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How dysfunctional are Dysfunctional Attitudes? A Threshold Model of Dysfunctional Attitudes and Depressive Symptoms in Children and Adolescents

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Abstract

In order to clarify further the role of Beck’s vulnerability-stress model in the early development of depression, this longitudinal study tested a threshold model of dysfunctional attitudes in children and adolescents. An initially asymptomatic sample of 889 youths aged 9–18 years completed measures of dysfunctional attitudes and depressive symptoms. Twenty months later, participants reported stressful life events and current depressive symptoms. Results support a threshold view of cognitive vulnerability as only dysfunctional attitudes above a certain threshold significantly interacted with life events to predict depressive symptoms. Thus, findings suggest that dysfunctional attitudes must exceed a certain threshold to confer vulnerability to depressive symptomatology in youth. The term “dysfunctional” might therefore only apply to higher levels of the “dysfunctional attitudes” proposed by A. T. Beck. Results also indicate that studies using non-clinical samples may systematically underestimate the effect of dysfunctional attitudes when relying on conventional linear methods.

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Notes

  1. Note that the described discontinuous linear effect differs from truly nonlinear effects in which the strength of the association between two variables changes continuously along the spectrum of one variable.

  2. Note that although these “reverse” effects and the effects postulated in Beck’s vulnerability-stress model are not mutually exclusive, detecting causal relationships can be impeded when using unselected samples. Moreover, it is not ruled out that cognitive vulnerability factors may not contribute to the further course of the symptomatology once an individual suffers from elevated depressive symptom levels. It is rather suggested that empirically demonstrating effects of putative vulnerability factors is complicated considerably when using unselected samples.

  3. Note that by entering baseline depressive symptoms prior to other predictors, residual change in depressive symptoms remains to be explained by the subsequent predictors (e.g. Abela and Sullivan 2003; D’Alessandro and Burton 2006). The dysfunctional attitudes and stressful life events variables should thus be interpreted as essentially predicting change in depressive symptoms between T1 and T2.

  4. It can be argued that when looking specifically at a group of individuals reporting particularly high levels of dysfunctional attitudes, the phenomenon of extreme responding should be considered. Extreme responding has been defined as the tendency to endorse end-of-scale responses as a result of automatic, rapid information processing, which remains uncorrected by subsequent reappraisal. Extreme responding has been shown to predict relapse in depressed individuals (Forand and DeRubeis 2014; Teasdale et al. 2001). However, it seems unlikely that our above-threshold scoring group represents a group of “extreme responders” as (a) extreme responding has been shown primarily in currently depressed individuals, while the current study drew on an initially non-depressed sample and (b) even in the above-threshold scoring group, extreme answers were endorsed rarely (the average score on the dysfunctional attitudes measure was M = 2.02, SD = 0.19 with a possible range of the measure of 0–4).

  5. However, age significantly moderated the impact of life events on future depressive symptoms. This interaction indicated that younger participants experienced a greater increase in depressive symptoms following life events than older participants, which is in line with theories suggesting that in younger children, environmental circumstances such as life events may be particularly strongly linked to depression (Nolen-Hoeksema et al. 1992; Shirk 1988). Further details on this interaction can be received from the first author upon request.

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Acknowledgements

We would like to thank the children and adolescents participating in the study as well as the schools and their staff from Potsdam and the area of Potsdam-Mittelmark for their willingness to cooperate and for their support of this research project. We would further like to express our thanks to Anne Wyschkon and Sabine Quandte for their valuable feedback on the manuscript.

Funding

This study was funded by the German Research Foundation (“Deutsche Forschungsgemeinschaft”), Grant No. GRK 1668/1.

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  1. Department of Psychology, Clinical Psychology, University of Potsdam, GRK 1668, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany

    Susanne Meiser & Günter Esser

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  1. Susanne Meiser
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Appendices

Appendix 1

See Fig. 2.

Fig. 2
figure 2

Prediction of change in depressive symptoms from T1 to T2 by stressful life events in participants scoring above and below the threshold in the spectrum of dysfunctional attitudes

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Appendix 2

See Tables 4 and 5.

Table 4 Exploratory breakpoint estimation using segmented regression analysis in subsample A
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Table 5 Confirmatory test of breakpoint from subsample A using segmented regression analysis with a priori fixed breakpoint in subsample B
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Meiser, S., Esser, G. How dysfunctional are Dysfunctional Attitudes? A Threshold Model of Dysfunctional Attitudes and Depressive Symptoms in Children and Adolescents. Cogn Ther Res 41, 730–744 (2017). https://doi.org/10.1007/s10608-017-9842-0

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