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Literature summary Theorizing Diversities in Youth Care
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Hyde et al (2008): The ABCs of depression: integrating affective, biological and cognitive models toexplain the emergence of the gender difference in depression
Introduction
- Estimates are that in adulthood twice as many women as men are depressed
- Although the exact gender ratio varies slightly from culture to culture, most nations reported
a gender ratio close to 2.0
- More girls than boys are depressed by ages 13 to 15
- The gender difference in depression has been attributed to a wide variety of factors including
girls’ and women’s greater ruminative coping , dependence on relationships or affiliative
needs, genetic factors, greater cognitive vulnerability, exposure to negative life events,
experiences of rape and child sexual abuse, gender intensification and adherence to
traditional gender roles and interactions among these factors
- The numerous theories and models of depression that have been proposed previously can be
broadly categorized as proposing explanations for the emergence of the gender difference in
depression emphasizing affective factors such as temperament or emotion regulation,
biological factors such as genetics or pubertal hormones or cognitive factors such as cognitive
style or ruminationF
- Lacking: A well-defined, integrated, testable, developmental model of gender differences in
depression that
o A) integrates affective, biological and cognitive factors
o B) is consistent with the developmental timing of the emergence of the gender
difference
o C) takes into account the most recent research and theorizing in relevant areas
- Our proposed ABC (affective, biological, cognitive) model integrates affective, biological and
cognitive factors into a vulnerability-stress model in which these factors are presumed to confer
vulnerability that in the presence of stress, leads to depression and specifically to the gender
difference in depression
The conceptualization and measurement of depression
- Consistent with the conclusions of many experts, we view depressed mood and depressive
disorders as variations along a continuum
- The evidence indicates that even subclinical or moderate levels of depressive symptoms are
associated with diminished psychosocial functioning and gender difference in depression is
found whether assessed by symptom measures or diagnoses
- Depression as a global term encompassing both diagnoses of depression and elevated scores on
symptom scales
Prior reviews
Nolen-Hoeksema and Girgus. Etiological factors:
- Personality: for example dependence on relationships, causal attributions and ruminative
coping
- Biological factors: for example hormonal changes at puberty
- Body dissatisfaction
- Social challenges: for example rape and sexual abuse, parental and peer enforcement of
gender roles
,Three basic developmental models of how the gender difference might appear:
- Model 1: the same factors cause depression in girls and in boys, but one or more of these
factors become more prevalent for girls than boys in early adolescence
- Model 2: different factors cause depression in girls compared with boys and the factors for girls
become more common in early adolescence, whereas the factors for boys do not become more
common or increase only slightly
- Model 3: interactive model that hypothesizes that, even before puberty, girls have more
vulnerability factors for depression than boys do but that it is not until early adolescence, when
major new challenges arise, that the vulnerability factors interact with the challenges to produce
more depression
o Evidence best supported model 3
Hankin and Abramson. Generic cognitive vulnerability-stress model
- Distal factors: genetic vulnerability and early environmental adversity
- Proximal factors: cognitive vulnerability (ruminative response styles and negative cognitions
about body image)
- Types and frequencies of stressful negative events that may interact with vulnerabilities to
produce depression
o Independent negative events (outside the individual’s control
o Dependent negative events (to which the individual contributes)
- Gender differences along points in this causal chain may explain gender difference in depression
Cryanowski et al. A model emphasizing the role of pubertal hormones in interaction with gender role
intensification in adolescence:
- Pubertal hormones ‘sensitize females to the depressogenic effects of negative events’ à through
mechanism of increased affiliative needs driven by intensified gender role socialization as well as
pubertal increases in oxytocin > combines with other depressogenic vulnerability factors (e.g.
highly anxious temperament, insecure attachment, poor coping skills) to create overall
depressogenic diathesis that interacts with stressors in the adolescent transition to produce
depression
Rationale for the ABC model
There are important developmental relationships among affective biological and cognitive vulnerabilities
so that these vulnerability factors do not operate simply in an additive manner, but, rather the presence
of one type of vulnerability may increase the likelihood of the development of another type
vulnerability, this increasing an individual’s overall depression vulnerability
Summary: Important affective and biological features of development can be integrated with cognitive
factors into a developmental vulnerability-stress model of gender and depression in substantive ways
that neither ignore the unique contributions of these processes nor simply provide more pathways to
depression that combine additively
ABC model: Distinctive from other models in the following ways:
1. it is an integrative model, integrates key categories of factors
2. incorporates cutting-edge research not available at the time the other models were proposed
Affective, biological and cognitive vulnerabilities converge in early adolescence form vulnerability that in
the presence of stress produces depression. Models ABC model:
, 1. The causes of depression are the same for boys and girls but an important causal factor (or
factors) becomes more prevalent for girls than boys in early adolescence
2. The causes of depression are somewhat different in girls compared with boys. Levels of the
causes for girls rise in early adolescence.
3. Girls are higher in vulnerabilities for depression even before adolescence and the increases in
stressful or negative life events in adolescence combine with the vulnerabilities to produce
depression.
4. There is greater female variability in one or more of the vulnerability factors.
5. Vulnerability-stress interactions: it’s possible that a vulnerability-stress interaction may be more
potent for girls than for boys
6. Mixed model that specifies that there are multiple pathways to depression, some of which are
more common in girls than in boys and that different pathways may conform to model 1, 2, 3, 4
or 5. Each pathway explains only a small percentage of the variance in depression, but taken
together the multiple pathways can explain most cases and can explain the gender difference.
Vulnerability factors are interactive; that is, the vulnerability factor by itself is not hypothesized to
increase depression. Rather, vulnerability factors, combined with negative life events, increase the
chance of depression. Risk factors, in contrast, show simple main effects that increase the chances of
depression.
Cognitive vulnerability to depression
Cognitive vulnerability stress models of depression posit that individuals with certain negative cognitive
styles have greater chances of developing depression when they encounter negative or stressful life
events
- Hopelessness theory: proposes that individuals who make negative inferences about causality,
self and consequences in response to negative events will be most likely to develop depression
in the wake of negative events
1. Studies: children’s and adolescents’ attributional style correlates with depressive
symptoms
2. Negative attributional style in interaction with negative vents typically predicts
depression in children only after age 11. We hypothesize that one reason for the
inconsistency in results is that children younger than 11 may not yet have formed a
stable cognitive style that functions as a reliable vulnerability factor. Maybe interaction
emerges only in early adolescence.
- Ruminative response styles theory: people with a ruminative response style think repetitively
and passively about the negative emotions elicited by negative events.
1. Numerous studies confirm the prediction that ruminative response styles predict
depression
2. The rumination-depression link had been found with third and seventh graders as well
Gender and cognitive vulnerability
According to cognitive vulnerability-stress models, the gender difference in depression could be
explained by one or more of several factors:
1. Females could demonstrate greater cognitive vulnerability either from childhood or beginning in
early adolescence
2. Girls could experience more stressors beginning in early adolescence
3. The vulnerability-stress-depression relationship could be stronger for females than for males
Research with adolescents shows girls having more negative styles. There is some indication in a study
of high school students that negative attributional style is more strongly linked to depression for girls
, than for boys. There is also evidence of a more potent cognitive vulnerability-stress interaction for
adolescent girls compared with adolescent boys. The gender difference in depression can be accounted
for, at least in part, by gender differences in the tendency to ruminate:
- College women ruminated more than college man, not only about depressed mood but also
about negative events in three domains: 1. Achievement, 2. interpersonal and 3. body
image/attractiveness
Cognitive vulnerability in the body image domain
Cognitive vulnerability-stress models of depression to date have emphasized negative belief about one’s
own worth and competence in the traditional domains of achievement and interpersonal relationships à
should be expanded: include negative beliefs about body
- Intensified in adolescence
- Contributes to depression in adolescent girls
Two processes are involved in the generation of negative beliefs about the body
1. Negative self-surveillance: a cognitive process in which individuals become observers and critic
of their bodies and appearance
2. 2. Body shame: an affective component in which individuals feel shame when their bodies don’t
conform to cultural ideals
o Research supports the link between negative body image and depressive symptoms
Gender and cognitive vulnerability in the body image domain
Developmental changes unique to adolescence may increase both self-surveillance and body shame,
particularly for girls. Early adolescence is a well-established time to intensified pressure to conform to
gender role expectations. This gender-intensification hypothesis holds that pressures for gender-role
conformity increase dramatically in adolescence.
- The pressures come from multiple sources including family, peers and media
- Pressure to conform to gendered expectations for appearance may contribute to gender
differences in cognitive vulnerability in the appearance domain and may lead to the experience
of more negative events in this domain.
- Research had linked these gender differences in body esteem to gender differences in
depression
Relationships among cognitive style, rumination and objectified body consciousness
There is a small body of evidence suggesting that cognitive style, rumination and negative body image
may be related both over time and within individuals. The integration of these three vulnerabilities is
recognized by the ABC model, and here we specifically outline 2 ways in which these vulnerability
factors may be related:
1. Cognitive style may prospectively predict rumination
o Rumination may mediate the relationship between cognitive style and depression
because it may be particularly difficult to disengage attention from highly negative
thoughts regarding causes and consequences of negative events
2. The self-surveillance component of negative body image may prospectively predict rumination
as well > self-surveillance may represent a specific example of ruminative focus on the self that
is both perseverative and evaluative
These data taken together support the notion that the gender difference in self-surveillance precedes
and predicts gender differences in both rumination and depression and that self-surveillance may
contribute, developmentally, to rumination
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