Teenage Girls Are Exposed to More Stressors that Increase Depression Risk

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"Adolescence is often a turbulent time, and it is marked by substantially increased rates of depressive symptoms, especially among girls. New research indicates that this gender difference may be the result of girls’ greater exposure to stressful interpersonal events, making them more likely to ruminate, and contributing to their risk of depression. The findings are published in Clinical Psychological Science, a journal of the Association for Psychological Science. This is a photo of a pensive looking girl sitting on steps.“These findings draw our focus to the important role of stress as a potential causal factor in the development of vulnerabilities to depression, particularly among girls, and could change the way that we target risk for adolescent depression,” says psychology researcher and lead author on the study, Jessica Hamilton of Temple University. “Although there is a range of other vulnerabilities that contribute to the emergence of girls’ higher rates of depression during adolescence, our study highlights an important malleable pathway that explains girls’ greater risk of depression.” Research has shown that cognitive vulnerabilities associated with depression, such as negative cognitive style and rumination, emerge during adolescence. Teens who tend to interpret events in negative ways (negative cognitive style) and who tend to focus on their depressed mood following such events (rumination) are at greater risk of depression. Hamilton, a doctoral student in the Mood and Cognition Laboratory of Lauren Alloy at Temple University, hypothesized that life stressors, especially those related to adolescents’ interpersonal relationships and that adolescents themselves contribute to (such as a fight with a family member or friend), would facilitate these vulnerabilities and, ultimately, increase teens’ risk of depression. The researchers examined data from 382 Caucasian and African American adolescents participating in an ongoing longitudinal study. The adolescents completed self-report measures evaluating cognitive vulnerabilities and depressive symptoms at an initial assessment, and then completed three follow-up assessments, each spaced about 7 months apart. As expected, teens who reported higher levels of interpersonal dependent stress showed higher levels of negative cognitive style and rumination at later assessments, even after the researchers took initial levels of the cognitive vulnerabilities, depressive symptoms, and sex into account. Girls tended to show more depressive symptoms at follow-up assessments than did boys — while boys’ symptoms seemed to decline from the initial assessment to follow-up, girls’ symptoms did not. Girls also were exposed to a greater number of interpersonal dependent stressors during that time, and analyses suggest that it is this exposure to stressors that maintained girls’ higher levels of rumination and, thus, their risk for depression over time. The researchers emphasize that the link is not driven by reactivity to stress — girls were not any more reactive to the stressors that they experienced than were boys. “Simply put, if boys and girls had been exposed to the same number of stressors, both would have been likely to develop rumination and negative cognitive styles,” Hamilton explains. Importantly, other types of stress — including interpersonal stress that is not dependent on the teen (such as a death in the family) and achievement-related stress — were not associated with later levels of rumination or negative cognitive style. “Parents, educators, and clinicians should understand that girls’ greater exposure to interpersonal stressors places them at risk for vulnerability to depression and ultimately, depression itself,” says Hamilton. “Thus, finding ways to reduce exposure to these stressors or developing more effective ways of responding to these stressors may be beneficial for adolescents, especially girls.” According to Hamilton, the next step will be to figure out why girls are exposed to more interpersonal stressors: “Is it something specific to adolescent female relationships? Is it the societal expectations for young adolescent girls or the way in which young girls are socialized that places them at risk for interpersonal stressors? These are questions to which we need to find answers!” Co-authors on the study include Jonathan P. Stange and Lauren B. Alloy of Temple University and Lyn Y. Abramson of the University of Wisconsin-Madison. This work was supported by NIMH Grants MH79369 and MH101168 to Lauren B. Alloy. Jonathan P. Stange was supported by National Research Service Award F31MH099761 from NIMH." For more information on mental health topics, please visit CEUs for MFTs

PTSD raises risk for obesity in women

Women with PTSD gain weight more rapidly than women without disorder Women with post-traumatic stress disorder (PTSD) gain weight more rapidly and are more likely to be overweight or obese than women without the disorder, find researchers at Columbia University's Mailman School of Public Health and Harvard School of Public Health. It is the first study to look at the relationship between PTSD and obesity over time. Results appear online in JAMA Psychiatry. One in nine women will have PTSD at sometime over the course of their lifetime—twice as often as men. Women are also more likely to experience extreme traumatic events like rape that carry a high risk for the disorder. "PTSD is not just a mental health issue," says study senior author Karestan Koenen, PhD, Mailman School associate professor of Epidemiology. "Along with cardiovascular disease and diabetes, we can now add obesity to the list of known health risks of PTSD." PTSD - Clinical Practice Guideline for Management of Post Traumatic Stress CEU Course "The good news from the study is that it appears that when PTSD symptoms abate, risk of becoming overweight or obese is also significantly reduced," says first author Laura D. Kubzansky, PhD, Professor of Social and Behavioral Sciences at Harvard School of Public Health. However, despite the growing evidence of potential far-reaching problems associated with PTSD, it's estimated that only half of women in the United States with the disorder are ever treated. "Hopefully, wider recognition that PTSD can also influence physical health will improve this statistic, leading to better screening and treatments, including those to prevent obesity," says Dr. Kubzansky. While it's known that women with PTSD have high rates of obesity, it has been unclear whether PTSD was actually driving the weight gain. To explore the issue, the researchers analyzed data collected from 50,504 women, aged 22-44 years, taking part in the Nurses' Health Study II between 1989 and 2009. Participants were asked about the worst trauma they experienced and if they had related post-traumatic stress symptoms. The threshold for PTSD was the persistence of four or more symptoms over a month or longer. Common symptoms include re-experiencing the traumatic event, feeling under threat, social avoidance, and numbness. Normal-weight women who developed PTSD during the study period had 36% increased odds of becoming overweight or obese compared with women who experienced trauma but had no symptoms of PTSD. The higher risk was evident even for women with sub-threshold symptoms levels and remained after adjusting for depression, which has also been proposed as a major risk factor for obesity. In women with PTSD that began prior to the study period, body mass index increased at a more rapid pace than women without PTSD. The observed effect of PTSD on obesity is likely stronger in the general population of women than in nurses, notes Dr. Koenen. "Nurses are great for studies because they report health measures like BMI with a high degree of accuracy. But they are also more health conscious and probably less likely to become obese than most of us, which makes these results more conservative than they would otherwise be." Symptoms of PTSD rather than the trauma itself seemed to be behind the weight gain. "We looked at the women who developed PTSD and compared them to women who experienced trauma but did not develop PTSD. On the whole, before their symptoms emerged, the rate of change in BMI was the same as the women who never experienced trauma or did experience trauma but never developed symptoms," says Dr. Kubzansky. How exactly does PTSD lead to weight gain? The biological pathway is unknown, but scientists have a number of guesses. One is through the over-activation of stress hormones. PTSD may lead to disturbances in functioning of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, each of which are involved in regulating a broad range of body processes, including metabolism. Another is through unhealthy behavior patterns that may be used to cope with stress. Ongoing research is looking at whether PTSD increases women's preference for processed foods and decreases their likelihood of exercising Social Worker Continuing Education ### Co-authors include Pula Bordelois, MPH, and Andrea Roberts, PhD, at Harvard School of Public Health; Hee Jin Jun, DrPH, at the Channing Division of Network Medicine at Brigham and Women's Hospital; Noah Blustone, BA, at Harvard Medical School and Boston University; and Magdalena Cerda, DrPH, at Columbia's Mailman School. The study was supported by grants from the National Institute of Mental Health to Dr. Koenen (MH078928 and MH093612). The authors declare no conflict of interest.