do you think the reason they broke up with you will cause others to break up with you in the future?”) about each that required them to rate the internal, stable and global nature of each event’s cause.  A rating of 7 (e.g., “Will cause others to break up”) indicated the most internal, stable and global attribution, while a rating of 1 (e.g., “Never again”) indicated the least.  The ASQ has reasonable internal consistency (alpha = .72; Peterson et al., 1982) and was administered at T1. 

Negative Life Events.  Negative life events were assessed using a modified version of the Life-Events Questionnaire (LEQ; Newcomb, Huba & Bentler, 1981).  The LEQ is designed for adolescents and consists of 39 activities or experiences related to school, family and friends, health, autonomy and legal behavior.  Our scale was adapted to fit a college population and was administered at T1.

Coping Style.  We used the Ruminative Responses Scale (RRS) of the Response Styles Questionnaire (RSQ; Nolen-Hoeksema & Morrow, 1991) to assess participants’ ruminative coping style.  The RRS consists of 21 items describing reactions to mood that are self-focused (e.g., I think, “Why do I react this way?”), symptom-focused (e.g., “think about your feelings of fatigue”), and focused on the mood’s possible consequences and causes (e.g., “I am embarrassing to my friend/family/partner”).  This measure shows good test-retest reliability (Nolen-Hoeksema, Parker & Larson, 1994) and internal consistency (Nolen-Hoeksema et al., 1991).  The RRS was administered at T1.    

Procedure

            To recruit participants with elevated negative affect, researchers included the PANAS-X (Watson et al., 1988) in a pre-test offered to all students in an introductory psychology course as a way of completing required hours of participation in experiments.  Those students who scored in the middle third of possible scores on the PANAS-X and were not currently undergoing treatment for depression were offered the chance to participate in this study and earn more credit hours.  At Time 1 (T1), students who chose to participate in the study were given a self-report questionnaire that included the measures listed above.  After two months, participants returned to the laboratory to complete the PANAS-X and the BDI as a way of assessing changes in their depression levels. 


 

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