Attachment theory

Attachment theorists propose that an individual’s earliest relationships are crucially linked to their emotional experiences later in life. Bowlby (1980) argues that a child’s bonds to his/her primary caregivers form the basis of his/her internal working model (IWM) of attachment figures and, on that basis, of the child’s complementary model of him-/herself – that is, of his/her own self. A child who has experienced consistent sensitive and responsive caregiving is likely to become securely attached and will consequently develop an expectation that important others are available, accessible, and supportive of their needs. The child’s complementary view of his/her self will be as someone valuable, lovable, and worthy of consistent support. Conversely, a child who has experienced caregiving that is inconsistent and largely determined by the caregiver’s own needs is likely to develop an anxious attachment, whereby they feel they have little control over the others’ responsiveness and become preoccupied with the attachment figures’ availability. Bowlby (1980) postulates that anxiously attached children are likely to doubt their own efficacy and worth and are therefore particularly vulnerable to depression. This vulnerability is especially acute when they are faced with the loss of a close relationship, no matter whether through illness, death, or some other form of separation.

Parenting style

The role of caregivers, particularly in infancy but also in later childhood, is seen as crucial to the development of a child’s sense of self (Bowlby 1980) or schemas (Beck 1967), and theories of youth depression consistently identify the important role of a child’s earliest relationships. There is extensive evidence linking parental factors to depressed youth, including the vastly higher rates of depression among children of depressed parents (Weissman, Warner, Wickramaratne, Moreau, and Olfson, 1997) and a well-established relationship between parenting style and child depression. In particular, parenting that is characterized by high levels of psychological control (overprotectiveness, guilt induction, shaming, intrusiveness) combined with low warmth has, in several studies, been linked to child depression (Alloy, Abramson, Smith, Gibb, and Neeren 2006; McLeod, Weisz, and Wood 2007; Rapee 1997). Parents of depressed children have been observed to be more critical (McCarty, Lau, Valeri, and Weisz 2004); so, unsurprisingly, depressed youth have been found to have less supportive and more conflicted relationships with their parents (Sheeber and Sorensen 1998; Sheeber, Davis, Leve, Hops, and Tildesley 2007). Additionally, parental marital conflict has been strongly associated with child depression, although it must be noted that this association applies to child psychopathology in general, not just to depression (Cummings 1994). Readers interested in the family factors relating to youth depression are referred to the comprehensive review by Restifo and Bögels (2009).

Beck’s cognitive theory

Beck’s cognitive theory centers on the construct of schemas (Beck 1983), which are defined as stored bodies of knowledge that affect the encoding, comprehension, and retrieval of information. According to Beck, some individuals have depressogenic schemas, which encompass a range of dysfunctional attitudes relating to themes of loss, failure, inadequacy, and worthlessness. Beck postulates that such schemas lie dormant until the individual encounters a negative life event, at which point they are activated and trigger a pattern of negatively biased, self-referencing information processing. The individual makes errors in thinking (such as overgeneralization) that lead to negative cognitive patterns about three areas: the world, the self, and the future. Beck refers to this as the negative cognitive triad and argues that, once the triad develops, depressive symptoms inevitably ensue.

Hopelessness theory

Hopelessness theory (Abramson et al. 1989) is a revision of the reformulated helplessness theory of depression (Abramson, Seligman, and Teasdale, 1978). Like Beck’s theory, hopelessness theory proposes that some individuals exhibit a depressogenic cognitive style that leaves them vulnerable to depression when a negative event occurs. However, hopelessness theory identifies a specific subtype of depression, called hopelessness depression. Hopelessness is defined as having the expectation that negative events will occur, that positive events will not occur, and that one is powerless to change this situation. The theory identifies the inferential styles that make one vulnerable to becoming hopeless. These are tendencies (1) to attribute negative events to global and stable causes; (2) to perceive negative events as having many disastrous consequences; and (3) to view the self as flawed and deficient following negative events. According to hopelessness theory, each of these inferential styles increases the chances of the occurrence of hopelessness. Hopelessness then leads to hopelessness depression.

Cognitive factors in children and adolescents

There is evidence that depressed youth exhibit a negative distortion in self-perception (Asarnow and Bates 1988; Hammen 1988; Kendall, Stark, and Adam 1990); but there have been some questions raised about the utility of cognitive theories when applied to child and adolescent populations. For example, Cole and Turner (1993) have argued that depression at younger ages results most directly from encountering negative life events and from subsequent environmental feedback rather than from the interaction of negative attributional style with stress. In a review of the literature regarding cognitive theories of depression in children and adolescents, Lakdawalla, Hankin, and Mermelstein (2007) concluded that the magnitude of effect for the cognitive vulnerability–stress interaction is in the small range in child populations and moderately larger in adolescent populations. More recently, however, evidence suggests that cognitive vulnerability theories may emerge as being more applicable to child populations when researchers statistically control for cognitive development (Weitlauf and Cole 2012).

Interpersonal skills

Interpersonal theories of depression emphasize the role of social relationships in the maintenance of depression. Theorists such as Coyne (1976) and Joiner (2002) argue that depressed individuals unintentionally generate interpersonal stress and conflict. Depressed individuals may generate this conflict both by selecting unsuitable relationships and by behaving in ways that cause relational difficulties. Interpersonal conflicts then serve to prolong or intensify depressive symptoms and result in the future recurrence of depression.

Rudolph, Flynn, and Abaied (2008), present an interpersonal model of youth depression that integrates traditional interpersonal theories with a developmental psychology perspective. They propose that early family disruption – such as insecure attachment or parental depression – interferes with the development of social competencies, resulting in social–behavioral deficits. Examples of such deficits are excessive reassurance seeking, social disengagement, social helplessness, aggression, and ineffective interpersonal problem solving. These social–behavioral deficits lead to relationship disturbances and cause youth to select maladaptive relationships, which add to the ongoing difficulties that may already exist within their family. Rudolph and colleagues (2008) argue that such relationship disturbances create a vulnerability to depression, and that this vulnerability is especially marked in youth whose personalities and sociocognitive styles make them particularly reactive to interpersonal stress. As youth move into adolescence, they are faced with a number of challenges such as the changes of puberty, the emergence of romantic relationships, and the growing complexity of peer relationships. Any interpersonal vulnerability to depression is therefore amplified at this time; this is particularly true of girls, who are more likely to rely on relationships as a source of self-definition. Depressive symptoms then interfere with young people’s interpersonal functioning and long-term social development, increasing their chances of further depressive episodes.

In a longitudinal study of young adolescents over two years, Flynn and Rudolph (2011) found that avoidance and denial in response to stress predicted subsequent self-generated interpersonal stress, and that this type of stress predicted, in turn, depression. There is also evidence that particular interpersonal behaviors are predictive of subsequent stress and conflict within child and adolescent relationships. These maladaptive behaviors include excessive reassurance seeking about one’s worth (Prinstein, Borelli, Cheah, Simon, and Aikins 2005; Shih, Abela, and Starrs, 2009), being unassertive or overly dependent on others (Shih and Eberhart, 2008), and negative feedback seeking (Borelli and Prinstein 2006).

Rumination

Response styles theory (Nolen-Hoeksema 1991) proposes that the way an individual responds to his/her own depressive symptoms impacts the severity and duration of these symptoms. In particular, Nolen-Hoeksema (1991) identifies rumination (as opposed to distraction or problem solving) as a response style that intensifies the depressive experience. It is argued that ruminative coping worsens depression in three ways. First, rumination impacts negatively on cognitions and information processing, as it increases the recall of negative events and reduces the individual’s perception of control. Second, rumination reduces the likelihood that the individual will engage in helpful, mood enhancing behaviors; and, finally, rumination impairs problem-solving abilities. Nolen-Hoeksema and Girgus (1994) have argued that response styles theory may help to explain why, although depression is equally common among boys and girls before puberty, adolescent females develop depression at a far higher rate than adolescent males. Women are known to ruminate more than men, and this sex difference has been replicated in adolescent populations (Rose and Rudolph 2006).

Stressors

The role of stressors is another key feature that overlaps across models of youth depression. It is commonly argued that depressive symptoms arise when a child’s or an adolescent’s underlying vulnerabilities interact with one or more stressful events. The ecological transactional model discussed below notes that stressors may arise from the family, from the community, and from the broader culture. Additionally, this model draws attention to the role of developmental adaptation and to the cumulative consequences of developmental challenges that are not adequately resolved. An especially important developmental period for girls appears to be adolescence, when rates of depression rise dramatically (Wade, Cairney, and Pevalin 2002). This may be, at least in part, due to greater exposure to total stress, particularly interpersonal episodic stress, for adolescent girls (Shih, 2006).

A community study of over 400 seventh graders by Ge, Conger, Lorenz, and Simons (1994) demonstrates the role of stress in youth depression within a family context. Stressful events experienced by the students’ parents were found to be related to parental depressed mood. This low mood was found to impact parenting practices negatively, which in turn placed the children of these parents at increased risk of developing depressive symptoms. This relationship between stress and parenting also featured in a meta-analytic study by Grant and colleagues (2003), which found that negative parenting mediates the relationship between a particular stressor – poverty – and psychological symptoms in children and adolescents.

Transactional/developmental theories

Cicchetti and Toth (1998) have argued for the importance of a developmental psychopathology conceptualization of childhood depression. Their ecological transactional model identifies a range of psychological, social, and biological factors, each of which influence a child’s capacity to meet new developmental challenges. It is argued that, when children are able to positively adapt to a developmental challenge, this leads to competence and better preparedness for the next developmental demand. Conversely, inadequate resolution of a stage-salient developmental challenge is likely to compromise the resolution of future developmental tasks. Cicchetti and Toth (1998) postulate that the occurrence of childhood depression depends not only on the presence or absence of specific vulnerability or protective factors, but also on the interplay between these factors and current and previous levels of developmental adaptation, as well as on the developmental period during which risk factors are experienced. In addition to this transactional complexity, they argue that risk and protective factors exist not only within the individual child, but also within his/her family (microsystem), the community in which the family lives (exosystem), and the broader culture of which the community is part (macrosystem).

Other models that emphasize the complex transactional nature of youth depression include those outlined by Restifo and Bögels (2009) and Shortt and Spence (2006). Some of the numerous risk factors identified by transactional models are genetic factors; parental psychopathology; low socioeconomic status; parental death, divorce, or separation; child maltreatment; parenting style; marital discord; low perceived academic confidence; poor adjustment to school; low availability of treatment services; rapid cultural changes and erosion of traditional cultural practices. Central to these models is the notion that none of these single risk factors will result in a depressive outcome, but rather that they interact with one another across all stages of the child’s development.