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Background: Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High‐Risk [HR]) and without (Low‐Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC). Method: Study 1 included LR (n = 65) and HR (n = 22) 12‐ to 14‐year‐olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid‐to‐late adolescents (64 females; 73.56%), including 57 MDD youth from a short‐term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies. Results: We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β =.22, CI95 = 0.01–0.42, p =.041), independent (β =.34, CI95 = 0.12–0.56, p =.003), and interpersonal (β =.23, CI95 = 0.004–0.45, p =.047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β =.62, CI95 = 0.45–0.79, p <.001) and dependent (β =.41, CI95 = 0.21–0.61, p <.001) stress than the HC group, but not independent (p =.083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17–10.70, p =.026). Conclusions: Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course. [ABSTRACT FROM AUTHOR]

Introduction: Religion is a salient aspect of patient background in treatment (The psychology of religion and coping: Theory, research, practice; Guilford Press). However, research investigating the role of religion in suicide is lacking and inconsistent (Journal of Religion and Health, 57, 2478–2499). The current study (1) clarifies the association between religious identity and fearlessness about death in a psychiatric sample and (2) tests whether religious identity moderates the association between fearlessness about death and suicidal ideation. Methods: Participants were 155 patients seeking treatment in a partial hospital program. Religious identity was assessed using the Identities in Treatment Scale (The Behavior Therapist). Fearlessness about death was assessed with two relevant items from the acquired capability with rehearsal for suicide scale (Psychological Assessment, 28, 1452–1464), as in prior studies (Suicide & Le‐Threatening Behavior, 50, 1230–1240; Journal of Affective Disorders Reports, 12, 100492). Results: Fearlessness about death interacted with religious identity to predict suicidal ideation, b = 0.47, 95% C.I. [0.02, 0.91], p = 0.042. Conditional effects showed that greater fearlessness about death was associated with greater suicidal ideation among non‐religious patients, b = −0.56, 95% C.I. [−0.88, −0.24], p = 0.001, but not in religious patients, b = −0.09, 95% C.I. [−0.41, 0.22], p = 0.559. Conclusions: Our results suggest that fearlessness about death is a risk factor for suicidal ideation, but only among those who do not identify as religious. Results from this study inform theories of suicide and elucidate the influence of religious identity on links among suicide risk factors and suicide‐related outcomes. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19 years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

Background Method Results Conclusions Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High‐Risk [HR]) and without (Low‐Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC).Study 1 included LR (n = 65) and HR (n = 22) 12‐ to 14‐year‐olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid‐to‐late adolescents (64 females; 73.56%), including 57 MDD youth from a short‐term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies.We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β = .22, CI95 = 0.01–0.42, p = .041), independent (β = .34, CI95 = 0.12–0.56, p = .003), and interpersonal (β = .23, CI95 = 0.004–0.45, p = .047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β = .62, CI95 = 0.45–0.79, p < .001) and dependent (β = .41, CI95 = 0.21–0.61, p < .001) stress than the HC group, but not independent (p = .083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17–10.70, p = .026).Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course. [ABSTRACT FROM AUTHOR]

Given low base rates of suicidal thoughts and behaviors (STBs) in national samples of adolescents, clarifying the sociodemographic and clinical correlates among psychiatric inpatients may afford insights into potential risk factors that predict STBs onset. Adolescents (N = 970; ages 12–19 years) admitted for acute, psychiatric inpatient care completed baseline clinical interviews and self-report measures assessing demographics and early life adversity. Lifetime and 12-month STBs prevalence were obtained, allowing for the estimate of STBs persistence (i.e., rates of those with both current and past STBs) and transition rates (i.e., proportion of ideators that transition to plans or attempts). Univariate and multivariate logistic regression tested sociodemographic and clinical correlates of STBs. Age-of-onset for STBs occurred in early adolescence. Most patients reported suicide ideation with nearly half of patients making a plan and one-third a suicide attempt. Although relatively modest, the strongest correlates of lifetime attempts were depressive disorders, physical abuse, and non-suicidal self-injury. Knowing a peer that had attempted suicide also increased the likelihood of a suicide attempt, especially among attempters who transitioned from ideation to planned attempts. STBs are highly prevalent among adolescents admitted for acute psychiatric inpatient treatment. The modest effects suggest that correlates, particularly those related to suicide attempts, are widely distributed. As a history of physical abuse and knowing a peer with a suicide attempt history are related to transitioning from ideation to action, these may be critical factors to target in the deployment of future suicide prevention and treatment programs. One-third of adolescent inpatients report a lifetime history of suicide attempts. Approximately 65% of adolescent inpatients with a lifetime plan attempt suicide. Knowing peers who attempt suicide may facilitate the transition from ideation to action. [ABSTRACT FROM AUTHOR]

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism. (Contains 3 tables, 2 figures and 10 footnotes.)

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism. Keywords: depression, stressful life events, self-criticism, dependency, treatment DOI: 10.1037/a0017149

The purpose of the present study was to uncover patterns in the generation of life events from symptom profiles and specific depression symptoms in an effort to obtain a fine-grained understanding of the stress-generation phenomenon. A community sample of 161 adolescents completed the Beck Depression Inventory-II (A. T. Beck, 1996) at Time 1, and then 88 returned 1 year later for an assessment of life events using a rigorous contextual interview and rating system. Consistent with hypotheses, and controlling for baseline stress, cognitive-affective symptoms of depression prospectively predicted higher levels of dependent interpersonal life events. In contrast, somatic symptoms prospectively predicted higher levels of independent life events. Further examination of the types of events generated by specific symptoms suggests that different mechanisms may drive specific patterns of symptom-event generation and suggests that broadening the definition of independence may be necessary to capture the full context of event generation. Keywords: depression, symptoms, stressful life events, stress generation, adolescence

The current study provided a novel investigation of relations among particular types of childhood maltreatment (emotional vs. physical vs. sexual maltreatment), specific cognitive schema themes and the generation of dependent versus independent life events. Participants included 227 adolescents and emerging adults (74% female; aged 12–29) in a current episode of a unipolar depressive disorder drawn from three archival cross‐sectional studies. Childhood maltreatment and life events from the past 6 months were assessed using detailed contextual interviews with independent, standardized ratings. Emotional maltreatment was uniquely associated with schema themes of emotional deprivation and subjugation, and sexual maltreatment was uniquely associated with schema themes of abandonment, vulnerability and dependence/incompetence. Further, subjugation and abandonment cross‐sectionally mediated the relations of emotional and sexual maltreatment, respectively, to greater dependent, but not independent, life events. Physical maltreatment was not associated with cognitive schemas or recent life events after accounting for its overlap with emotional and sexual maltreatment. Results suggest targets for cognitive intervention that may improve outcomes for youth with specific histories of emotional and sexual maltreatment. [ABSTRACT FROM AUTHOR]

According to several interpersonal theories of depression, excessive reassurance-seeking is one way depressed individuals may contribute to relationship deterioration, particularly in romantic relationships. The present study is the first behavioral investigation of the hypothesis that reassurance-seeking induces negative affect in interaction partners in real time. This study also investigates potential affective precursors to reassurance-seeking behaviors. A videotaped discussion task completed by 121 women and their male romantic partners was behaviorally coded to assess reassurance-seeking and affect in both members of the couple. Female depression was measured via self-report. Results indicated that the association between female reassurance-seeking and male partner's subsequent anxiety approached statistical significance, but no other significant relations between reassurance-seeking and partner affect were found. Additionally, female anxious affect positively predicted subsequent reassurance-seeking, and depression symptoms moderated this relation. Unexpectedly, the relation between anxious affect and reassurance-seeking was stronger among women with less severe depression symptoms. Our findings support integrated and revised theories of reassurance-seeking and underscore the need to further investigate reassurance-seeking behavior in real-time interactions. [ABSTRACT FROM AUTHOR]