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dissertation committee. Further thanks go to Trail Blazers Camp for their cooperation in the collection of these data. Thanks also go to Emily Hauck, Dave Jobes, ...
Cognitive Therapy and Research, Vol. 16, No. 6, 1992

Stress and Attributional Style as Predictors of Self-Reported Depression in Children 1 J. Faye D i x o n 2

The Medical College of Pennsylvania~EasternPennsylvaniaPsychiatricInstitute A n t h o n y H. Ahrens 2

The American University

Attributional approaches to depression, such as hopelessness theory (Abramson, Metalsky, & Alloy, 1989), suggest that a stable, global attributional style for negative events combined with failure to achieve a highly valued outcome will lead to depression. The current study assessed the ability of the interaction o f attributional style and daily negative events to predict self-reported depression in children. Eighty-four children between the ages of 9 and 12 participated in this longitudinal study. Self-reported depression symptoms were assessed before and after exposure to stressful events. The data analysis consisted of stepwise hierarchical multiple-regression procedures. While attributional style alone did not predict change in self-reported depression symptoms following stressful events, the interaction of attributional style with stress did predict them. Stress predicted depression symptoms as well. KEY WORDS: depression; attributional style; childhood depression.

1This paper was based on the dissertation of J. Faye Dixon under the direction of Anthony Ahrens at The American University. Portions of this research were presented at the Midwestern Psychological Association Convention, Chicago, May 1991. We wish to thank Rebecca del Carmen, Mary Parpal, and Jon Rolf for their service as members of the dissertation committee. Further thanks go to Trail Blazers Camp for their cooperation in the collection of these data. Thanks also go to Emily Hauck, Dave Jobes, and Maureen Lyon for their help in coding data, and to Constance Hammen and three anonymous reviewers for their helpful comments on a prior draft of this paper. 2Address all correspondence concerning this article to J. Faye Dixon, Medical College of Pennsylvania, EPPI, Department of Child and Adolescent Psychiatry, 3200 Henry Avenue, Philadelphia, Pennsylvania 19129, or Anthony H. Ahrens, Department of Psychology, The American University, 4400 Massachusetts Avenue, N.W., Washington, DC 20016.

623 0147-5916/92/1200-062356.50/0 © 1992 Plenum Publishing Corporation

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Whereas adult depression is well-documented and heavily studied, the existence and manifestation of depression in children has long been an area of debate. Only recently has empirical research begun to substantiate the presence of this syndrome in children (Hammen & Goodman-Brown, 1990; Kendall, Cantwell, & Kazdin, 1989). A question of importance is whether processes causing depression in children are similar to those causing depression in adults. According to theories relating attributions and depression (Abramson, Metalsky, & Alloy, 1989; see also Abramson, Seligman, & Teasdale, 1978), the explanations that an individual makes for the causes of negative events can influence subsequent depression. When causes of failure are seen as stable across time and global across situations, hopelessness occurs. Hopelessness then leads to depression. Abramson et al. (1989) propose a diathesis-stress model of one causal pathway to depression, with attributional style (the diathesis) serving as a moderator between perceived negative life events (stress) and depression. When negative life events are missing, individuals with a depressive attributional style are not expected to develop depressive symptoms. However, when they are present, it is expected that the combination of stressful life events and a negative attributional style will lead to depression. A relationship between depression and depressive attributional style has been demonstrated (e.g., Peterson & Seligman, 1984; Sweeney, Anderson, & Bailey, 1986). However, only recently has research examining the diathesis-stress aspect of attribution theories been performed (see Abramson et al., 1989; Barnett & Gotlib, 1988). For instance, Metalsky, Halberstadt, and Abramson (1987) examined the effect of a negative event (poor exam performance) on subsequent depression. Although immediate depressive reactions were predicted solely by exam performance, longer lasting depressive reactions were predicted by the interaction of a stable, global attributional style for failure and poor exam performance (see also Alloy, Kayne, Romer, & Crocker, 1992; Folette & Jacobsen, 1987; Hummer & Hokanson, 1990; Hunsley, 1989; Persons & Rao, 1985; Robins & Block, 1989, for further, mixed, research on the interaction of attributional style and stress in adults). Only two studies have examined the utility of the interaction of attributional style and stress in predicting depression in children, and these have shown mixed results (Hammen, Adrian, & Hiroto, 1988; Nolen-Hoeksema, Girgus, & Seligman, 1986). Nolen-Hoeksema and her colleagues followed schoolchildren over the course of a year, measuring self-reported depression symptoms, stress, and attributional style five times, thus creating four intervals. They found that the interaction of attributional style and stress predicted change in depression symptoms significantly during one of

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the four periods, marginally during a second, but not during the other two. It should be noted that the main effect of attributional style predicted change in depression during the other two intervals. These results yielded partial support for attributional approaches to depression. Hammen et al. (1988) used children of depressed and nondepressed parents for their sample. They measured depression and attributions initially and depression and retrospective stress at an average of 8.4 months later. For these researchers, the interaction of stress and attributional style failed to predict change in depression. The interaction did, however, predict change in nondepressive diagnosis. The results of this study did not support attributional approaches to depression. The divergence of these results from those of Nolen-Hoeksema and her colleagues (1986) suggests that it is important to perform further tests on the relations of attributions and stress to depression in children. The current study differed from previous studies in three major respects. First, the attribution measure used was the generality scale for negative events, that is the combination of stable and global attribution for negative events. This measure was used to be consistent with the recently proposed hopelessness theory of depression (Abramson et al., 1989). Previous work used the difference in composite scores (i.e., the sum of internality, stability, and globality) for positive and n e g a t i v e events (Nolen-Hoeksema et al., 1986) and the composite score for negative events (Hammen et al., 1988). Second, this study examined stress items more reminiscent of daily hassles (Kanner, Coyne, Schaefer, & Lazarus, 1981) rather than major negative life events. A recent study by Banez and Compas (1990) found that children's self-reports of depression were related to daily stressors. Prior research on attributional style and stress has examined major events rather than hassles. Finally, the subjects for this study were members of a population "at risk" for psychopathology based on economic and social disadvantages, poor peer relationships, and family discord. Prior studies have examined schoolchildren more representative of the general population (Nolen-Hoeksema et al., 1986) and a sample with a large percentage of another high-risk group, children of depressed parents (Hammen et al., 1988).

METHOD

Subjects Subjects for this study were children in attendance at a summer camp. Referrals to the camp were made by social service agencies, school guid-

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ance departments, mental health clinics, and independent practitioners. Reasons for referrals to the camp included school problems, academic and/or behavioral problems, family problems, and/or peer relationship problems. We did not have access to diagnostic information concerning individuals. The study group contained 84 children) Sixteen subjects from the original pool of 100 were dropped from the study because they were missing at either pre- or posttesting. Causes for absence included arriving late to camp, leaving the camp session early, illness, or disruptive behavior. The children ranged in age from 9 to 12 years, with a mean age of 11. This age range was selected because it grouped children at similar cognitive, developmental, and psychosocial stages (Bee, 1985). 4 The racial/ethnic composition of the population was 53% black, 20% white, 19% Hispanic, 5% Asian, and 3% other. Socioeconomic status ranged from poverty level to affluence. However, approximately 60% of children in attendance came from homes receiving financial assistance. Single-parent families comprised approximately 55% of the participant households. A cutoff of 13 on the Children's Depression Inventory has been suggested to indicate mild depression and of 19 to indicate severe depression (Kovacs, 1983). At Time 1, 23 boys and 7 girls scored 13 or higher. At Time 2, 11 boys and 13 girls scored 13 or higher. 5 Instruments 1. KASTAN-R. The KASTAN Children's Attributional Style Questionnaire-Revised (KASTAN-R; Kaslow, Tanenbaum, & Seligman, 1978) was used to assess the way children attribute causality for good and bad events. The scale consists of 48 items. Each item contains an event and two attributions explaining why each hypothetical situation might have happened. Half the situations represent "good" outcomes and half the situations represent "bad" outcomes. Subjects were instructed to pick the one sentence from the pair that best explained why the event happened to them. The KASTAN-R has six subscales: (1) Good-Internal/External, (2) Good-Stable/Unstable, (3) Good-Specific/Global, (4) Bad-Internal/Exter3Forty-five subjects were girls. Thirty-nine were boys. 4Nolen-Hoeksema et al. (1986) used 8- to ll-year-old children. Hammen et al. (1988) used 8- to 16-year-old children, with a mean age of 12. 5Hammen et al.'s (1988) subjects reported a mean CDI score of 4.7, whereas Nolen-Hoeksema's (1986) subjects' mean was between 7.6 and 8.8. The current study used subjects who reported more depression, with a Time 1 average of 12.1. Kovacs (1983) reported a mean of 9.3 for a nonpsychiatric population.

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nal, (5) Bad-Stable/Unstable, (6) Bad-Specific/Global. The present study employed the revisions to the scale suggested by Metalsky and his colleagues (1987). According to the hopelessness theory, global and stable attributions for negative events alone are expected to lead to depression. Therefore, only the negative Generality scale (the average of the negative global and negative stable subscales) was utilized in the current study. The Generality scale had low internal consistency, .284, as calculated by the Kuder-Richardson 20 formula. This is likely to limit the predictive power of the KASTAN-R. 6 2. CDI. The Children's Depression Inventory (CDI; Kovacs, 1983; Kovacs & Beck, 1977) was used to measure current level of self-reported depression. In this study it was expected that children with depressive attributional styles would report more depression symptoms after experiencing stressful events than those children without depressive attributional styles. The inventory contains 27 "depressive" items. Each item contains three statements graded in severity from 0 to 2. The total score is obtained by adding all the items together, with a higher score representing more self-reported depression. The test-retest reliability of the CD! is reported to range from r = .43 to .83 (Kovacs, 1983). This finding is substantiated by Blumberg and Izard (1986), Finch, Saylor, Edwards, and McIntosh (1987), and Kazdin, Esveldt-Dawson, Unis, and Rancurello (1983). Concurrent validity has been established in a study that found a significant correlation (r = -.72) between level of depression symptoms and self-esteem as measured by the Coopersmith Self-Esteem Inventory (Kaslow et al., 1984). Kazdin (1981) also reported that the correlation between the CDI and psychiatric diagnosis of depression by professionals was r = .54. It should be noted that, as with other measures of depression in children, the discriminant validity of the CDI has been called into question. In particular, there is a strong relation between CDI scores and anxiety (Kendall et al., 1989). We will refer to CDI scores as "self-reported depression" to distinguish them from the diagnoses that might have been made had we been able to conduct clinical interviews.

6Hammen et al. (1988) reported an alpha of .58 for the negative events composite score, as compared to .50-.54 reported by Seligman et al. (1984). Seligman et al. did not report consistency information for the negative generality scale, but did report alphas ranging from .13 to .42 for the globality and stability subscales individually. Nolen-Hoeksema et al. (1986) did not report consistency information in their sample. In this study, the composite for negative events had an internal consistency of .19, whereas the composite for both good and bad events had consistency of .319, both calculated using Kuder-Richardson formula 20.

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3. CDCEQ. The Child Daily Camp Event Questionnaire (CDCEQ), developed by the authors, was used to assess the perceived impact of daily negative events within the camp context. Its purpose in this study was to measure the occurrence of daily demands or hassles. This study employed two versions of this scale. An initial scale evaluated the child's beliefs and feelings about the importance of the events before the events actually occurred. This version was administered at the beginning of camp. A sample item is: "Sometimes doing all these new things can be scary. How important is it for you to feel comfortable and not be scared?" Importance was assessed on a 3-point scale in which the values were very, a little, and not important. A followup scale completed near the end of the camp session evaluated the child's beliefs about the outcome of these events after the events occurred. A sample item is: "Were you scared at camp this month?" Other items assessed whether children were accepted by their group or witnessed any fighting. Outcome was assessed on a 3-point scale, in which the values, generally, were most days, some days, and never. Each answer on the initial importance scale was multiplied by the answer on the followup outcome scale and summed to obtain a composite stress score. We used this composite stress score in the regression equations. The split-half reliability of the importance CDCEQ was r = .82 and for the outcome measure r = .75 using the Spearman-Brown formula.

Procedure The first author served as the sole experimenter. There were two assessment groups during the summer camp program corresponding with the beginning and the end of the two camp sessions. Subjects in both camp sessions were initially tested 1 day after arrival at camp and given the followup measures 1 week prior to departure. Data collection was conducted in groups of 8-16. Before data were collected, children received a short presentation concerning the nature of the study and were given the opportunity to ask questions and give verbal consent. Parents had previously provided written consent. At the initial assessment, children completed the KASTAN-R, CDI, and the importance version of the CDCEQ. At the followup the children completed only the CDI and the outcome version of the CDCEQ. Within each subject group, all inventory items were read aloud to the children, and all children completed the items simultaneously. Following the initial assessment, subjects were given an opportunity to ask questions and/or share concerns either in the group or privately with the investigator. After the foUowup all sub-

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Table I. Prediction of change in depression from Time 1 to Time 2 for KASTAN-R Generality Scalea Order of entry 1. CDI1 2, KASTAN 3. CDCEQ 4. KASTAN-R x CDCEQ

Change in R 2

F

df

Partial correlation

,2335 ,0097 ,2083 .0307

24.99b 1.03 30.44/' 4.69c

1, 82 1, 81 1, 80 1, 79

.4832 .1119 .5250 .2344

aNote: KASTAN-R = KASTAN Children's Attributional Style Questionnaire-Revised; CDI = Children's Depression Inventory; CDCEQ = Child Daily Camp Event Questionnaire. bp < .0001. Cp < .05.

jects received a presentation about the study and were again given the opportunity to ask questions.

RESULTS It was expected that those children with a depressive attributional style (KASTAN-R) at Time 1 would experience a change in self-reported depression from Time 1 to Time 2 if they scored high on the index of daily negative events (CDCEQ). Stepwise hierarchical multiple-regression analyses (Cohen & Cohen, 1983) were used to test whether the hypothesized relation between attributional style, stress, and change in CDI score was present in the data. The results, summarized in Table I, reveal that initial self-reported depression predicted subsequent self-reported depression, accounting for 23.3% of the variance. Those subjects who reported more depression at Time 1 were more likely to report depression at Time 2. Attributional style alone did not predict CDI score at Time 2, a finding that is consistent with the 1987 Metalsky et al. study. However, daily or current stress alone did predict self-reported depression at Time 2, F(1, 80) = 30.44, p < .0001, accounting for an increment of 20.8% in R 2. Those children reporting at Time 2 that they had experienced more stress since Time 1 were more likely to report depression at Time 2. This finding was expected and further substantiates the direct relation of stress to depression. It should be noted that self-reported depression at Time 1 has been partialed out and does not account for the relation of stress to CDI scores at Time 2. Of major importance to the hypothesis is the significant interaction of attributional style and daily stress, F(1, 79) = 4.69, p < .03. This interaction confirms the main hypothesis, and accounts for an additional 3% of the variance in CDI scores at Time 2. In order to examine this interaction,

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Table II. Predicted Values for Time 2 Depression, KASTAN-R a Stress

Less general

More general

Low High

7.56 11.58

4.95 15.81

aNote: KASTAN-R = KASTAN Children's Attributional Style Questionnaire-Revised.

values of stress and attributional style 1 standard deviation above and below the mean were entered into the regression equation to derive the predicted values. Table II presents the values produced by the regression equation. Subjects with high levels of negative attributional style in combination with high levels of stress were most likely to report depression at Time 2. The effect of stress is larger for subjects with a more depressogenic attributional style. This suggests that the interaction of attributional style and daily stress predicts subsequent self-reported depression for children in much the same way that it does for adults. 7

DISCUSSION The interaction between attributional style and stress predicted later self-reported depression, replicating earlier work with adults (e.g., Metalsky et al., 1987). Subjects with a stable, global attributional style for negative events who experienced stress were more likely to report depression at Time 2. This suggests that some processes in the development of depression in adults may generalize to children. This study also broadened research in this area by examining the interaction of attributions with daily stressors. As in earlier studies (e.g., Metalsky et al., 1987), attributions predicted subsequent self-reported depression beyond the predictive ability of concurrent self-reported depression. This result runs counter to arguments that the cognitions of depressed people are symptoms of, rather than contribu7An exploratory analysis revealed that the interaction of stress, attributions, and gender did not predict change in CDI scores. In order to determine whether differences in the results of studies on attributions, stress, and depression in children might be due to the attribution subscales used, supplementary analyses were performed in which the measures used in other studies were substituted for the Generality subscale. The composite scale for negative events interacted only marginally with stress, F(1, 79) = 3.66, p = .059, pr = .21, change in R z = .024. The difference between the composite scales for positive and negative events did not interact with stress to predict self-reported depression, F(1, 79) = .0009, p > .98.

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tors to, the depressed state (e.g., Barnett & Gotlib, 1988; Coyne & Gotlib, 1983). In the absence of an experimental manipulation, causality cannot be established. However, the temporal precedence of cognitions provides support for their causal role. Taken together, research concerning the attributional style-stress interaction in children provides a mixed picture. Hammen and her colleagues (1988) failed to find an interaction. Nolen-Hoeksema and her colleagues (1986) found an interaction at one of four time intervals, and a main effect of attributions twice. We, too, found an interaction. However, given the small effect size and mixed results in other studies, the clinical significance of the attribution-stress interaction in children is not clear. (But see Peterson, 1991, for an argument that "small" effect sizes can have practical importance, s) Future work should identify factors producing these differing results. We have indicated a number of procedural differences. Other factors to be considered are whether the interaction is central only to a subtype of depression (Abramson et al., 1989), and the time course of effects (see Hunsley, 1989; Metalsky et al., 1987). We found a strong relationship of daily stress to CDI score, consistent with prior research (Banez & Compas, 1990). 9 Although cognitive theories of depression do discuss the role of the situation in depression's onset (e.g., Abramson et al., 1989), the tendency of depressed people to experience fewer positive events (Lewinsohn & Graf, 1973), marital difficulties (Lewinsohn, Hoberman, & Rosenbaum, 1988), and stress (Brown & Harris, 1978) is often overlooked. Future research would do well to consider the nature of depression-evoking environments (Coyne, Burchill, & Stiles, 1990; Hammen, Burge, & Adrian, 1991) as well as the complex interplay of situation and thought (Bandura, 1986; Darley & Fazio, 1980). The current project was limited by the scales used for assessment. First, the internal consistency of the KASTAN-R was low, limiting its predictive power. In addition, forced choice responses to hypothetical situations might not be the most effective way of assessing attributional style (see Peterson, 1991, and the accompanying commentaries). Third, it is difficult to make conclusive statements about the relationship between selfreported depression and clinically diagnosed depression. However, two recent studies (Kazdin & Petti, 1982; Saylor, Finch, Spiroto, & Bennett, 1984) have found that the CDI could discriminate children with major de8In this study, the interaction accounted for 3% of the variance after an initial 45% had been accounted for. In comparison, in the Metalsky et al. (1987) study, the interaction accounted for 8% of the data, with a partial correlation of .289. 9This closer relation of stress than attributional style to self-reported depression might partially be due to the temporal proximity of the measures.

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pression from nondepressed children. Finally, the specificity of the results to depression should be examined. Elevated scores on the CDI seem to also be related to anxiety (Saylor et al., 1984). In addition, Hammen et al. (1988) found that attributional style interacted with stress to predict nonaffective psychopathology in children. A criticism of depression research with children is that samples are generally drawn from the middle class and are ethnically homogeneous. This study examined an economically and ethnically diverse group of children defined as "at risk" for psychopathology due to stressors in the home or school environments. Studying children with vulnerability is particularly relevant since these are the children prone to manifest disorders. The current study contributes to cognitive theories of depression by suggesting that children follow at least one pathway to self-reported depression that parallels a pathway for adults. Combined with previous studies, these results suggest that the interaction of attributional style and stress predicts subsequent depression. Future work might do well to use adult models of depression to generate further hypotheses about depression in children.

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