Child Psychiatry Hum Dev DOI 10.1007/s10578-013-0416-4

ORIGINAL ARTICLE

Depressogenic Thinking and Shame Proneness in the Development of Internalizing Problems Rosemary S. L. Mills • Paul D. Hastings • Lisa A. Serbin • Dale M. Stack • John R. Z. Abela Kimberley A. Arbeau • Debra I. K. Lall

•

Ó Springer Science+Business Media New York 2013

Abstract This study examined depressogenic thinking and shame proneness as factors in the development of internalizing problems in a longitudinal sample of 174 children (99 boys, 75 girls). At 7.6–9.4 years of age (Time 1), mothers assessed general internalizing problems in their children and depressogenic thinking, shame proneness, and anxiety were assessed by child self report. At 10.2–11.8 years of age (Time 2), mothers reassessed internalizing problems, and children reported their anxiety and depression. At 12.3–13.1 years of age (Time 3), children who had been high on any Time 2 measure of internalizing problems were selected for assessment of anxiety and depressive disorders. Depressogenic thinking and shame were significantly correlated and predicted subsequent problems. Depressogenic

thinking predicted internalizing problems and anxious and depressive symptoms. Shame directly predicted boys’ depressive symptoms, and indirectly predicted boys’ general internalizing problems and girls’ social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. Findings suggest that both shame and depressive thinking contribute to the development of children’s internalizing problems. Keywords Children’s internalizing problems
Depression
Anxiety
Depressogenic thinking
Shame proneness

Introduction R. S. L. Mills (&) Department of Family Social Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada e-mail: [email protected] P. D. Hastings Center for Brain and Mind, University of California, Davis, Davis, CA, USA L. A. Serbin
D. M. Stack Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, PQ, Canada J. R. Z. Abela Department of Psychology, Rutgers University, Piscataway, NJ, USA K. A. Arbeau Department of Family Social Sciences, University of Manitoba, Winnipeg, MB, Canada D. I. K. Lall Department of Psychology, University of Manitoba, Winnipeg, MB, Canada

Internalizing problems are the most common form of maladjustment in children and youth, affecting 14–18 % of young people [1]. These problems are social and emotional difficulties characterized by overcontrolled behavior and inner-directed symptoms comprised of anxiety, depressed mood, and negative self-beliefs. They emerge early in childhood, are relatively stable across the school years, and often increase and evolve into anxiety disorders and/or depression during adolescence [2–4], with anxiety often preceding and predicting subsequent depression [2, 5]. Researchers and clinicians have emphasized the need for more investigation of how internalizing problems develop, worsen, and evolve into specific disorders [6–8]. Cognitive and emotional vulnerabilities have been posited as key mechanisms in the worsening of symptoms and, eventually, emergence of diagnosable disorders. In the present study, we sought to determine whether negative self-beliefs and emotions would predict worsening internalizing problems

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and differentially predict whether they take the form of anxiety or depression. Anxiety and depression frequently co-occur [1]. Efforts to understand the link between them have led to the recognition that they have both overlapping and distinct features. According to the tripartite model [9, 10], anxiety and depression share a general distress factor in common and can be distinguished by the absence of positive affect that is relatively unique to depression and the presence of somatic tension and arousal that is relatively unique to anxiety. Research seeking to distinguish them further in terms of their core affects and associated cognitive content is important in delineating the likely developmental course of internalizing problems and their differentiation into anxiety and/or depression [2, 11, 12]. For example, there is recent neurobiological evidence that depression involves an affective bias specifically involving sadness, as seen in unipolar depressed patients’ elevated bilateral amygdala response to sad faces, but not fearful faces [13]. It has been suggested that as socialization shapes children’s cognitiveaffective processes, generalized internalizing problems may begin to refine into the features of anxiety and depression through the development of distinct cognitiveaffective biases that moderate the developmental trajectory of internalizing problems [14–16]. Depressogenic thinking may be an important vulnerability factor in internalizing pathways. Cognitive vulnerability models of depression suggest that negative cognitive styles increase susceptibility to the depressogenic effects of negative events by biasing the interpretation of these events and generating depressive affect [17–19]. According to one major theory [18], three negative cognitive styles engender a sense of hopelessness about the possibility of improving adverse circumstances and serve as a proximal sufficient cause of depression: the tendency to make global and stable attributions about negative events, the tendency to perceive negative events as having disastrous consequences, and the tendency to view the self as flawed or deficient following negative events. For adolescents and adults, hopelessness theory has been supported by evidence linking these three styles to increases in depressive symptoms [18, 20]. Hopelessness theory appears to be applicable to children as well. Children are capable of these maladaptive inferential styles by middle childhood. This is a period of major advances in self-cognition, with self-conceptions becoming more abstract, differentiated, stable, and realistic [21]. Children begin to view themselves in less concrete and allor-none terms and more in abstract and differentiated ways, and they learn to evaluate themselves more realistically by comparing themselves against standards and expectations. The failure to construct a positive view of the self during this period is likely to contribute to a negative cognitive style that begins to operate when children encounter

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stressors. Although there has been mixed support for hopelessness theory in younger populations, particularly for causal attributional style [22], there is consistent support for the other two negative cognitive styles: the tendency to perceive negative events as having disastrous consequences, and the tendency to view the self as flawed or deficient following negative events. In prospective studies of children in the third grade, these inferences contributed to elevations in depressive symptoms following elevations in stress [23, 24]. In the present study we expected that a depressogenic style of thinking about consequences both general and specific to the self in middle childhood would predict an increase in children’s internalizing problems between middle and late childhood and heighten the risk of disorders in early adolescence. Further, we expected that depressogenic thinking would predict increases in both anxiety and depressive symptoms. According to the tripartite model [9], depressogenic thinking would magnify the general distress common to both disorders, leading to an increase in both anxious and depressive symptoms. Shame proneness may be another important vulnerability factor in internalizing pathways. Shame involves a feeling of inferiority or defectiveness as a person. Cognitive theories suggest that shame is precipitated by a global negative self-attribution [25–27]. Occasional or short-lived states of shame are adaptive, helping to protect social relationships by eliciting an image of disapproval or rejection and motivating efforts to avoid rejection [28, 29]. A trait or disposition to respond with shame, on the other hand, is likely to be maladaptive. In states of shame, children tend to focus attention on images of devaluation and rejection by others and associated feelings of helplessness and hopelessness about the self. Continual experiences of shame may reinforce these images and feelings over time, strengthening them and increasing the risk of disturbance. According to the tripartite model [9], shame would exacerbate the general distress common to depression and anxiety, leading to an increase in both anxious and depressive symptoms. There has been limited research assessing the extent to which shame predicts internalizing problems in preadolescents [30]. All but one study [31] has combined preadolescents and adolescents, making it difficult to draw precise conclusions about the magnitude of the relation prior to adolescence. Moreover, most studies have employed a cross-sectional design, limiting conclusions about the causal relations that may exist between shame and internalizing problems. An association between shame and depressive symptoms has been found in both adults [32] and adolescents [30], and there is evidence that it also exists in middle childhood [31]. Shame may also be associated with anxiety, particularly social anxiety. The image

Child Psychiatry Hum Dev

of an actual or imagined disapproving other is a core feature of shame [25]. It has been suggested that shame is a key signal of threat to social acceptance, esteem, or status and plays an important role in the mobilization of responses to social threats [33]. As such, shame is likely to be both a cause and an effect of social anxiety. Although we know of no research on the association between shame and social anxiety in children, there is evidence for a link in adults [34, 35]. In a clinical sample of young adults with anxiety disorders, some specificity of relations was shown by the finding that shame proneness was related to symptoms of social anxiety disorder and generalized anxiety disorder after controlling for other types of anxiety disorder symptoms and for depression [36]. Several studies of adolescents have linked social evaluative threat with anxiety diagnoses, although the specificity of the link to social anxiety disorder is unclear from these studies [37]. In the present study, we examined prospectively the extent to which shame proneness in middle childhood would predict an increase in children’s internalizing problems between middle and late childhood and heighten the risk of disorders in early adolescence. We expected that shame would specifically predict depression and social anxiety. We also examined the extent to which depressogenic thinking and shame proneness are associated with one another in middle childhood. They may be construed as cognitive and affective sides of the same coin—a maladaptive cognitive-affective style that heightens vulnerability to internalizing problems. According to theories of shame [25–27, 33], a disposition to respond to negative events with shame will contribute to an aversive and painful sense of hopelessness and rejection which may lead to the use of maladaptive coping strategies that heighten the risk of psychological disorders. Thus, in the developmental process of shame and depressogenic thinking becoming integrated components of a general cognitive style, one might set the stage for, or increase the likelihood of, the other. Although the two components have been linked in adolescence [38], the strength of their concurrent association in preadolescence has not previously been assessed. In summary, the purpose of this study was to assess the extent to which depressogenic thinking and shame proneness would contribute to worsening internalizing problems in late childhood and diagnosed disorders in early adolescence. In addition, we examined gender differences in the extent to which depressogenic thinking and shame proneness would predict worsening internalizing problems. Rates of internalizing problems begin to differ by gender in adolescence when girls show more anxious and depressive symptoms than boys [e.g., 2, 4, 39]. For example, in a national community-based sample of internalizing trajectories in Canadian children aged 10–15 [39], at around age

13 trajectories showed an increase in the rate of internalizing problems for girls and a decrease for boys. The divergence in rates in adolescence has been attributed to gender differences in cognitive vulnerabilities that emerge prior to adolescence [40, 41]. However, there has been a lack of research examining gender differences in depressogenic thinking and shame proneness and the extent to which they predict internalizing problems prior to adolescence.

Methods Sample The study was carried out with a community sample of typically developing children. The sample originally included 252 children (141 boys, 111 girls) and their parents who volunteered to participate in a longitudinal study that began when the children were between 3.6 and 4.5 years (M = 4.09 years, SD = 0.27). Of the original sample, 180 returned when children were between 7.58 and 9.42 years (M = 8.12 years, SD = .28), and depressogenic thinking, shame proneness and internalizing problems were assessed; this is Time 1 for the present analyses. Then, 138 returned when children were between 10.17 and 11.83 years (M = 10.96 years, SD = .40), and internalizing problems were reassessed; this is Time 2 for the present analyses. At Time 1, 14 % of the children were in the borderline to clinical range of internalizing problems; at Time 2, the comparable proportion was 12 %. The present analyses were performed with 174 children (99 boys, 75 girls) for whom there were data on at least three of the key predictor and criterion variables, and missing values were handled by using multiple imputation (see data preparation section below). Finally, 50 children were selected for a follow-up diagnostic interview in early adolescence, of whom 39 (25 boys, 14 girls; M = 13.14 years, SD = .32) participated; this is Time 3 for the present analyses. Families with young children living in a Canadian city were recruited with the assistance of a provincial health administrative agency, through letters of invitation mailed to a randomly selected sample of all families living in the area with a child between 3.0 and 4.9 years at the time of recruitment. The 252 participating families were all English-speaking, predominantly married or cohabiting (89 % of mothers, 96 % of fathers), employed (93 % of fathers, 41 % of mothers), had a postsecondary trades or community college certificate (48 % of mothers, 43 % of fathers) or an undergraduate degree (35 % of mothers, 30 % of fathers), and had a family income over $40,000/year (73 %). The sample was 75 % Caucasian and 25 % other races and ethnicities (First Nations, Black, Asian). Attrition

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analyses indicated that children who continued to participate at Time 2 did not differ from those who discontinued after Time 1 on any of the demographic or study variables. A composite measure of Time 1 family socioeconomic status was created by standardizing and then averaging measures of mother’s education, father’s education, family income, and highest occupational prestige in the family [42]. Families that continued to participate at Time 2 did not differ significantly in socioeconomic status from those that withdrew at that time point. Procedures Parents provided informed consent for their own and their child’s participation in the procedures. Children provided their verbal assent and, beginning in middle childhood, their written consent as well. At each time point, families received an honorarium and children were given a small gift. At Time 1, the instruments were administered during an assessment that involved mailed questionnaires that parents were asked to complete independently, including a measure of internalizing problems. This was followed shortly thereafter by a laboratory visit in which the child was administered measures of internalizing problems, depressogenic thinking, and shame proneness by a researcher in a private room. After the visit, teachers were mailed a questionnaire assessing internalizing problems to complete and return by mail. At Time 2, internalizing problems were reassessed. At Time 3, diagnostic interviews with both child and mother were conducted to assess anxiety and depressive disorders in children with a high score (above the clinical cut-off or, in the case of subscales, at least one standard deviation above the normed mean) at Time 2 on any measure of internalizing problems. Measures Parent and Teacher Assessments of Internalizing Problems at Time 1 and Time 2 Internalizing problems were assessed by mothers, fathers, and teachers using the Child Behavior Checklist 6-18 version [CBCL; 43]. Complete data were available for mother assessments at Time 1 and Time 2, whereas father and teacher assessments could not be obtained at Time 1 for 20 and 27 % of the sample, respectively, and at Time 2 for 18 and 25 % of the sample, respectively. To limit missing data, mother assessments were used in the prediction of internalizing problems at Time 2, but assessments by all three sources were used to screen children for the diagnostic interview at Time 3.

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The CBCL is the most widely-used tool for assessing internalizing problems. It has good reliability and validity. The internalizing problems scale is comprised of 32 items rated from 0 (not true as far as you know) to 2 (very true or often true). At Time 1 and Time 2, respectively, alphas for mother reports were .87 and .90 for girls, and .81 and .87 for boys. At Time 2, alphas for father and teacher reports were .83 and .84 for girls, and .76 and .89 for boys, respectively. Total scores were obtained by summing ratings of the items and converting to T scores derived from population norms established separately for girls and boys. Child Self-report of Anxiety and Depressive Symptoms at Time 1 and Time 2 Children completed measures of general and social anxiety at both Time 1 and Time 2, and a measure of depressive symptoms at Time 2 only. The Revised Children’s Manifest Anxiety Scale [RCMAS; 44] is a self-report measure designed for children and adolescents aged 6–19 years. The scale includes 28 items assessing physiological anxiety, worry/oversensitivity, and social concerns (e.g., others seem to do things easier than I can; I feel that others do not like the way I do things) [45]. Children responded to each item by circling yes (1) or no (0) to indicate whether they thought the statement was true about them. The scale has an interval test–retest reliability of .68 and has been validated against the State-Trait Anxiety Inventory for Children [46]. For the overall scale, alphas were .88 and .89 for girls and boys, respectively, at Time 1, and .87 and .91 for girls and boys, respectively, at Time 2. An overall score was computed by averaging the 28 item scores (possible range 0–1). A measure of children’s social anxiety symptoms at Time 2 was obtained using the Spence Children’s Anxiety Scale [SCAS-P; 47]. Children reported on their social anxiety symptoms, using the 6-item social phobia subscale of the measure. For each of 6 items, children rated the frequency of symptoms (e.g., I worry what other people think of me) on a 4-point scale (0 = never; 1 = sometimes; 2 = often; 3 = always). An overall score was computed by averaging the items in the subscale (possible range 0–3; alpha = .73 for girls, .79 for boys). A measure of Time 1 social anxiety was provided by the 7-item social concern and concentration subscale of the RCMAS (e.g., I feel someone will tell me I do things the wrong way) (possible range 0–1; alpha = .68 for girls, .71 for boys). The Children’s Depression Inventory [CDI; 48] was administered at Time 2 only. It consists of 27 items assessing the cognitive, affective, and behavioral symptoms of depression. The CDI is one of the most widely used self-report measures of depressive symptoms in children [49]. It has been shown to have moderately good test–retest

Child Psychiatry Hum Dev

reliability and a high level of internal consistency [50]; in the present study, internal consistency was high (alpha = .85 for girls, .86 for boys). In addition, the CDI accurately distinguishes children with major depressive disorders from non-depressed children [50]. Total scores were obtained by summing the items and converting to T scores derived from population norms. Diagnostic Interview to Identify Anxiety and Depressive Disorders at Time 3 Children scoring high on any measure of internalizing problems at Time 2 were followed up 2 years later to assess anxiety and depressive disorders through diagnostic interviews conducted with mother and child separately. Children were identified for follow-up if at Time 2 they had an elevated score on the CBCL (a T score above 64 on the basis of mother, father, or teacher ratings), the CDI (a T score above 19), or the RCMAS (a total score above 18, a score above 6 on the Physiological Anxiety subscale, a score above 8 on the Worry/Oversensitivity subscale, or a score above 4 on the Social Concern and Concentration subscale). Using these screening criteria, 50 children were selected, of whom 45 could be reached about participating and, of these, 39 agreed to be interviewed. On average, interviews were administered 5 years (Mean = 5.04 years; SD = .44 years) following the assessment of depressogenic thinking and shame proneness (Time 1). Interviews were administered over the telephone, a method that has been shown to be reliable [51]. As expected, those who met the screening criteria had scored significantly higher on the Time 2 internalizing measures (generalized internalizing problems, general and social anxiety, and depressive symptoms) compared to those who did not meet the criteria; smallest t(136) = 4.33, p \ .001. Interviews consisted of two parts. The Anxiety Disorders Interview Schedule for Children for DSM-IV [ADISC-IV; 52] is designed to assess anxiety disorders experienced by children and adolescents according to DSM-IV criteria. It consists of two semi-structured clinical interviews that are conducted separately with a child and their parent(s). The ADIS-C-IV explores the frequency and intensity of symptoms and assists clinicians in identifying which diagnostic criteria are met by the child. Each diagnosis is rated by clinicians on a 9-point scale of severity (0–8). These ratings are used to assign a principal diagnosis, representing the disorder currently causing the most life interference, and secondary diagnoses that include all other disorders for which criteria are met. The Schedule for Affective Disorders and Schizophrenia for School-Age Children [K-SADS; 53]. The K-SADS is a semi-structured clinical interview designed to arrive at DSMIV diagnoses in a consistent way using Research Diagnostic

Criteria [54, 55], a set of inclusion and exclusion criteria developed to improve the reliability of psychiatric research. The K-SADS is administered separately to the child and the parent. A summary diagnosis is based on both sets of information. The K-SADS has been shown to yield reliable diagnoses of depressive disorders [56] and is frequently used in clinical studies of depression in children [57, 58]. Of the 39 children administered the interview, 36 % (n = 14) had one or more diagnoses. The criteria for diagnosis of an anxiety disorder were met by 36 % of girls (n = 5) and 36 % of boys (n = 9), 5 of whom (2 girls, 3 boys) also met the criteria for a depressive disorder. Of the 14 anxiety diagnoses, 9 were based on the child interview and 5 were based on interviews with both child and mother; in all but 4 of the diagnoses, the criteria for social phobia were met (often comorbid with other anxiety disorders). Of the 5 depression diagnoses, 2 were based on the child interview, 2 were based on the mother interview, and 1 was based on interviews with both child and mother. Depressogenic Thinking at Time 1 Children were administered the Children’s Cognitive Style Questionnaire[CCSQ; 59], a measure of depressogenic cognitive style that assesses the tendency to catastrophize the consequences of negative events and the tendency to view oneself as flawed or deficient following negative events. Studies of its reliability and validity for school-age children indicate that the measure is internally consistent, stable over time, and correlates with depressive symptoms [59, 60]. Children are asked to imagine each of 24 hypothetical negative events happening to them. In response to the first 12 vignetttes (e.g., Your friend is mad at you; You are on stage in the school play and you forget your lines), children choose from four responses describing their expectations: (a) this won’t cause other bad things to happen to me, (b) this might cause other bad things to happen to me; (c) this will cause other bad things to happen to me, and (d) this will cause many terrible things to happen to me. Each choice is assigned a score from 0 to 3, with higher scores indicating a greater tendency to catastrophize the consequences of negative events. In response to the last 12 vignettes (e.g., Your teacher gives a lesson and you don’t understand it; You’re the last person to be picked on a team in gym class), children choose from three responses describing their self-evaluations: (a) this does not make me feel bad about myself, (b) this makes me feel a little bad about myself, and (c) this makes me feel very bad about myself. Each choice is assigned a value from 0 to 2, with higher scores indicating a greater tendency to view the self as flawed or deficient following negative events. On average, overall scores were at or close to 1 for catastrophizing (might cause other bad things to happen to me) and

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below 1 for negative self-evaluations (makes me feel a little bad about myself). Examined together, the 24 items demonstrated strong internal consistency as indicated by alphas of .80 and .83 for girls and boys, respectively. Correlations between the subscores for catastrophizing and negative self-evaluation were .28 and .42 for girls and boys, respectively, larger p = .024. Therefore, a single overall index of depressogenic thinking concerning the self was created by standardizing each subscore and then averaging the two standard scores. Proneness to Shame at Time 1 Children’s shame proneness was assessed using the Test of Self-Conscious Affect [TOSCA-C; 61], a scenario-based measure for children 8–12 years of age comprised of potentially shame- and/or guilt-inducing everyday situations (e.g., making a mistake, damaging someone’s property, failing at something), each followed by situationspecific phenomenological descriptions of affective, cognitive, or behavioral responses capturing shame (negative self-feeling or judgment, desire to hide), guilt (remorse, repair), externalizing (blaming other person or situation), detachment (unconcern), pride in one’s self, and pride in one’s behavior. Respondents imagine themselves in each situation and rate the likelihood of each response on a 5-point scale (1 = not at all likely; 2 = unlikely; 3 = maybe (half & half); 4 = likely; 5 = very likely). The TOSCA-C has good internal consistency [61, 62] and studies showing that scores on the shame scale correlate with various psychological symptoms in school-age children, including low self-esteem [63], depressive symptoms [31], and internalizing problems [64], suggest that it measures maladaptive shame in middle childhood. A measure of shame proneness was created using the shame and guilt scores that were computed from children’s responses to nine negative scenarios. Alphas for shame and guilt, respectively, were .70 and .59 for girls and .78 for both shame and guilt for boys. Scores were computed by averaging responses across scenarios. On average, the likelihood of shame was low (2.57 and 2.24 on a 5-point scale) and the likelihood of guilt was somewhat higher (4.13 and 3.95 on a 5-point scale) for girls and boys, respectively. This pattern of differences involving higher scores for guilt than for shame has consistently been found in research with the TOSCA from middle childhood onward [38, 62, 65] and may reflect the TOSCA’s emphasis on maladaptive shame associated with self-criticism and adaptive guilt associated with reparative behavior. Because the two measures tend to be related in opposite directions to other variables [66], they are believed to operate as cooperative suppressors [66, 67]. As such, their power to predict other variables improves when their common variance is removed [66, 68].

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Accordingly, shame proneness was measured by computing a residual score (unstandardized) in which the variance attributable to guilt was removed from the shame score. Data Preparation Prior to analysis, the distributional properties of the variables were examined. Several variables deviated somewhat from normal and were normalized using either a rank transformation (Time 1 raw guilt score, Time 2 depressive symptoms) or a square-root transformation (Time 2 social anxiety). Several outliers were detected and were changed to the closest value that was not an outlier to reduce their influence. Missing values were found for measures of Time 1 depressogenic thinking (girls 11.8 %, boys 22.2 %), shame scores (girls 6.6 %, boys 10.1 %), guilt scores (girls 11.8 %, boys 9.1 %), mother-reported internalizing problems (girls 9.2 %, boys 6.1 %), and child-reported general and social anxiety (girls 6.6 %, boys 10.1 %), and measures of Time 2 mother-reported internalizing problems (girls 19.7 %, boys 23.2 %) and child-reported general anxiety (girls 19.7 %, boys 23.2 %), social anxiety (girls 18.4 %, boys 23.2 %) and depressive symptoms (girls 19.7 %, boys 25.3 %). Given the sample size, the amount of missing data was within the recommended limits for effective multiple imputation [69]. Little’s [70] omnibus test of data missing completely at random indicated that the pattern of missing data did not deviate significantly from randomness, ps = .34 and .10, for girls and boys, respectively. To avoid losing power and biasing parameter estimates, we performed the analyses without excluding any cases, using multiple imputation to handle missing values [e.g., 71]. The analyses were performed on each of 5 imputed datasets, and the results were pooled through averaging into a single set of results.

Results Preliminary Analyses Gender Differences Descriptive statistics for the variables in their original form are presented in Table 1 for girls and boys. At Time 1, girls showed greater proneness to shame (M = .23; SD = .75) than boys (M = -.18; SD = .73), t(172) = 3.51, p \ .001; d = .55 (medium effect). According to mother reports, boys had more internalizing problems (M = 53.74; SD = 9.9) than girls (M = 50.31; SD = 9.7), t(172) = 2.14, p = .034; d = .35 (small effect). At Time 2, girls reported more social anxiety (transformed M = .90; SD = .28) than boys (M = .69; SD = .38), t(172) = 3.23, p \ .01; d = .64 (medium effect), and boys reported more depressive

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variables were examined in girls and boys (see Table 2). As Table 2 shows, internalizing problems were highly stable over time for both girls and boys. Time 1 depressogenic thinking and shame proneness were significantly correlated for both girls and boys; the correlation was somewhat stronger for girls than for boys, but not significantly, Fisher’s z = .64. For boys, Time 2 mother and child reports of problems were related to both depressogenic thinking and shame proneness. For girls, only Time 2 child reports of problems were related to these variables, and shame proneness were related only to general anxiety. Contrary to expectations, shame was related to fewer mother-reported internalizing problems in girls at both time points (p = .10 two-tailed at Time 1).

Table 1 Descriptive statistics for the study variables Girls

Boys

Mean

SD

Mean

SD

Child age (years)

8.09

0.27

8.14

0.29

Family socioeconomic status (z score)

0.09

0.71

-0.06

0.75

50.31

9.90

53.74

9.80

Time 1 general anxiety

0.42

0.24

0.36

0.23

Time 1 social anxiety

0.36

0.27

0.30

0.27

-0.06

0.78

0.03

0.85

0.23

0.75

-0.18

0.73

51.73

11.52

52.40

10.41

0.34

0.22

0.31

0.25

Time 1 internalizing problems (T score)

Time 1 depressogenic thinking (z score) Time 1 shame proneness (residual score) Time 2 internalizing problems (T score)

Prediction of Internalizing Problems in Late Childhood

Time 2 anxiety Time 2 social anxiety Time 2 depressive symptoms (T score)

0.92

0.54

0.83

0.77

46.87

8.18

46.09

8.19

The hypothesis that shame and depressogenic thinking contribute to increasing internalizing problems during middle childhood was evaluated using hierarchical regression to determine whether the addition of these factors would predict unique variance in Time 2 internalizing problems after controlling for possible covariates (child age, family socioeconomic status and, where possible, the initial level of problems at Time 1). Child age was included as a covariate because age-related changes in social cognition and self-evaluation could be related to patterns of thinking and emotional responding. Family socioeconomic status was included because it represents a family risk variable in child development [72], and lower family

symptoms (transformed M = 38.58; SD = 22.27) than girls (M = 30.72; SD = 18.37), t(172) = 2.12, p = .038; d = .39 (small effect). There were no other significant gender differences. Zero-Order Correlations As a preliminary step in examining the prediction of Time 2 internalizing problems, zero-order correlations among the Table 2 Intercorrelations 1. 1. Child age 2. Family socioeconomic status 3. Time 1 internalizing problems 4. Time 1 general anxiety 5. Time 1 social anxiety 6. Time 1 depressogenic thinking 7. Time 1 shame proneness (residual) 8. Time 2 internalizing problems

2.

3.

4.

5.

6.

7.

-.05

-.06

-.06

-.13

-.11

-.10

-.08

-.10

-.11

-.07

-.20

.02

.10

-.08

-.19

.76***

-.17 .13

.14

-.03

.04

.00

.06

.76***

.22?

.14

.26*

.31**

.37**

.25*

.24*

.21?

.12

.41***

.26*

.18

.63***

.57***

.32**

.44***

.60***

.22*

.16

.27**

.23*

.13

.17

.06

.42***

.08 -.18

.31*

.54***

.09

11. Time 2 depressive symptoms

.17

.26*

-.03 -.10

.09

-.11

-.02

.28*

.26*

-.02

-.05

-.06

.33**

.35***

.15 -.13

-.01

.06

.16

-.09

.08 -.10

.12

.21?

-.06 -.03

9. Time 2 general anxiety

11.

.36**

.77***

10. Time 2 social anxiety

10.

.05

.03

.11

9.

?

.17

.01

.13

.22

?

8.

.21

-.15

.45***

.44***

.33**

.29**

.21*

.20*

.19

.28*

.37***

.12

.45***

.28**

.27**

.27**

.34***

.16

.62***

.50*** .42***

Correlations are above the diagonal for girls (n = 75) and below the diagonal for boys (n = 99). All tests 2-tailed ?

p B .07; * p \ .05; ** p \ .01; *** p \ .001

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Child Psychiatry Hum Dev Table 3 Prediction of Time 2 mother reports of child internalizing problems sr2

SE B

b

-1.84

1.28

-.09

.01

1.13

.77

.11

.01

.67

.81

.06

.00

.75

.67

.43

B Step 1 Child gender Child age Family socioeconomic status Time 1 internalizing problems R2

7.18*** .46***

Step 2 Time 1 depressogenic thinking

3.33***

Time 1 shame proneness

-.53

DR2

.95

.27

.05

1.26

-.04

.00

.07***

Step 3 Gender 9 Time 1 depressogenic thinking

1.30

2.03

.08

.00

Gender 9 Time 1 shame proneness

2.03

2.52

.11

.00

DR2 Model R2

.01 .54***

For gender, girls = 0, boys = 1 *** p \ .001

socioeconomic status appears to be associated with earlyemerging internalizing problems [8]. Gender and the twoway interactions between gender and the cognitive-affective variables were included to assess the moderating effect of gender. To provide for more meaningful interpretation of any interaction effects, the continuous predictors were rescaled by putting them in the form of mean-deviation scores (centering) [73, 74]. The moderating effects of gender were examined in the final step of the regression models after accounting for main effects. Because moderation effects can be difficult to detect due to the lower power of the tests [75], and because greater consideration of gender differences in the development of internalizing psychopathologies has been emphasized as critically important [2, 76], a liberal threshold of inspecting relatively weak interactions was adopted. Tables 3 and 4 display the unstandardized regression coefficients (B) and standard errors of the coefficients (SE B), the standardized regression coefficients (b), and the semipartial correlations (sr2) indicating the unique variance explained by each variable entered into the equation, and the amount of variance explained at each step (R2 or R2 change) and for the full model (Model R2). Prediction of Mother Reports of Child Internalizing Problems As Table 3 shows, mother reports of Time 2 internalizing problems could be predicted significantly from Time 1

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internalizing problems (sr2 = .43 indicating 43 % unique variance explained by earlier problems) and depressogenic thinking (sr2 = .05), but was not significantly predicted from shame proneness, b = -.04. The two interactions involving Gender were nonsignificant: between gender and depressogenic thinking, b = .08, and between gender and shame proneness, b = .11. After step 1, with covariates in the equation, R2 = .46 (adjusted R2 = .45), F(4, 169) = 36.05, p \ .001. After step 2, with the cognitive-affective variables added to the equation, R2 = .52 (adjusted R2 = .51), Finc(6, 167) = 30.70, p \ .001. Addition of these variables resulted in a significant increment in explained variance, R2inc = .07, Finc(2, 167) = 11.35, p \ .001. After step 3, with all variables in the equation, R2 = .54 (adjusted R2 = .51), F(8, 165) = 23.99, p \ .001. Addition of the interactions did not significantly improve prediction, R2inc = .01, Finc(2, 165) = 2.37, p \ .10. Thus, there was no evidence of a gender difference in the contribution of Time 1 depressogenic thinking to Time 2 mother-reported internalizing problems. Prediction of Child Self-assessments of Anxiety and Depressive Symptoms As Table 4 shows, child self reports of Time 2 general anxiety could be significantly predicted from Time 1 general anxiety (b = .41, sr2 = .16). There was a near-significant predictive effect of depressogenic thinking (b = .19, p = .057, sr2 = .03) and a nonsignificant effect of shame proneness, b = .06. The two interactions involving Gender were nonsignificant: between gender and depressogenic thinking, b = .00, and between gender and shame proneness, b = .01. After step 1, with covariates in the equation, R2 = .20 (adjusted R2 = .18), F(4, 169) = 10.78, p \ .001. After step 2, with the cognitive-affective variables added to the equation, R2 = .25 (adjusted R2 = .22), Finc(6, 167) = 9.31, p \ .001. Addition of these variables resulted in a significant increment in explained variance, R2inc = .05, Finc(2, 167) = 5.24, p \ .01. After step 3, with all variables in the equation, R2 = .25 (adjusted = .22), F(8, 165) = 7.02, p \ .001. Addition of the interactions did not significantly improve prediction, R2inc = .00, Finc(2, 165) = .37, ns. Time 2 social anxiety could be significantly predicted from gender (b = -.27, sr2 = .07) and from Time 1 social anxiety (b = .28, sr2 = .08). It was also significantly predicted from depressogenic thinking (b = .21, sr2 = .03) but not from shame proneness, b = .15, p = .112. The two interactions involving Gender were nonsignificant: between gender and depressogenic thinking, b = -.03, and between gender and shame proneness, b = .40, p = .178. After step 1, with covariates in the equation, R2 = .18 (adjusted R2 = .16), F(4, 169) = 9.18, p \ .001. After step 2, with the

Child Psychiatry Hum Dev Table 4 Prediction of Time 2 child self-assessments of anxiety and depressive symptoms General anxiety

Social anxiety

SE B

b

-.01

.05

.02

.02

B

2

Depressive symptoms 2

sr2

SE B

b

-.20

.06

-.27

.07***

7.63

3.74

.18

.02

.04

.05

.00

-.12

2.02

-.01

-.03

.04

-.08

.01

-2.04

1.99

-.10

.11

.03

.28

–

–

sr

B

-.02

.00

.09

.01 .01

sr

B

SE B

b

Step 1 Child gender Child age Family socioeconomic status

-.03

.02

-.12

Time 1 general or social anxiety

.10

.02

.41

R2

.20***

Step 2 Time 1 depressogenic thinking

.05

Time 1 shame proneness

.02

DR2

.05**

.16***

.08***

.18*** .03 .03

.19 .06

.03? .00

.09 .07

–

.03*** .00 .01 –

.05* .04 .04

.21

.03*

5.38

2.16

.21

.04**

.15

 

3.95

2.85

.15

.02

.00

.02

.08***

.09***

Step 3 Gender 9 Time 1 depressogenic thinking

.00

.06

.00

.00

-.01

.07

-.03

.00

-.55

5.49

-.02

Gender 9 Time 1 shame proneness

.01

.07

.01

.00

.11

.08

.40

.01

8.56

5.36

.22

DR2 Model R2

.00 .25***

.01 .27***

.02 

.02 .16***

For gender, girls = 0, boys = 1  

p \ .12; ?p \ .06; * p \ .05; ** p \ .01; *** p \ .001

cognitive-affective variables added to the equation, R2 = .26 (adjusted R2 = .23), Finc(6, 167) = 9.62, p \ .001. Addition of these variables resulted in a significant increment in explained variance, R2inc = .08, Finc(2, 167) = 8.85, p \ .001. After step 3, with all variables in the equation, R2 = .27 (adjusted R2 = .23), F(8, 165) = 7.63, p \ .001. Addition of the interactions did not significantly improve prediction, R2inc = .01, Finc(2, 165) = 1.49, ns. Thus, there was no evidence of a gender difference in the contribution of Time 1 depressogenic thinking to Time 2 child reports of social anxiety. Time 2 depressive symptoms could be significantly predicted from gender (b = .18, sr2 = .03) and depressogenic thinking, b = .21, sr2 = .04), but not from shame proneness, b = .15, p = .176. The interaction between gender and depressogenic thinking was nonsignificant, and the interaction between gender and shame proneness approached typically-examined levels of significance, b = .22, p = .116. After step 1, with covariates in the equation, R2 = .05 (adjusted R2 = .03), F(3, 170) = 2.98, p \ .05. After step 2, with the cognitive-affective variables added to the equation, R2 = .14 (adjusted R2 = .12), Finc(5, 168) = 5.51, p \ .001. Addition of these variables resulted in a significant increment in explained variance, R2inc = .09, Finc(2, 168) = 8.89, p \ .001. After step 3, with all variables in the equation, R2 = .16 (adjusted R2 = .13), F(7, 166) = 4.69, p \ .001. Addition of the

interactions did not significantly improve prediction, R2inc = .02, Finc(2, 166) = 2.39, ns. In light of the pattern of correlations indicating that shame was significantly associated with depressive symptoms for boys only, the gender x shame proneness interaction was considered noteworthy [75] and was inspected further. Simple slopes tests were performed examining the prediction of Time 2 depressive symptoms from Time 1 shame proneness separately for girls and boys, with child age, family socioeconomic status, and depressogenic thinking included as covariates. Over and above the predictive effect of depressogenic thinking, shame significantly predicted Time 2 depressive thinking for boys, b = .28 (sr2 = .04), p = .024, but not for girls, b = -.02, ns (see Fig. 1). In summary, unique predictive effects on depressive symptoms were found for both depressogenic thinking and shame proneness; however, the predictive effect of shame was specific to boys. In summary, regression analyses to evaluate the unique predictive effects of depressogenic thinking and shame proneness on late childhood internalizing problems showed that all measures were uniquely predicted by depressogenic thinking. Shame proneness was not a significant unique predictor except when the moderating effect of gender was examined, when it was found to be a significant unique predictor of depressive symptoms in boys. Given the moderately strong correlations that were found between

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Time 2 Depressive Symptoms (ranks)

Child Psychiatry Hum Dev 50

Table 5 Results of testing indirect effects of shame proneness on internalizing problems

45 40

Girls

35

B

30

Boys SE B

B

SE B

b

Mother-reported internalizing problems

25

a (IV ? M)

.59

.12

20

b (M ? DV) 2.51 General anxiety

1.38

15 10

Girls

5

Boys

.55*** .18?

.56

.14

.45***

3.59

1.23

.31***

a (IV ? M)

.52

.12

.48***

.43

.14

.35**

b (M ? DV)

.03

.05

.17

.04

.04

.16

Social anxiety

0 High

Low

Time 1 Shame Proneness Fig. 1 Moderation of the predictive relation between Time 1 shame proneness and Time 2 depressive symptoms by gender

depressogenic thinking and shame proneness in both girls and boys, exploratory analyses were performed to examine indirect effects of shame on internalizing problems through depressogenic thinking. Exploratory Tests of Indirect Effects of Shame Proneness on Internalizing Problems To explore possible indirect effects of shame proneness on internalizing problems through depressogenic thinking, we performed tests using a regression-based path-analytic approach [77–79]. In this approach, an indirect effect is calculated as the product of coefficients for the relation between the independent variable and the hypothesized mediator (path a) and the relation between the mediator and the outcome variable (path b). Two equations are estimated: (a) the relation of the independent variable to the hypothesized mediating variable (path a), and (b) the relation of the mediating variable to the outcome variable adjusted for the independent variable (path b). The product of the two estimates (a 9 b) forms the indirect effect. To estimate path a for each measure of internalizing problems at late childhood, we performed a regression analysis assessing the prediction of depressogenic thinking from the covariates (child age, family socioeconomic status, initial level of problems) and the independent variable (shame proneness). Next, to estimate path b, we performed regression analyses estimating the prediction of each measure of internalizing problems from the covariates, the independent variable (shame proneness), and depressogenic thinking. The results of these analyses, performed for girls and boys separately, are shown in Table 5. Table 5 shows, for each measure of internalizing problems, the unstandardized coefficients for the relation of the independent variable (shame proneness) to the hypothesized mediating variable (depressogenic thinking) controlling for

123

b

a (IV ? M)

.56

.12

.52***

.48

.16

.39**

b (M ? DV)

.12

.05

.33*

.05

.06

.12

.54***

.54

.14

.44***

4.21

3.09

Depressive symptoms a (IV ? M)

.59

.12

b (M ? DV)

4.82

3.48

.21

.17

IV = independent variable (shame proneness); DV = outcome variable; M = mediator variable (depressogenic thinking) ?

p \ .08; * p \ .05; ** p \ .01; *** p \ .001

the covariates (child age, family socioeconomic status, initial level of problems) (path a), and the relation of the mediating variable to the outcome variable controlling for the covariates and the independent variable (path b). The results of analyses performed to estimate path a indicate that, for both girls and boys, depressogenic thinking was significantly predicted by shame proneness independent of the covariates and initial level of problems, smallest b = .35, p \ .01 (sr2 = .10 indicating 10 % of unique variance explained). The results of analyses performed to estimate path b indicate that, for girls, depressogenic thinking significantly predicted social anxiety symptoms, B = .12, b = .33, p \ .02 (sr2 = .08), was a near-significant predictor of mother-reported internalizing problems (B = 2.51, b = .18, p = .075 (sr2 = .02), and did not significantly predict self reports of general anxiety, B = .05, b = .17 ns, or depressive symptoms, B = 4.82, b = .21, ns. For boys, depressogenic thinking significantly predicted motherreported internalizing problems, B = 3.59, b = .31, p \ .001 (sr2 = .07), but not self reports of general anxiety, B = .04, b = .16, ns, social anxiety symptoms, B = .05, b = .12, ns, or depressive symptoms, B = 4.21, b = .17, ns. To test the significance of the indirect effects, we performed bootstrapping which, compared to other tests of significance, has been shown to provide the most power to detect mediation and the most accurate Type I error rates in small-to-moderate-sized samples [77, 80]. The method involves repeatedly estimating the indirect effect, using the sampling distribution of the resulting coefficients to derive a confidence interval (CI) for the mean coefficient. When the CI excludes zero, the indirect effect is significant. To

Child Psychiatry Hum Dev

obtain the most accurate CIs, we performed bias-corrected bootstrapping, which corrects for bias in the central tendency of the estimate [80, 81]. In the absence of a method for pooling results across multiple imputation datasets, we performed bootstrapping on all five datasets. The results revealed significant indirect effects in the relation between shame proneness and girls’ increased social anxiety symptoms (smallest value of a 9 b = .06; 95 % CI .01– .13), and between shame proneness and boys’ increased mother-reported internalizing problems (smallest value of a 9 b = 1.50; 95 % CI .42–3.20). In summary, shame proneness was indirectly related through depressogenic thinking to girls’ social anxiety and boys’ general internalizing problems. We also tested an alternate possibility, that depressogenic thinking was related to internalizing problems indirectly through shame proneness. These tests were nonsignificant. Thus, to the extent that indirect effects exist, they reflect the influence of shame proneness occurring through depressogenic thinking. Prediction of Anxiety and Depressive Disorders in Early Adolescence To assess the extent to which depressogenic thinking and shame proneness in middle childhood would predict the diagnosis of anxiety and depression in early adolescence, we performed two logistic regressions to estimate the probability of each type of diagnosis. Because of the substantially reduced sample for the diagnostic interviews (n = 39), gender could not be included as a predictor. In each analysis, Time 1 depressogenic thinking and shame proneness were entered as the predictors using a simultaneous method, in which the contribution of each predictor is evaluated after accounting for all others [82]. Anxiety Disorders Neither depressogenic thinking nor shame proneness added significantly to the prediction of the presence of an anxiety disorder. To assess whether there was a specific link to social anxiety, a separate analysis was performed focusing on the 10 children (7 boys, 3 girls) who met criteria for social phobia or social phobia comorbid with other anxiety disorders. Neither depressogenic thinking nor shame contributed significantly to the prediction. Depressive Disorders Time 1 shame proneness added significantly to the prediction of a depressive disorder, B = 3.42, Wald = 5.41, odds ratio = 30.52 (95 % CI 1.53, 608.93), p = .025, but

Time 1 depressogenic thinking did not, B = .20, Wald = .22, odds ratio = 1.22; for the full model, v2 (2, N = 39) = 11.82, p \ .01. For shame proneness, classification accuracy was improved substantially over the rate achieved by chance alone, from 77.6 to 94.9 %. Adolescents were 30 times more likely to meet the criteria for a depressive disorder when they had been highly prone to shame at Time 1 than when they had not been highly prone to shame.

Discussion The purpose of this study was to assess the extent to which depressogenic thinking and shame proneness contribute to the development of internalizing problems between middle and late childhood. Rates of internalizing problems increase dramatically during adolescence, and theories suggest that the increase can be attributed to intrapersonal vulnerabilities emerging prior to adolescence [40, 41]. These vulnerabilities may predict an increase in internalizing problems as children approach adolescence. In the present study, we assessed whether depressogenic thinking and shame proneness in middle childhood would predict internalizing problems in late childhood and diagnosed disorders in early adolescence and whether shame would be a differentiating factor in trajectories leading to depression and/or anxiety. Internalizing problems were highly stable over time. Depressogenic thinking and shame proneness were significantly correlated and both were predictive of subsequent problems in late childhood. Depressogenic thinking uniquely predicted internalizing problems and anxious and depressive symptoms in both boys and girls. Shame directly predicted boys’ depressive symptoms, and indirectly predicted boys’ general internalizing problems and girls’ social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. Depressogenic thinking in middle childhood was a significant unique predictor of mother reports of internalizing problems and child reports of anxiety and depressive symptoms in late childhood. These findings add to the limited evidence that exists prior to adolescence for prospective longitudinal relations between depressogenic thinking and internalizing problems [23, 24]. They are consistent with the suggestion of hopelessness theory [18] that negative cognitive styles are cognitive vulnerability factors that appear as early as middle childhood. A pattern of appraising negative events as having disastrous consequences and viewing the self as flawed or deficient following negative events is a maladaptive inferential style that contributes to increasing internalizing symptoms such as sad mood and social withdrawal.

123

Child Psychiatry Hum Dev

Shame proneness in middle childhood also was a significant predictor of internalizing problems in late childhood. Shame had modest effects, consistent with the findings of previous research [30], and it appeared to have both direct and indirect effects. Shame had direct effects on boys’ depressive symptoms. This finding may reflect a characteristic of the present sample of boys. In middle childhood, boys had significantly more mother-reported general internalizing problems than girls, although that difference had diminished by late childhood, in accord with epidemiological evidence that boys and girls do not differ strongly in internalizing problems until early adolescence [39]. Boys with early-emerging internalizing characteristics have been found to have more social difficulties and negative views of self [83], whereas such characteristics are seen as relatively normative in girls [76], which might account for this sample of boys showing the particular link between shame proneness in middle childhood and worsening self-reported problems over time. Shame also appeared to have an indirect effect on boys’ worsening general internalizing problems between middle and late childhood. For girls, shame appeared to have an indirect effect specifically on worsening social anxiety symptoms, which were more pronounced for girls in late childhood. These indirect effects appeared to operate through depressogenic thinking. Children who were highly prone to shame were more likely to engage in depressogenic thinking. In turn, depressogenic thinking predicted general internalizing problems and anxious and depressive symptoms. These findings fit with theories of shame [25–27, 33] and with suggestions that shame exerts its influence on psychological disorders primarily through other variables [30, 84, 85]. Shame-related rumination is likely to be a key mediating process, and it has been demonstrated to occur in shame prone adults [86–88]. The focus on a flawed and hopeless self that accompanies shame may precipitate ruminative thought or repetitive negative thinking. Rumination in response to shame experiences is likely to further elaborate and magnify a depressogenic cognitive style and intensify its effects on internalizing problems [89–91]. In turn, depressive rumination may elicit associated aversive states such as shame, reinforcing and magnifying them and promoting a disposition to respond with these emotions. Prospective analyses with time-lagged assessments of shame and depressive rumination are needed to confirm that depressive rumination mediates the effect of shame on the development of internalizing problems and to assess reciprocal influences between depressive rumination and shame. These reciprocal influences could be a potent factor in the worsening of internalizing problems during the preadolescent period. It remains uncertain when shame-related rumination is initiated and whether it begins in early, middle or late childhood, or not until adolescence. Gender

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differences may exist as well. Research indicates that girls engage in more rumination than boys by late childhood or early adolescence [92, 93], but whether they ruminate more than boys in response to shame experiences is unknown. Shame proneness in middle childhood uniquely predicted depression diagnosed 5 years later in early adolescence. Adolescents who had been highly shame prone in middle childhood were 30 times more likely to meet the criteria for a diagnosis of depression than those who had not been highly shame prone. This is a noteworthy finding in light of the long time span of prediction. It may have been specific to depression due to the especially close relation that exists between shame and depressed mood. Both are affective phenomena that have at their core a negative belief about the self as worthless and hopeless. Further investigation with a larger sample and adequate representation of the two sexes is needed to assess the reliability of this finding. The finding that shame was linked to social anxiety symptoms suggests that more attention to the link between shame and social phobia is warranted. Although theories of social anxiety recognize the role played by social cognitions and emotions, there has been limited research on their importance in the development of social phobia [30, 37, 94]. The findings of the present study should be interpreted in the light of particular strengths and limitations. One of the strengths was the use of multiple measures of internalizing problems based on different informants. The consistency in the findings across measures suggests that the findings are reasonably reliable and not based on a single informant. Because the prospective longitudinal design allowed for the assessment of predictors and outcomes across time from middle childhood to adolescence, and analyses predicting Time 2 internalizing problems were adjusted for Time 1 internalizing problems (with one exception), the results can tentatively be attributed to influences of the cognitive-affective variables on the development of these problems. However, the Time 3 interview sample was small, limiting the power of these analyses to detect influences of the cognitive-affective variables on diagnosed disorders and precluding the examination of gender differences. Moreover, it remains unclear whether increases in internalizing problems were due to the predictors or to other variables that influenced both the predictors and internalizing problems themselves. To determine with greater certainty whether depressogenic thinking and shame influenced internalizing problems in late childhood, multiple repeated assessments of the variables across time should be done to see whether changes in these variables are tied to changes in internalizing problems over and above the stability of internalizing problems. The results of the present study add support to the idea that cognitive-affective style may play a role in the

Child Psychiatry Hum Dev

developmental course of internalizing problems before adolescence. Given the frequent observation that adolescence is accompanied by sharp increases in the rates of anxiety and depression, especially for girls [2], it is of crucial importance to understand the way in which internalizing problems evolve into these disorders and why the transition to adolescence appears to be a sensitive period for their emergence. The findings of the present study support the idea that a depressogenic cognitive-affective style may be a crucial factor in the persistence and worsening of these problems during middle childhood and their evolution into full-blown disorders, and they suggest that shame may be a differentiating factor in trajectories leading to social anxiety and/or depression.

Summary Rates of internalizing problems increase dramatically during adolescence, and theories suggest that the increase can be attributed to intrapersonal vulnerabilities emerging prior to adolescence [40, 41]. In the present study, we assessed whether depressogenic thinking and shame proneness in middle childhood predicted internalizing problems in late childhood and diagnosed disorders in early adolescence. Depressogenic thinking uniquely predicted internalizing problems and anxious and depressive symptoms in both boys and girls. Shame directly predicted boys’ depressive symptoms, and indirectly predicted boys’ general internalizing problems and girls’ social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. The findings tentatively suggest that a negative self-view emerges as an important factor in internalizing trajectories during middle childhood. To the extent that this is so, it would be important for cognitive therapies and preventive interventions to target both the cognitive and affective components of this self-view. Acknowledgments This research was supported by Canadian Institutes of Health Research grants MOP-74642 awarded to the team and MOP-57670 awarded to Rosemary Mills. We thank the children and parents who made this research possible and gratefully acknowledge the assistance of Hayley Lyons and Danielle Turnbull. John R. Z. Abela, our wonderful colleague, passed away on June 18, 2010.

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