depression-related stress generation: a longitudinal study of black adolescents

BEHAVIOR THERAPY 35,247--261,2004

Depression-Related Stress Generation: A Longitudinal Study of Black Adolescents

LARICKA R. WINGATE

THOMAS E . JOINER, JR.

Florida State University

The authors examined Hammen's (1991) model of stress generation in depression in a Black adolescent population. The longitudinal sample of 1,766 participants entered the study at ages 13 to 18. Stressful events and depressive and other symptom occurrence over a 1-year period were analyzed. Results supported the stress generation model, Depressive symptoms were associated with an increase in negative stressful events. In addition, the study supported the symptom specificity of stress generation to depression versus anxious and conduct disorder symptoms.

Hammen, Davila, and colleagues have documented in a series of empirical studies the phenomenon of stress generation (Adrian & Hammen, 1993; Daley, Hammen, Burge, & Davila, 1997; Davila, Bradbury, Cohan, & Tochluk, 1997; Davila, Hammen, Burge, & Paley, 1995; Hammen, 1991; Hammen, Davila, Brown, Ellicott, & Gitlin, 1992). Hammen (1991) suggested that some subsets of depressed people are exposed to considerable stress by virtue of their condition and their characteristics and behaviors and that, to some degree, depressed persons generate the stressors that befall them. The stress generation phenomenon is defined as actively contributing to the occurrence of one's own negative life events, and serves to remind us that individuals help to create environments for themselves (Hammen, 2000).

This phenomenon was found in Hammen's (1991) 1-year study of women with depression, bipolar disorder, medical illness, or no disorder. Hammen assessed the stressful events in her study through an interview schedule with

We would like to thank the Henry A. Murray Research Center and Dr. Felton Earls for the use of data and materials.

This research used the Adolescent Health Care Evaluation Study data set (made accessible in 1990, machine-readable data files). These data were collected by F. Earls and are available through the archive of the Henry A. Murray Research Center of the Radcliffe Institute for Advanced Study, Harvard University, Cambridge, Massachusetts (Producer and Distributor).

Address correspondence to Thomas Joiner, Department of Psychology, Florida State Univer- sity, Tallahassee, FL 32306-1270; e-mail: [email protected].

247 005 -7894/04/0247-0261 $1.00/0 Copyright 2004 by Association for Advancement of Behavior Therapy

All rights for reproduction in any form reserved.

248 WINGATE & JOINER

a method that placed the stressful events in the context that they occurred, and conducted objective ratings on the stressfulness of events. The data showed that depressed women, even compared to the women with bipolar disorder and medical illness, experienced more stress to which the women themselves contributed. The methodology that has been consistently used to study stress generation includes a longitudinal design and the investigation of whether a depression measure at a specific point in time predicts a particular measure of stress at a later time. Although different measures of stress and depression have been used in various studies, the outcome regarding stress generation is consistent. This finding has been replicated in samples of men and women (Hammen et al., 1992), marital couples (Davila et al., 1997), adolescent women (Daley et al., 1997; Davila et al., 1995), children (Adrian & Hammen, 1993), as well as by other research groups (Joiner, Wingate, Gen- coz, & Gencoz, in press; Potthoff, Holahan, & Joiner, 1995; Simons, Angell, Monroe, & Thase, 1993; Wagner, Berenson, Harding, & Joiner, 1998).

However, there is a noteworthy lack of information in the stress generation literature. There have been no studies that have attempted to examine this phenomenon specifically in minority cultures. Hammen's (1991) and Adrian and Hammen's (1993) participants were mostly Caucasian with groups of 0% to 30% non-White; however, the minority groups were not specified. The Davila et al. (1995) and Daley et al. (1997) studies included 54% of participants from various ethnic groups, with 2% African American. Davila et al. (1997) included 39% ethnic minorities, 5% of whom were African American. Although minorities were included in these previous studies, African Ameri- cans only consisted of a small percentage of the population and no analysis looked specifically at the minorities.

There is a relative lack of information on psychiatric disorders and symptoms among minority adolescents in the United States and only a minority of studies has focused on African Americans (Roberts, 1992; Roberts, Chen, & Solovitz, 1995). It has been reported that there may be minimal differences in the phenomenology of DSM major depression symptoms across groups of Anglo and African American adolescents (Roberts et al., 1995). Anglo and African American adolescents also exhibited similar depressive factor structure, represented by negative affect, low positive affect, and psychosomatic symptoms (Roberts, 1992). Because there are minimal differences in depression between groups, it may be logical to assume that stress generation occurs similarly in Black adolescents as in the mostly Caucasian populations that have been studied previously. However, according to many sources (e.g., the DSM), culture can influence the experience and communication of symptoms of depression.

Research in adults has suggested differences in depression and stress among African Americans. It has been found that race (when socioeconomic status is not accounted for) and low income (current sample is both African American and low income) are associated with higher levels of depressive symptoms (Ficsella & Franks, 1997; Schraedley, Gotlib, & Hayward, 1999). With specific relevance to the current study, it has been found that African

STRESS GENERATION A N D BLACK A D O L E S C E N T S 249

American adults had significantly more negative life events, especially adverse financial events (Jackson-Triche et al., 2000). This may suggest that there is a cultural influence on stress. If it is the case that minorities, specifically Afri- can Americans, may experience and communicate stress differently than Cau- casian people do, the question stands as to whether depression in minority populations predicts stress generation.

Hammen (1991) suggested that the stress generation effect was specific to depression as opposed to generally related to numerous mental disorders. Hammen found that women with unipolar depression were more likely than women with bipolar disorder, chronic medical illness, or non-ill women to experience higher rates of stress generation. This finding speaks to the idea of specificity, or the idea that there is something about stress generation that causes it to occur only as a result of depression as opposed to other disorders. Along with establishing the presence of a stress generation effect in a minority population, the question stands as to whether this effect is specific to depression in minority populations.

In discussions of causality in nonexperimental research (e.g., Garber & Hollon, 1991), three criteria have been repeatedly emphasized. First, a predictor and an outcome should covary. Second, a predictor should temporally precede an outcome. And third, the relationship between a predictor and an outcome should be specific and nonspurious (e.g., should not be better accounted for by a third variable). If stress generation meets these criteria, support for the causal status of depressive symptoms in relation to stressful life events is bolstered.

The main purpose of the present study was to evaluate the presence of stress generation phenomena in a minority adolescent population and to evaluate the specificity of stress generation to depression vs. other symptoms. Examination of these issues is important in itself, but even more so with regard to an understudied population. Regarding this situation, Popper (1959, p. 269) stated, " . . . once a theory is well corroborated, further instances raise its degree of corroboration only very little. This rule however does not hold good if these new instances are very different from the earlier ones, that is if they corroborate the theory in a newfield of application." The study was longitudinal, using a 1-year time frame, and examined interviewer-rated negative life stress and depressive and other symptoms. The participants were Black adolescents from 10 health-care programs throughout the country. Adoles- cents represent a particularly interesting group to study because there is a relative lack of mental health disorder information on adolescents, and this lack of information among minority adolescents is even greater (Roberts, 1992; Roberts et al., 1995). Moreover, the adolescent years tend to be a time of emotional stress in American society. Interestingly, in the majority of people who have suffered from depression, the symptoms of depression tend to emerge or worsen during adolescence. It has also been found that the age of onset for depression is dropping toward the adolescent years (e.g., Smith & Weissman, 1992).


We predicted that depressive symptoms reported at Time 1 would be predictive of the number of negative stressful life events at Time 2 (controlling for negative life events reported at Time 1). It was also expected that the stress generation effect would be specific to depressive versus nondepressive symptoms, such as anxious or conduct disorder symptoms. Because both anxious and conduct disorder symptoms are associated with depressive symptoms and stress (Meller & Borchardt, 1996), a finding of stress generation that occurs only in relation to depressive symptoms would provide support for the specificity of stress generation to depression. We expect to find specificity, despite the theoretical and empirical overlap between depression, anxiety, and conduct disorder, for two reasons. First, Hammen found specificity in her 1991 study, and second, we believe that stress generation may be related to level of behavioral activation and active coping, which are specifically low among depressed people (a point to which we return in the Discussion). Finally, although not central to our stress generation hypotheses, we predicted that the number of negative stressful life events at Time 1 would be predictive of depressive symptoms reported at Time 2 (controlling for depressive symptoms reported at Time 1).

Method Participants and Procedure

Participants were 1,766 African American adolescents (13 to 18 years of age; average age was 16.3, SD = 1.14), predominantly working class, who were drawn from 10 health-care programs throughout the country. Both the adolescents and their parents were present and provided informed consent to participate in the study. All participants self-identified as African American, and those who identified otherwise (e.g., Hispanic, interracial, or other) are not included in this sample. At Time 1 there were 476 males and 1,500 females; at Time 2 there were 418 males and 1,348 females. The participants were interviewed in the order that they presented at the clinics for a variety of health-care concerns. Participation in the study was not specific to those who had or had not received previous mental or physical health treatment, so that some participants had received prior treatment and others had not. Only those participants completing all assessments in the initial interview and follow-up interview were included in the analysis (N = 1,766). The 210 participants who were excluded did not differ from those included in age, t(1, 1,974) = - 1.67, p = ns, sex, t(1, 1,974) = 1.09,p = ns, stressful events, t(1,1,974) = - 0 . 2 1 , p = ns, depression symptoms t(1, 1,974) = -1 . 38 , p = ns, anxiety symptoms, t(1, 1,974) = 0.45, p = ns, or nonaggressive conduct disorder symptoms, t( l , 1,974) = -0 .18 , p = ns. The only difference between the two groups on study variables was that those who did not return had significantly more aggressive conduct disorder symptoms than those who returned: partial correlation (pr) = -0 .06 , t(1, 1,974) = -2 .57 , p = .01. Lewinsohn et al. (1993) reported a similar finding of higher attrition rates for subjects who had


a history of disruptive behavior disorders in the Oregon Adolescent Depres- sion Project. Participants were initially interviewed in 1984-1985 and were followed up in 1985-1986. ~ The interviews at Time 1 were face-to-face and were conducted by trained professional interviewers in the clinic. The interviews lasted roughly 50 minutes and occurred on the same day that the participant presented to the clinic for medical services. The majority of interviews conducted at Time 2 were administered at the home of the participant (see Earls, 1989; Stiffman, Earls, Robins, Jung, & Kulbok, 1987, for more information on data-collection procedures).

Materials

Data were collected using a structured closed-ended interview schedule to obtain information on participants' reasons for attending the clinic, other health services used, physical and mental health status, family background, school adjustment, peer relations, stressful events, social adjustment and sup- ports, health practices, and extracurricular activities. Portions of the Diagnos- tic Interview for Children and Adolescents (DICA) were included as part of the interview schedule to examine aggressive or antisocial traits. The DICA is a valid and reliable instrument for both clinical and research purposes (kappa -- 0.80 for the assessment of conduct disorder; Welner et al., 1987). In addition, specific portions of the Diagnostic Interview Schedule (DIS) that consisted of questions to assess symptoms of depression and anxiety were included in the interview schedule. The DIS appears to be a reasonably satis- factory instrument for making psychiatric diagnoses (kappa = .63 for depression; range: .40 to .67 for anxiety; Robins, Helzer, Croughan, & Ratcliff, 1981).

Hammen (1991) and Daley et al. (1997) found evidence for the stress generation effect in participants with a depression diagnosis. The current study, like that of Davila et al. (1995), assessed the generality of stress generation to depressive symptoms vs. depressive diagnoses. 2 The depressive symptoms assessed in the interview included the time-period criteria of feeling depressed for more than 2 weeks (a key criterion for current depression) or 2 years (a key criterion for dysthymia) for major depression and dysthymia, re- spectively. The other depressive symptoms that were assessed include work suffering, change in appetite and sleep, loss of energy and interest, feelings of worthlessness, trouble thinking, emotional changes, and thoughts of death.

1 This research used the Adolescent Health Care Evaluation Study data set, collected by F. Earls and available through the archive of the Henry A. Murray Research Center of the Rad- cliffe Institute for Advanced Study, Harvard University, Cambridge, Massachusetts.

2 A focus on symptoms (as opposed to diagnoses) is not only legitimate in the context of past work (e.g., Davila et al., 1995), the "continuity-category" debate (see Ruscio & Ruscio, 2000; Vredenburg, Flett, & Krames, 1993), and the pernicious qualities of subclinical depressive symptoms (Judd, 2000), but also given the features of the data set (from which symptom counts are readily available, but from which diagnostic status is more difficult to establish).


T h e d e p r e s s i v e s y m p t o m s c o r e w as t he to ta l n u m b e r o f d e p r e s s i v e s y m p t o m s tha t w e r e e n d o r s e d by e a c h p a r t i c i p a n t . T h e s co re r a n g e s f r o m 0 to 11.

T h e s t r e s s fu l e v e n t s a s s e s s e d in the i n t e r v i e w f o c u s e d o n e v e n t s t ha t o c c u r r e d in the pa s t year , a n d i n c l u d e d f igh t ing at h o m e , r e s p o n d e n t ' s i n v o l v e - m e n t w i t h f i g h t i n g at h o m e , b ig m o n e y w o r r i e s , l i v i n g w i t h a h a n d i c a p p e d

p e r s o n , s o m e o n e c a r e d a b o u t d i ed , s o m e o n e at h o m e d r i n k s a lot , s o m e o n e at h o m e h a s p r o b l e m s w i t h t he po l i c e , a n y o n e h u r t o r t h r e a t e n e d r e s p o n d e n t ,

a n y o n e h u r t a n o t h e r h o u s e h o l d m e m b e r , a n d a n y o n e k n e w we l l k i l l e d ? E a c h s t r e s s fu l e v e n t w a s i n d i v i d u a l l y a s s e s s e d f r o m a s t r u c t u r e d l is t b y an in te r -

v i e w e r a n d w a s r a t e d as e i t h e r p r e s e n t o r a b s e n t w i t h i n the las t y e a r b y the i n t e r v i e w e r . In s o m e p r e v i o u s s tud ie s o f s t ress g e n e r a t i o n , t he a u t h o r s

a s s e s s e d the t y p e a n d s eve r i t y o f s t r e s s fu l e v e n t s as we l l as the n u m b e r o f

s t r e s s fu l l i fe e v e n t s (e .g. , A d r i a n & H a m m e n , 1993; D a l e y e t al. , 1997; D a v i l a

3 Previous work on stress generation distinguishes between dependent events (the participant is involved in, or is at least partially responsible for, the occurrence of the event) and independent stressful events (Hammen, 1991 ). The stressful event questions in this study did not specifically distinguish between dependent and independent events. In order to make this distinction in congruence with previous literature, the authors judged on rational grounds that two events were dependent (respondent's involvement with fighting at home, anyone hurt or threatened respondent) as they significantly involved the participant. When these dependent events (respondent's involvement with fighting at home, anyone hurt or threatened respondent) were analyzed separately, the stress generation effect was still present. Depression predicted dependent stressful events, t(1,760) = 4.21, p < .001. The data also suggested that depression predicted independent stressful events, t(1,760) = 4.93, p < .001.

To take a more empirical approach to the distinction between dependent and independent events, a mini-study on the categorization of the stressful events as either dependent or independent was conducted. Participants in the study were 35 graduate students and professors of clinical psychology at Florida State University. Participants were asked to distinguish the 10 stressful events as either a dependent stressful event (defined as the kind of event which the participant may have substantially caused by his or her own behavior) or an independent stressful event (defined as the kind of event which was "fateful," not caused by the participant's behavior). Results indicated that participants consistently rated (1) respondent's involvement with fighting at home (94% of respondents) and (2) big money worries (94% of respondents) as dependent events. When these dependent events (respondent's involvement with fighting at home, big money worries) were analyzed separately, the stress generation effect was still present. The same pattern of results emerged; depression predicted both dependent and independent events.

The dependent events in this study are also very similar to events in a validated and reliable measure that has also been used to examine the stress generation phenomenon, the Negative Life Events Questionnaire (NLEQ; Saxe & Abramson, 1987; cf. Joiner, Wingate, Gencoz, & Gencoz, in press). Then NLEQ asks about big money worries, specifically, a significant negative change in financial circumstances, and not enough money for necessities. The NLEQ also assesses respondents' involvement with fighting in the family, specifically, significant fight or argument with close family member, fights or disagreements with one or more close family member, or conflict with parents.

Of note, all of the stressful events in this study were endorsed by at least some participants. The least commonly endorsed event was someone at home having problems with the police, and was endorsed by 4.6% of respondents. The most commonly endorsed stressful event was endorsed by 32.2% of respondents and was someone the respondent cared about died.

STRESS GENERATION A N D BLACK ADOLESCENTS 253

et al., 1995; Davila et al., 1997; Hammen, 1991). We, like Joiner et al. (in press), examined the dichotomous rating of stressful events as either present or absent because we were particularly interested in the occurrence of these events, and specifically did not want to confound the occurrence of the negative events with the interpretation of the events (which severity ratings may pull for). The stress score was the total number of stressful events that were endorsed by each participant. The score ranges from 0 to 10. The interview- based assessment of stress used in the study is the preferred assessment approach, and has accrued good reliability and validity data (e.g., McQuaid et al., 2000). Hammen (1991) suggests that the interview-based collection of life stress data is preferable because of the insensitivity of questionnaire assessments to the personal significance of events and the occurrence of idio- syncratic events. Importantly, the interviewer thoroughly ascertained whether or not negative events should be rated as such (e.g., that events had actually occurred during the relevant time frame; that a particular event had occurred at all; etc.). In addition, events that were assessed were likely to be salient and severe (e.g., someone cared about died, anyone hurt or threatened respondent, anyone knew well killed), which should minimize reporting biases. Test-retest correlation in the present study (interval was 1 year) was .38, very similar to the values of .38 and .39 reported by Daley et al. (1997, p. 256) for test- retests of well-validated interview-based stress measures over approximately 1 year. Internal consistency of this scale was 0.87.

The anxiety assessed in the interview focused specifically on the physical symptoms of anxiety, and included shortness of breath, heart pounding, dizzi- ness, digits tingling, chest pain/tightness, feeling smothered, feeling faint, sweating, trembling or shaking, hot/cold flashes, things seeming unreal, afraid might die. The anxiety score was the total number of anxiety events that were endorsed by each participant. The score ranges from 0 to 12. The nonaggressive conduct disorder symptoms assessed included suspension from school, expulsion from school, stealing, playing hooky, lying to get out of trouble, running away, and receiving payment for sex. The aggressive conduct disorder symptoms assessed included physical fights, hurting someone badly, injuring an animal, physically taking things from others, starting fires, destroy- ing property, breaking into buildings, threatening others with weapon, and carrying a weapon. The conduct disorder score was the total number of conduct events that were endorsed by each participant. The nonaggressive score ranges from 0 to 7. The aggressive score ranges from 0 to 9.

Results Descriptive statistics and intercorrelations are summarized in Table 1. It was

predicted that depressive symptoms reported at Time 1 would be predictive of the number of negative stressful life events at Time 2 (controlling for negative life events at Time 1), and that this effect would be specific to depressive symptoms. To test this hypothesis, a regression equation was constructed. For the


T A B L E 1 MEANS, STANDARD DEVIATIONS, AND INTERCORRELATIONS OF ALL MEASURES

1 2 3 4 5 6

1. T2 STRESS 1.00"* 2. Tl STRESS .38** 1.00**

3. TI DEP .29** .42** 1.00"*

4. T I A N X .13"* ,16"* .28** 1.00"*

5. TI AGG CD .11"* .14"* .15"* .04*

6. TI NON A G G C D .13"* ,17"* .19"* .09**

Mean 2.20 2,56 3.66 0.05 SD 1.37 1,53 4.00 0.29

1.00"*

.28** 1.00"*

0.06 1.44 0.22 0.72

Note. N = 97. DEP = Depressive Symptoms; ANX = Anxiety Symptoms; AGG CD =

Aggressive Conduct Disorder Symptoms; T1 = Time 1; T2 = Time 2.

*p = .05; **p < .01.

equation, Time 2 total number of negative events was used as the dependent variable. Next, Time 1 total number of negative events was entered into the regression equation, thereby creating residual change scores in number of negative events from baseline to follow-up (Cohen & Cohen, 1983). The total number of depressive symptoms, conduct disorder symptoms, and anxiety symptoms that were endorsed were entered as predictors. If, as hypothesized, depressive symptoms precede negative life stress, then depressive symptoms will emerge as a significant predictor in the regression equation. If this effect is specific to depressive symptoms, anxiety and conduct disorder symptoms will emerge as nonsignificant predictors of changes in negative life stress.

As can be seen in Table 2, this was, in fact, the finding. Overall, depressive symptoms at Time 1 were associated with increases in negative life stress from Time 1 to Time 2,pr = .13, t ( l , 760) = 5 . 7 7 , p < .001. It thus appears

T A B L E 2 DEPRESSION, ANXIETY, AND CONDUCT DISORDER SYMPTOMS PREDICTING INCREASES IN

NUMBER OF STRESSFUL EVENTS, DEPENDENT VARIABLE -- TIME 2 STRESS SYMPTOMS

Order of t for Partial Entry Within-Set Correlation Model of Set Predictors in Set F for Set Predictors df (PR/pr) R 2

Time 1 stress 288.82 16.10"* l 1,764 .375 0.14

Time I depression sx 70.49 5.78** 5 1,760 .136 0.16

Time 1 anxiety sx 70.49 1.58 5 1,760 .038 0.16

Time I aggressive cd sx 70.49 1.85 5 1,760 .044 0.16 Time 1 nonaggressive cd sx 70.49 1.34 5 1,760 .032 0.16

Note. pr = partial correlation for within-set predictors; sx = symptoms; cd = conduct disorder. **p < .01.

STRESS GENERATION AND BLACK ADOLESCENTS 255

T A B L E 3 STRESS, ANXIETY, AND CONDUCT DISORDER SYMPTOMS PREDICTING INCREASES IN NUMBER

OF DEPRESSIVE SYMPTOMS, DEPENDENT VARIABLE = TIME 2 DEPRESSIVE SYMPTOMS

Order of t for Partial Entry Within-Set Correlation Model of Set Predictors in Set F for Set Predictors df (PR/pr) R 2

Time 1 depression sx 692.80 26.32** 1 1,764 .531 0.14 Time 1 stress 152.37 3.31"* 5 1,760 .079 0.16 Time 1 anxiety sx 152.37 4.21"* 4 1,760 .100 0.16 Time 1 aggressive cd sx 152.37 1.50 4 1,760 .036 0.16 Time 1 nonaggressive cd sx 152.37 3.20** 4 1,760 .076 0.16

Note. pr = partial correlation for within-set predictors; sx = symptoms; cd ~ conduct disorder. **p < .01.

that depression may be involved in the development and persistence of stress. 4 It is also important to note that anxiety and conduct disorder symptoms were not significantly associated with increases in the number of negative life events (see Table 2). Accordingly, we suggest that the stress generation phenomenon shows some specificity to depressive vs. other symptoms.

Additionally, we examined whether the number of negative stressful life events at Time 1 would be predictive of depressive symptoms reported at Time 2 (controlling for depressive symptoms reported at Time 1). To test this hypothesis, a regression equation was constructed. For the equation, Time 2 total number of depressive symptoms was used as the dependent variable. Next, Time 1 total number of depressive symptoms was entered into the regression equation, thereby creating residual change scores in number of depressive symptoms from baseline to follow-up (Cohen & Cohen, 1983). The total number of stressful events, conduct disorder symptoms, and anxiety symptoms that were endorsed were entered as predictors. If, as hypothesized, negative life stress also precedes depressive symptoms, then negative life stress will emerge as a significant predictor in the regression equation. If this effect is specific to negative life stress, anxiety and conduct disorders symptoms will emerge as nonsignificant predictors of changes in depressive symptoms.

As can be seen in Table 3, overall, negative life stress at Time 1 was associated with increases in depressive symptoms from Time 1 to Time 2, pr = .08, t(1,760) = 3.31 ,p = .001. It thus appears that stress may be involved in the development and persistence of depression. It is also interesting to note that both anxiety and nonaggressive conduct disorder symptoms were significantly associated with increases in the number of depressive symptoms (see Table 3). This finding suggests that the generation of depressive symptoms is

4Results were generally similar among men and women. Depressive symptoms at Time 1 were associated with increases in negative life stress from Time 1 to Time 2 (men: pr = .15, t[412] = 3.14,p = .002; women: pr = .13, t[1,342] = 4.91,p < .001).

256 W I N G A T E & J O I N E R

not specific to stress vs. symptoms of anxiety and conduct disorder. We also conducted three similar analyses to examine whether the number of negative stressful life events at Time 1 predicted changes in anxiety, aggressive conduct disorder, and nonaggressive conduct disorder symptoms at Time 2 (controlling for anxiety, aggressive conduct disorder, nonaggressive conduct disorder, and depressive symptoms reported at Time 1). Negative life stress at Time 1 was associated with increases in anxiety symptoms, pr = .06, t(1,760) = 2.37, p < .05, from Time 1 to Time 2. Negative life stress at Time 1 was also associated with increases in aggressive conduct disorder symptoms, pr = . 1 O, t(1,760) = 4.25, p < .001, from Time 1 to Time 2. Negative life stress at Time 1 was also associated with increases in nonaggressive conduct disorder symptoms,pr = .09, t(1,760) = 4.04, p < .001, from Time 1 to Time 2. It thus appears that stress may be involved in the development and persistence of depressive, anxious, aggressive, and nonaggressive conduct disorder symptoms.

Discussion The current study replicated and extended work on the stress generation

effect reported by Hammen, Davila, and colleagues (e.g., Hammen, 1991) to a Black adolescent population. Furthermore, to our knowledge, this study is only the second study to evaluate the specificity of stress generation to depressive symptoms, and symptom specificity was clearly supported, at least as regards anxious and conduct disorder symptoms. Among Black adolescents, like in other groups (Hammen, 1991), depressive symptoms predicted increases in subsequent experience of stressful life events.

The analysis of stress generation in this study represents a successful application of criteria to demonstrate that a predictor may be causal in nonexperimental research (cf. Garber & Hollon, 1991). The first criterion, that depression and stress should covary, was met (see Table 1; r = .29, p < .01). The second criterion, that depression should temporally precede stress, was also met. We specifically examined depression (and other) symptoms that occurred 1 year before the stressful events. And third, the relationship between depression and stress was specific, even despite a methodology that rigorously challenged specificity. For example, we controlled for baseline symptoms of stressful events when assessing the predictive effect of depression (and other) symptoms. Secondly, and more importantly, we examined the specificity of stress generation to depression vs. other symptoms closely related to depression (and to stress, for that matter). Depression symptoms were predictive of stressful events, and anxiety and conduct disorder symptoms were not, even despite the high overlap of these disorders. Because the current study of stress generation successfully applied these criteria, the causal status of depressive symptoms in relation to stressful life events is supported.

The current study not only supported the generality of stress generation to a minority population, but it supported the generality of stress generation


to diverse stressors and settings as well. Events experienced by the participants in the present study may have been qualitatively different than events experienced by participants in previous studies, because current participants were of a different race and socioeconomic status than many participants in previous studies. It has been found that African Americans had significantly more negative life events, especially adverse financial events (Jackson-Triche et al., 2000), than Caucasians. Also, it is likely that negative life events occur more frequently in lower SES settings, because control of the environment may be less, and financial stress may be higher. Moreover, participants in this study were from different programs throughout the U.S., supporting the generality of findings to various settings and regions. Our findings thus represent compelling support for the resilience of the stress generation effect: It occurred in an understudied group across various settings and across various stressors.

In the current study stress generation appeared to occur regardless of the distinction between independent and dependent events, suggesting that in this population, depression predicts stress in general (as opposed to dependent stress in particular; see Footnote 3). From stress generation theory (Hammen, 1991), it is clear why stress generation occurs with regard to dependent stressors (i.e., people struggling with depressive symptoms may behave in ways that produce stress). It is less clear why stress generation may occur with regard to independent stressors, and indeed, past work has suggested that depressive symptoms tend not to induce independent stressors.

However, in our study, depressive symptoms were at least as related to independent as to dependent stressors (see Footnote 3). These findings could be due to the fact that the questions pertaining to negative life events in our study did not precisely differentiate between dependent and independent stress. Future empirical work on this specific issue may wish to determine whether our findings on independent stressors are specific to this sample. Future conceptual work may wish to reconsider the distinction between dependent and independent events. It is possible that stressors fall on a continuum from clearly dependent to absolutely independent or fateful, and that stress generation processes may affect larger segments of the continuum in given samples. It is also important to note that many of the stressful events evaluated in this study were interpersonal events. Depression and stress generation may be related to general interpersonal stressful events in this population (and, at least in some samples, stress generation processes may be operative with regard to interpersonal events in general, as opposed to dependent interpersonal events in particular).

Another speculation that may guide future work on specificity involves the possibility that the generation of stress is significantly related to coping style, such that those with a more passive coping style are more likely to generate negative life events. People with passive coping styles are likely to let stressful events occur without actively working to prevent or intervene in their occurrence. Also, once a negative event has occurred, a person with a passive


coping style is less likely to prevent it from occurring again, and less likely to appropriately handle the consequences of the event. Interestingly, people with depression both tend to have a more passive coping style and tend to generate stressful life events. Features of depression include a significant decrease in activation, which can be related to more passivity. Unlike people with depressive symptoms, people with symptoms of other disorders, such as anxiety and conduct disorder (and bipolar disorder and medical illness; e.g., Hammen, 1991), are more likely to be more active in their style of coping.

It is also possible that our findings of depression predicting both dependent and independent stressful events could be explained by the passive coping style characteristic of people with depressive symptoms. People with depressive symptoms may generate dependent stressful life events, but, in addition, their passive coping style may prevent them from averting both current and future independent events. Although independent events may be fateful, their persistence and effects may not be, and may be specifically related to passive coping in depression. To further illustrate this idea, consider the example of an independent stressful event -- being laid off from a job due entirely to lack of seniority. A person with an active coping style in this situation may actively and immediately take steps to find another job. On the other hand, a person with a passive coping style is less likely to take active steps, and there- fore the effects of the fateful event may be exacerbated and prolonged due, at least in part, to the passive behavior of the individual. In this example, the original event was fateful or independent, but its sequelae were not. People with depressive symptoms and passive coping style may be less likely to prevent dependent events and more likely to encounter (by way of passivity) independent stressful events. Further study of passive coping style and its relation to stress generation may serve as a fruitful avenue for stress generation research.

Our symptom specificity results support the view that processes and features specifically associated with depression lead to increased stress, and, whatever these processes and features are, they are not as operative with regard to anxious and conduct disordered symptoms. The delineation of these features and processes represents another area in need of future work (cf. Davila et al., 1995). We offer one speculation that may guide future work: Negativism, pessimism, and hopelessness (more associated with depressive than anxious or conduct symptoms) may, due to their embittering and stulti- fying effects, produce views of depressed people in the minds of others that are negative and change-resistant (see Sacco, 1999, for a full articulation of this view). Others' negative views may, in turn, subserve critical communications from others to the depressed person (one form of life stress). Importantly, such communications have been shown to be strong predictors of depression and its recurrence (Hooley & Teasdale, 1989; cf. Joiner, 2000). A related possibility was already mentioned; specifically, depressed people may be subject to generated as well as maintained stress (both dependent and possibly fateful forms as well) as a result of passive coping and behavioral inactivation.


In addition to examining the stress generation hypothesis, we also examined the prediction that negative stressful life events would be predictive of later depressive symptoms. Our findings supported the prediction and suggest that stress may be involved in the occurrence and persistence of depression. We also found that stress may be involved in the occurrence and persistence of other symptoms as stress predicted anxiety and both nonaggressive and aggressive conduct disorder symptoms. The result on stress predicting depression, considered together with the finding that depression predicts stress, suggests a cycle wherein one leads to another, which leads to the first, and so on. This cycle represents one possible explanation for the chronicity of depression (Joiner, 2000).

It would be of interest, of course, to replicate this study and focus on depression diagnoses as opposed to symptoms among Black adolescents. Re- garding other limitations, it should be noted that nonreturners at Time 2 had significantly more aggressive conduct disorder symptoms than those who returned. A similar finding was apparent in the Lewinsohn et al. (1993) Oregon Adolescent Depression Project. While this difference in attrition rate should be considered, we do not believe it substantially affected our results or conclusions.

That the data analyzed in this study were collected in 1985-1986 could be considered a drawback. In addressing this concern it is important to note the similarity of definitions of depression (and most other disorders) .since the DSM-III in 1980. In versions from the DSM-III to the DSM-IV-TR the criteria for major depressive episode have changed very little, and include depressed mood, loss of interest or pleasure, change in appetite and weight, insomnia or hypersomnia, psychomotor agitation or retardation, loss of interest or pleasure in usual activities, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, and recurrent thoughts of death, suicidal ideation or suicide attempt. We there- fore suggest that the findings of the current study remain relevant.

Hammen (1991) suggested that there are important implications of stress generation, including that people both create and respond to their environments. As noted above, depressive symptoms and behaviors may serve to generate stressful conditions and events, which, in turn, may lay the ground- work for future depressive symptoms, and may partially explain depression chronicity (Joiner, 2000). A fruitful approach for future research would be to further test this cycle with a longitudinal data set that includes three measure- ment points to assess Time 1 depression, predicting Time 2 stress, in turn predicting Time 3 depression. People with depressive symptoms and characteristics may contribute to the occurrence of negative events, and may also find themselves in unstable social circumstances and high-risk situations in which certain stressors may be likely to occur. Therapeutics that specifically develop skills for managing and muting life stress (McCullough, 2000; Rudd, Joiner, & Rajab, 2001) may thus truncate stress-generation cycles, which appear operative across a wide range of people.


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depression-related stress generation: a longitudinal study of black adolescents

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