J Abnorm Child Psychol DOI 10.1007/s10802-013-9828-7

Cognitive Vulnerabilities as Mediators between Emotional Abuse and Depressive Symptoms Patricia Padilla Paredes & Esther Calvete

# Springer Science+Business Media New York 2013

Abstract This study tested whether childhood parental emotional abuse and peer emotional bullying serve as antecedents of depression in adolescence and identified the cognitive mechanisms involved in this process. It was hypothesized that the experience of emotional abuse would predict depressive symptoms via development of rumination and negative inferences. A 3-wave longitudinal study was carried out with 998 adolescents (471 girls and 526 boys) between 13 and 17 years of age. Results showed that emotional abuse by parents and peers at Time 1 predicted a worsening of several cognitive vulnerabilities at Time 2. In addition, brooding mediated between the experiences of abuse and the increase of depressive symptoms at Time 3. Thus, findings suggest that the experiences of childhood emotional abuse by parents and peers serve as antecedents to develop a negative cognitive style, vulnerability that, once developed, is a risk factor for the onset of depressive symptoms in adolescence. Keywords Emotional abuse . Bullying . Adolescence . Rumination . Inferential styles . Depression Adolescence is a key period for the study of depression. This is due to the considerable increase in prevalence rates of depressive disorders occurring during this developmental period (Avenevoli et al. 2008; Costello et al. 2006; Costello et al. 2005). For example, Hankin and colleagues (1998) found that prevalence rates of depressive disorders increased from 3 % to 18 % between ages 15 and 18. One of the most important predictors of depression onset during adolescence and over the entire life span is to have suffered experiences of maltreatment by significant others at P. Padilla Paredes (*) : E. Calvete Department of Personality, Psychological Assessment and Treatment, University of Deusto, Apdo. 1, 48080 Bilbao, Spain e-mail: [email protected]

early ages (for a review, see Harkness and Lumley 2008). Specifically, of all the forms of maltreatment (sexual, physical, emotional, neglect), emotional abuse has been proposed to be the most relevant for the development of depression (Gibb et al. 2003; Gibb et al. 2007). Furthermore, diverse prospective studies reveal that childhood emotional abuse is the greatest predictor of the onset of episodes of clinical depression in early adulthood (Gibb et al. 2001; Hankin 2005; Liu et al. 2009; Spasojevic and Alloy 2002) and in childhood itself (Gibb and Alloy 2006). Specifically, some research has found that experiences of emotional abuse perpetrated by parents are associated with changes in depressive symptoms over time in children (Gibb and Abela 2008). However, although parental influence plays a relevant role in the development of affective disorders, peer experiences begin to gain importance throughout adolescence (Steinberg and Morris 2001). Likewise, the psychological consequences of peer bullying are as noteworthy as those of emotional abuse perpetrated by parents. In fact, a strong prospective association is found between peer victimization and forms of psychological maladjustment, particularly depression in community samples of youth and adults (Farrington et al. 2011; Gibb and Abela 2008; Gibb et al. 2007; Gibb et al. 2011; Liu et al. 2009; for a review, see Reijntjes et al. 2010). Few studies have examined the processes by which experiences of childhood abuse lead to development of depression. From the cognitive perspective, it is proposed that the processes by which children interpret, recall, organize and think about these negative events of abuse—that is, their cognitive styles—are the crucial paths connecting these experiences of abuse to psychological prognoses (Ingram 2003). In this context, some of the cognitive models proposed to explain the etiology of depression have incorporated the role played by such experiences of abuse in the origin of cognitive vulnerabilities to depression. Specifically, the present study explores

J Abnorm Child Psychol

the role of emotional abuse by parents and peers as antecedents of the development of the cognitive vulnerabilities proposed by two of the most influential cognitive models of depression: the hopelessness theory of depression (Abramson et al. 1989) and the response styles theory (RST; Nolen-Hoeksema 1991). The hopelessness theory posits that people who tend to attribute negative events to stable and global causes (attributional style) and to infer negative consequences (inferential style for consequences) and negative personality characteristics about the self (inferential style for self-characteristics) after the occurrence of negative events are at high risk for the onset of a subtype of depression called hopelessness depression. A large number of studies have shown that the inferential styles for causes, consequences, and selfcharacteristics predict the development of depression in clinical and nonclinical samples of adolescents (with inferential style for causes: Calvete 2011; Calvete et al. 2008; Carpentier et al. 2007; Cole et al. 2008; Hankin et al. 2001; Heilbron et al. 2008; Joiner 2000; Lee et al. 2010; Prinstein and Aikins 2004; Southall and Roberts 2002; with all three inferential styles: Abela et al. 2011; Hankin 2008a; Hankin and Abramson 2002). On the other hand, RST proposes that the way people respond to their symptoms will determinate symptom severity and duration. Specifically, people who tend to ruminate in response to their depressive symptoms are at high risk of increasing and maintaining their symptoms over time in comparison to people who use distraction or solve the problem. Ruminative response style refers to a contemplative and passive style that includes “behaviors and thoughts focusing the person’s attention on the depressive symptoms and their implications” (Nolen-Hoeksema 1991, p. 569). More recently, Treynor et al. (2003) have included the differentiation of two rumination components: brooding and reflection. Whereas brooding is a passive and contemplative attitude that compares the current situation with an unachieved situation from an outlook of lamentation and complaint, the component of reflection refers to an insight aiming to solve cognitive problems (Treynor et al. 2003). These ruminative response style components have been shown to relate differentially to depression. Namely, brooding is strongly associated with the prediction of depressive symptoms in community samples of adolescents (Burwell and Shirk 2007; Cova et al. 2009; Mezulis et al. 2011; Yang et al. 2010) and children (Gibb et al. 2012; Lopez et al. 2009; Verstraeten et al. 2011; Verstraeten et al. 2010). In contrast, results regarding the component of reflection are mixed. Whereas some studies with community samples of youth have found that reflection is prospectively associated with depression (Grassia and Gibb 2008; Mezulis et al. 2011)— albeit to a lesser extent than is brooding—other studies with children and adolescents have found no association between

these variables (Cova et al. 2009; Lopez et al. 2009; Verstraeten et al. 2011; Yang et al. 2010) or they have even found a negative association between levels of reflection and levels of depressive symptoms (Verstraeten et al. 2010). This has led to suggesting that this rumination component may be less maladaptive than brooding. The former models have included the role of early negative events, such as maltreatment, in the genesis of the depressogenic cognitive styles. Concerning the hopelessness theory, Rose ad Abramson (1992) proposed that when experiences of emotional abuse occur initially tends to make inferences to sustain hope, such as external, unstable, and specific attributions of the occurrence of abuse (e.g., “My dad was in a bad mood today”). But if the abuse is a chronic experience across different situations, these positive inferences are repeatedly disconfirmed, so the child will begin to consider the cause of abuse as stable and global, and to infer negative consequences and negative self-characteristics, such as “I am a bad boy”. Over time, the child may generalize this type of inferences to other negative events (e.g., flunking an exam, not having a girlfriend/boyfriend, etc.), developing as a result a stable, negative, inferential style that increases vulnerability to depressive episodes due to hopelessness. In general, the etiological extension of the hopelessness model (Rose and Abramson 1992) has obtained support for its diverse postulates (for an exception, see Leeson and Nixon 2011). Specifically, experiences of childhood emotional abuse are more strongly associated with the presence of a negative inferential style (Gibb 2002) and with negative changes in attributional style over time in community samples of children (Gibb et al. 2006) than other types of maltreatment (physical or sexual). Moreover, some studies have examined the independent contribution of experiences of emotional abuse by parents and peer bullying. The first study providing evidence of the existence of an independent contribution of each source of maltreatment was carried out by Gibb et al. (2004). In a sample of university students, they found that verbal peer bullying suffered before the age of 15 was significantly related to negative inferential style, whereas parental emotional abuse was significantly associated with the dysfunctional attitudes proposed by the model of Beck (1967). In the same vein, in a community sample of children tracked from birth until 11 years of age, Mezulis et al. (2006) also found a predictive relationship between peer victimization (sexual, relational, and direct) and development of negative inferential styles. Consistent with these results, in a community sample of children, mean age of 12 years, Gibb and Abela (2008) found that parental emotional abuse and verbal peer bullying were both significantly associated with prospective changes in inferential styles for causes and consequences, as well as with the weakest link (Abela and Sarin 2002) but not with inferential style for self-characteristics.

J Abnorm Child Psychol

The above studies indicate that experiences of emotional abuse are involved in the origin of inferential styles. Nevertheless, very few studies have examined whether inferential styles mediate the relationship between experiences of emotional abuse and depressive symptoms. For example, the results of two independent prospective studies performed by Hankin (2005) with community samples of young adults reported that inferential styles mediated the relationship between experiences of emotional abuse and subsequent development of depressive symptoms. Likewise, in a 6-month research of a community sample with 10- and 11-year-old children, Gibb and Alloy (2006), found that attributional style mediated the relationship between verbal victimization experiences and development of depressive symptoms. On the other hand, concerning the origin of ruminative response style, Nolen-Hoeksema (1991, 1998, 2004) also postulated that children who perceive low control over their environment are particularly at risk of engaging in ruminative response style. Maltreatment at early ages constitutes an outof-control context that is propitious for experiencing high levels of hopelessness and psychological symptoms leading to development of passive coping strategies such as rumination. Nevertheless, even considering the important role of rumination in the course of depression, empirical research has paid remarkably little attention to the origins of such cognitive vulnerability. The scarce studies exploring the origin of this response style have found that the tendency to ruminate partially mediates the association between an emotional abuse history and the prospective onset of depression acros two and a half years in a sample of university students (Spasojevic and Alloy 2002). Likewise, congruent results were found in the study of Barchia and Bussey (2010) in a community sample of adolescents between 12 and 15 years, indicating that the relationship between peer bullying experienced at the start of the study and level of depression displayed 8 months later was partially mediated by a ruminative response style. More specifically, studies differentiating between the two rumination components have found that brooding partially mediates the relationship between experiences of emotional abuse and depressive symptoms in a sample of university students, mostly female (Raes and Hermans 2008). Although the above-mentioned studies have contributed valuable results about the origin of cognitive vulnerabilities, this prior research has important limitations. The first limitation is that only a few studies have formally assessed whether inferential styles and response styles mediate the relationship between experiences of emotional maltreatment and increased depressive symptoms (e.g., Barchia and Bussey 2010; Gibb and Alloy 2006; Hankin 2005). Assessment of the mediational hypothesis implies taking measures at least in three waves to examine whether experiences of maltreatment at Time 1 (T1) predict worsening of inferential styles and response styles at Time 2 (T2), and whether these, in turn, predict an increase of

depressive symptoms at Time 3 (T3). A second limitation of prior research is that very few studies have simultaneously examined the contribution of parental emotional abuse and of bullying by peers as antecedents of the described cognitive vulnerabilities. Moreover, the majority of the previous studies have assessed only the attributional component or a general construct of inferential style. However, findings from some studies suggest that each component may play a different role as predictors of depression (e.g., Calvete et al. 2008) and that the origin of each component may be different (Gibb and Abela 2008). Furthermore, most studies have focused on the inferential styles as mediator mechanisms between maltreatment and depression, and very few studies have examined the role of the two components of rumination: brooding and reflection. Therefore, the main goal of this study is to assess the role of experiences of emotional abuse by parents and peers as antecedents of inferential styles (inferential style for causes, consequences, and self-characteristics) and the two rumination components (brooding and reflection), and how such cognitive vulnerabilities, in turn, predict subsequent development of depressive symptoms in a community sample of adolescents. We expected that the antecedents of emotional abuse measured at T1 would predict inferential styles for causes, consequences, and self-characteristics as well as the two components of rumination (brooding and reflection) measured at T2. Grounded on previous research, we expected that, in particular, inferential styles for causes and brooding, in turn, would predict depressive symptoms at T3, as shown in Fig. 1.

Method Participants A community sample of 1,316 adolescents from seven schools of Bizkaia (Basque Country, Spain) participated at T1 of the study, which was conducted at the beginning of the school term. Of them, 591 were girls (45 %) and 723 were boys (55 %). Ages ranged between 13 and 17 years, (M age =13.42; SD age =1.30). We used a convenience sample in which educational levels and their proportions represented the population. Socioeconomic level was determined from parents’ educational levels and professions, according to the criteria of Arias et al. (2004). Distribution of levels was as follows: 19.1 % low level, 17.5 % medium-low level, 25.8 % medium level, 18.7 % medium-high level, and 18.6 % high level. Of the 1,316 adolescents who began the study, a total of 998 (471 girls and 526 boys) also participated at T3 (survival rate=75.83 %). No significant differences were found in any variable of the T1 study between adolescents who remained in the study and those who dropped out.

J Abnorm Child Psychol Fig. 1 Hypothesized model of cognitive styles as mediators of the relationship between experiences of parental emotional maltreatment and of bullying and depressive symptom

T3 depressive symptoms

T2 depressive symptoms

T2 inferences for causes

T2 inferences for causes

T2 inferences for consequences

T2 inferences for consequences

T3 depressive symptoms

T1 Abuse by parents

T2 inferences for the self

T2 inferences for the self

T1 Abuse by peers

T2 brooding

T2 reflection

Measures To assess emotional abuse by parents, we adapted the Emotional Abuse Scale of the Conflict Tactics ScalesParent-to-Child version (CTS-PC; Straus et al. 1998) to Spanish. This scale is made up of six items (e.g., “At home, my mother or my father makes me feel worthless”). Participants indicate the frequency with which these experiences have occurred in their lifetime, on a 4-point response scale, ranging from 1 (Has not occurred) to 4 (Occurs very often). The psychometric characteristics of this measure have proven to be adequate (Straus and Hamby 1997) and the factor structure of the scale has been confirmed in Spanish adolescents (Calvete in press). Specifically, in this study, an alpha coefficient of 0.77 was obtained at T1. To measure emotional abuse by peers, we adapted the 6 items from the Victimization Scale of the Peer Relations Questionnaire for Children (PRQ, Rigby and Slee 1993). Within the Victimization Scale are statements such as: “At school or at the institute, they pick on me”. Participants indicate the frequency with which this type of experience has occurred on a 4-point response scale, ranging from 1 (Has not occurred) to 4 (Occurs very often). In this study, only items describing verbal victimization were used. Studies have shown this questionnaire to be a well established measure of the experience of bullying, with good validity and reliability (Bond et al. 2007). In this study, internal consistency was 0.84.

T2 brooding

T2 reflection

For the assessment of the two components of rumination (brooding and reflection), we used the adaptation to Spanish adolescents carried out by Padilla and Calvete (2011) of the Ruminative Responses subscale from the Children’s Response Styles Scale (CRSS; Ziegert and Kistner 2002). The Spanish adaptation of the Ruminative Responses subscale has 10 items on which participants indicate the extent to which each statement reflects what they usually do when they feel bad, on a 4-point scale ranging from 1 (Almost never) to 4 (Almost always). An example item is: “I think back to other times when I felt this way”. The Spanish adaptation also confirmed a factor structure consisting of the two rumination factors, Brooding (5 items) and Reflection (5 items), with good psychometric properties and an alpha coefficient of 0.84 for the total Rumination Scale, and coefficients of 0.77 and 0.69, respectively, for the subscales of Brooding and Reflection (Padilla and Calvete 2011). In this study, Cronbach alpha coefficients at T1 were 0.77 and 0.69, respectively, for Brooding and Reflection subscales, and at T2, Cronbach alpha coefficients were 0.70 and 0.78. To assess negative inferential styles, we used the Spanish version of the Adolescent Cognitive Style Questionnaire (ACSQ; Hankin and Abramson 2002) adapted by (Calvete et al. 2007) to Spanish adolescents. Adolescents are instructed to imagine a series of scenarios (e.g., “You get a poor grade in an exam;” “You are not invited to a birthday party to which several friends are invited”). Next, participants must indicate

J Abnorm Child Psychol

the degree to which, for them, the cause of this event is internal, stable, and global; the likelihood that future negative consequences will derive from this event; and the degree to which they think that this event shows that they failed as persons. The response scale ranges between 1 and 7, with higher scores indicating a more negative or hopeless cognitive style. The adaptation to Spanish of this self-report has shown excellent reliability, a structure consistent with the theory, and good validity (Calvete et al. 2007). Likewise, many longitudinal investigations have shown the validity of the hopelessness theory, using the ACSQ as an adequate measure to assess negative inferential styles (e.g., Calvete 2011). Specifically, in the present study, at T1, alpha coefficients of 0.81, 0.79, and 0.71 were obtained, and at T2, alpha coefficients of 0.84, 0.81, and 0.80 were obtained for inferences for causes, for consequences, and for self-characteristics, respectively. The Depression Scale of the Epidemiological Studies Center (CES-D; Radloff 1977) was used to measure depressive symptoms. The items of this scale include symptoms associated with depression identified in the clinical literature and in factorial studies, such as depressive mood, feelings of guilt, and lack of self-worth, feelings of helplessness and hopelessness, psychomotor retardation, lack of appetite and sleeping problems. This scale contains 20 statements that are rated on a 4-point scale, ranging from 1 (Practically never) to 4 (Almost all the time), according to whether the adolescent has experienced them in the past month. Previous studies with the Spanish version of this scale indicate excellent psychometric properties in adolescents (Calvete and Cardeñoso 1999). Mild depressed mood is indicated by a score of 16– 22, moderate depressed mood is indicated by a score of 23– 27, and scores of 28 or higher indicate severe depressed mood consistent with major depressive disorder (Radloff 1991). In this study, the alpha coefficient at T1 was 0.85, and at T2 and T3, 0.88. Procedure The Ethics Committee of the University of Deusto approved this study. Various schools from the province of Bizkaia (Spain) were contacted, providing them with information about the characteristics of the study. After gaining approval of the school directors, the school staff sent the parents an informed consent form, including a file with the questionnaires, allowing them to refuse to let their adolescent children participate in the study. None of the parents refused to let their children participate. Test administration was carried out in groups by members of the research team during normal school hours. The researchers first informed the students about the goals of the investigation, its voluntary and confidential nature, finally providing instructions to complete the questionnaires. The battery of self-reports at T1 included measures of

childhood experiences of maltreatment in the family, experiences of bullying, cognitive styles, and symptoms of depression. At T2, we assessed cognitive styles and symptoms of depression, and at T3, we again assessed symptoms of depression.

Results Descriptive statistics and correlations of the target variables Table 1 shows the descriptive statistics and correlations between the variables of the study. All the associations were significant at p< 0. 001. The prevalence of moderate depressed mood (cutoff score > 23 on the CESD) was 21.1, 17.9, and 16.7 % at T1, T2, and T3, respectively. The prevalence of severe depressed mood (cutoff score > 28) was 12, 10, and 10.1 % at T1, T2, and T3, respectively. Cognitive vulnerabilities as mediators between victimization and depressive symptoms The models were tested via maximum likelihood (ML) estimation with LISREL 8.8 (Jöreskog and Sörbom 2007). Following the recommendations of several authors (Hu and Bentler 1999), goodness of fit was evaluated using the comparative fit index (CFI), the nonnormative fit index (NNFI), and the root mean square error of approximation (RMSEA). Generally, CFI and NNFI values of 0.90 or higher reflect a good fit. In addition, RMSEA values lower than 0.06 indicate excellent fit, whereas values between 0.06 and 0.08 indicate acceptable fit. The hypothesized structural model is presented in Fig. 2 and includes measures of emotional abuse by parents and peers, inferential styles (for causes, consequences, and self), rumination (brooding, and reflection), and depressive symptoms. The model includes autoregressive paths between depressive symptoms at T1, T2, and T3, and autoregressive paths between the cognitive vulnerabilities at T1 and T2. These autoregressive paths represent the stability of the latent variables over time. Moreover, it includes paths from T1 emotional abuse by parents and peers to T3 depressive symptoms and T2 cognitive vulnerabilities, and paths from T2 cognitive vulnerabilities to T3 depressive symptoms. Finally, cross-sectional associations among all variables at T1 were included in the model in order to control overlapping among variables. The fit indexes were excellent for the model, χ 2(646, n =998)=2,843, χ 2/df =4.4, RMSEA=0.062 (90 % Confidence Interval-CI: 0.059, 0.064), NNFI =0.97, CFI= 0.97, SRMR=0.08. All autoregressive paths were significant. Emotional abuse by parents predicted T2 inferences for causes, inferences for the self, and brooding, and T2 brooding, in turn, predicted T3 depressive symptoms. The direct path between emotional abuse by peers and depressive symptoms

J Abnorm Child Psychol Table 1 Descriptive statistics and correlations between variables of the study

1. Parental emotional abuse T1 2. Peer emotional abuse T1 3. Brooding T1 4. Brooding T2 5. Reflection T1 6. Reflection T2 7. Inferences for Causes T1 8. Inferences for Causes T2 9. Inferences for Consequences T1 10. Inferences for Consequences T2 11. Inferences for Self T1 12. Inferences for Self T2 13. Depressive Symptoms T1 14. Depressive Symptoms T2 15. Depressive Symptoms T3 Mean SD

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

– 0.21 0.29 0.27 0.27 0.22 0.24 0.25 0.31 0.23 0.19 0.18 0.35 0.31 0.27 3.27 3.17

– 0.24 – 0.22 0.52 – 0.20 0.66 0.45 – 0.21 0.43 0.68 0.56 – 0.13 0.31 0.28 0.31 0.23 – 0.11 0.30 0.31 0.26 0.26 0.54 – 0.17 0.33 0.28 0.29 0.24 0.69 0.47 – 0.16 0.24 0.26 0.20 0.23 0.39 0.70 0.53 – 0.16 0.30 0.25 0.30 0.22 0.57 0.37 0.53 0.35 – 0.17 0.29 0.27 0.25 0.24 0.38 0.64 0.36 0.58 0.43 – 0.31 0.53 0.36 0.53 0.37 0.30 0.28 0.32 0.26 0.30 0.28 – 0.27 0.37 0.51 0.39 0.52 0.27 0.38 0.30 0.39 0.24 0.33 0.58 – 0.25 0.31 0.40 0.34 0.41 0.26 0.30 0.28 0.30 0.21 0.38 0.52 0.65 – 1.54 11.15 11.15 10.86 10.90 66 67.33 16.34 16.49 21.80 21.37 12.48 11.27 11.33 2.35 3.10 3.20 3.52 3.63 17.28 18.23 7.12 7.49 9.12 9.46 5.55 5.62 5.73

All correlation coefficients were significant at p

Cognitive vulnerabilities as mediators between emotional abuse and depressive symptoms.

This study tested whether childhood parental emotional abuse and peer emotional bullying serve as antecedents of depression in adolescence and identif...
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