Cognitive Correlates of Depressive Symptoms in Hospitalized Adolescents

Article excerpt

The literature on depression in adolescence is very limited. While adult depression has been extensively studied, evidence for childhood depression as a distinct syndrome, with similar symptoms as the adult disorder, emerged only slightly over a decade ago (Cytryn, McKnew, & Bunney, 1980; Kovacs & Beck, 1977). These findings suggest that child and adult depression may fall along a continuum and call for an investigation of depression during adolescence, as it is unclear to what extent the findings that have emerged from the adult and child literature generalize to adolescents. For instance, it has been reported that adolescents may be more severely depressed than both adults (Garrison, Schoenbach, & Kaplan, 1985; Schoenbach, Garrison, & Kaplan, 1984) and children (Angold, 1988; Rutter, 1986). Moreover, somewhere between childhood and adulthood, the proportion of depressed females to males increases considerably (Weissman & Klerman, 1977; Lewinsohn, Duncan, Stanton, & Hautzinger, 1986).

Cognitive factors have been implicated in several theoretical models of depression (Abramson et al., 1978; Beck, 1967; Rehm, 1977) and have been supported by evidence that depressed adults selectively attend to negative events, set unrealistic goals, and evaluate themselves negatively when they fail to meet expectations (Klein & Seligman, 1976; Price, Tryon, & Raps, 1978; Sweeney, Anderson, & Bailey, 1986).

Like adults, depressed school-aged children exhibit impairments in self-control skills, problem-solving, self-esteem, and hopelessness, and are pessimistic about the future (Kazdin, Rodgers, & Colbus, 1986). Several studies of schoolchildren have consistently found significant positive correlations between depression and internal, stable, and global attributions for negative events, and occasionally have found significant negative correlations between depression and internal, stable, and global attributions for positive events (Craighead, Smucker, & Duchnowski, 1981; Kaslow, Rehm, & Siegel, 1984; Nolen-Hoeksema, Seligman, & Girgus, 1986; Seligman et al., 1984). However, these findings may not generalize to clinical populations, as the majority of these studies sampled nonhospitalized schoolchildren. In fact, studies of psychiatric populations of children and adults indicate only a weak relationship between a self-deprecatory attributional style and depression (Gong-Guy & Hammen, 1980; Hamilton & Abramson, 1983; Kaslow, Rehm, Pollack, & Siegel, 1989; Miller, Klee, & Norman, 1982; Saylor, Finch, Spirito, & Bennett, 1984).

Relative to the substantial investigation of depression and cognitive factors with adult and child populations, little attention has been directed to the role of cognitive factors in adolescent depression. Results from the few studies using clinical samples of adolescents have been inconsistent. While some have found correlations between depression and self-blame for negative events (Saylor et al., 1984), others report that depression is related only to failure to make internal attributions for positive events and not to self-blame for negative events (Benfield, Palmer, Pfefferbaum, & Stowe, 1988; Curry & Craighead, 1990). McCauley, Mitchell, Burke, and Moss (1988) found that clinically depressed children and adolescents evidenced significantly lower self-esteem, more hopelessness, an external locus of control, and negative attributional style when compared with nondepressed peers. Inconsistency in these findings calls for clarification of the role of cognitive factors in adolescent depression.

The present study was designed to examine the relationship between self-reported depression and cognitive style in psychiatrically hospitalized adolescents. It was hypothesized that global, stable, and internal attributional style for negative events, perception of lack of control over the environment, and hopelessness would be significantly related to depression, while controlling for general psychiatric disturbance. …