In the current study, appraisals of the negative impact of recent LEs were examined as a risk factor for depression and anxiety disorders in an adolescent sample. Negative impact appraisals were significantly associated with depression and anxiety such that higher or more elevated appraisals of the negative impact of LEs were linked with remitted and current clinical syndromes of both disorders. Importantly, elevated negative impact appraisals were also predictive of subsequent first onsets of both depressive and anxiety disorders. These associations were demonstrated despite controlling for a number of covariates, including exposure to LEs, current depressive symptoms, and the presence of the other disorder, suggesting that the tendency to appraise LEs as having elevated negative impact represents a vulnerability factor for both depressive and anxiety disorders. Additional analyses revealed, however, that negative impact appraisals were particularly associated with co-morbid depression and anxiety. Indeed, negative impact appraisals significantly predicted co-morbid depression and anxiety over pure depression and pure anxiety in the current study. Thus, a tendency toward making elevated appraisals of the negative impact of LEs may not only increase risk for depression and anxiety disorders, it may represent a specific risk factor for the combination of depression and anxiety.
Though other investigators have suggested that elevated appraisals of the negative impact of LEs among currently affected individuals reflect dispositional vulnerability for depression and anxiety disorders, prior studies could not rule out plausible alternative explanations. While negative impact appraisals were significantly correlated with current depressive symptoms, associations between negative impact appraisals and the experience of depression and anxiety disorders (past, current, and future first onsets) were demonstrated despite controlling for current depressive symptoms. Thus, any effects that current depressive mood may have had on the reporting of LEs cannot account for the observed associations between negative impact appraisals and the experience of depression and anxiety disorders. Furthermore, prospective associations of negative impact appraisals with depression and anxiety disorders included additional controls for prior disorders, thus ruling out “scarring” effects of previous emotional disorders as an alternative explanation. Altogether, the current findings permit more definitive conclusions regarding systematically elevated appraisals of the negative impact of LEs as a vulnerability factor that contributes to the onset of both emotional disorders.
The current study was conducted in sample that was followed from mid-adolescence into early adulthood, a period that has been associated with increased risk for first onsets of depression and a number of anxiety disorders. Establishing the link between elevated negative impact appraisals and risk for depression and anxiety disorders in this sample suggests that the tendency to appraise LEs as having elevated negative impact may be an important dispositional risk factor for depression and anxiety during this developmental period. Though cognitive-emotional appraisal processes are likely to vary substantially with development (Grant et al., 2003
; Muldoon, 2003
), such processes may stabilize in the transition from childhood to adolescence developing into trait-like vulnerability factors for emotional disorders during this stage. Studies have shown that ratings of the severity of negative LEs vary as a function of age. For instance, Gothel et al. (2004)
in a sample consisting of children and adolescents demonstrated that older age predicted higher ratings of the negative impact of LE even while controlling for anxiety and depression. Additional studies are needed to determine whether negative impact appraisals stabilize during adolescence and whether developmental shifts in appraisal tendencies can help account for the increased risk for emotional disorders during adolescence.
Consistent with other studies, females reported elevated appraisals of recent LEs in comparison to males (Espejo et al., 2011
; Muldoon, 2003
; Newcomb, Huba, & Bentler, 1986
). However, there was no evidence in the current study that the association between negative impact appraisals and depression and anxiety disorders were moderated by gender. It may be necessary to distinguish among specific domains of LEs in order elucidate gender differences in the association between negative impact appraisals and depression and anxiety. For instance, females may be more sensitive than males to negative interpersonal LEs especially during adolescence which may help to account for the gender disparity in depression and anxiety which begins to emerge during this period (Rudolph, 2002
). Recently, Charbonneau et al. (2009)
demonstrated that appraisals of the negativity of interpersonal LEs moderated the relationship between exposure to negative interpersonal LEs and depressive symptoms; this interaction in turn helped to account in part for gender differences in depressive symptoms. Examining negative impact appraisals without differentiating between different domains of LEs in the current study may have masked meaningful gender moderating effects in the association between negative impact appraisals and depression and anxiety disorders.
Nonetheless, the current study adds to the extensive literature on the relationship between negative LEs and depression and anxiety disorders. Negative LEs as measured by both subjective and objective measures has been repeatedly linked with depression and, to a lesser extent, anxiety disorders. By examining subjective ratings of the negative impact of LEs while controlling for objective ratings of stressor severity and exposure to negative LEs, the current study isolated individual differences in the tendency to appraise LEs as having negative impact which both influences subjective ratings of stressor severity and represents an independent vulnerability for depression and anxiety disorders. This finding has broad implications for life stress research in providing definitive evidence that life stress assessment methods that rely on subjective or respondent-based ratings of stressor severity confound measures of life stress with vulnerability for depression and anxiety (Simons et al., 1993
). Additionally, individual differences in the tendency to appraise LEs as having high negative impact may represent a dispositional vulnerability that can help account for variability in depressive and anxious reactions following negative LEs. Indeed, a critical follow-up to the current study would be to determine if systematic biases in appraisal, as measured by the current approach, moderates risk for depressive and anxiety disorder onset following exposure to negative LEs, such that tendencies toward elevated appraisals of negative impact increase risk for depression and anxiety following exposure to both major and minor objectively-defined LEs (“diathesis-stress”).
The current findings are consistent with prominent theories of cognitive vulnerability for depression which posit cognitive sets that lead to systematically biased interpretations of negative LEs (Beck, 1987
). While this was confirmed in the current study, it was also demonstrated that cognitive biases in the evaluations of the negative impact of LEs are not specific to risk for depression but also pose risk for anxiety. Future studies should determine whether negative impact appraisals for specific types of LEs are differentially associated with depression versus anxiety. For instance, interpersonal loss events (e.g., separations or endings) may be more strongly linked to depression whereas danger/threat events (e.g., accidents or assaults) may be more strongly link to anxiety disorders (e.g., Sandin, Chorot, Santed & Valiente, 2004
). Individuals at risk for depression may exhibit elevated appraisals of the negative impact of interpersonal loss events whereas individuals at risk for anxiety disorders may exhibit elevated appraisals of the negative impact of danger/threat events. Alternatively, at-risk individuals may have a non-specific tendency toward elevated appraisals and experience depression or anxiety depending on whether loss or danger/threat events are experienced.
The findings are also consistent with cognitive theories of anxiety which posit that interpretive biases, including viewing potential negative LEs as having exaggerated negative costs (Foa & Kozak, 1986
) play a causal and maintaining role in anxiety disorders. Though cognitive theories of anxiety posit that exaggerated judgments of negative costs are content specific for each anxiety disorder (e.g., individuals with social phobia exaggerate the cost of negative social situations but not physically threatening events), the current study found associations with negative impact appraisals without differentiating among different anxiety disorders or among different domains of LEs. While it is possible that the current findings reflect a non-specific tendency toward elevated appraisals as a general risk factor for anxiety disorders, future studies should examine disorder-specific biases in the appraisal of actual LEs.
Consistencies between the current findings and two other lines of research in the risk for depression and anxiety should also be noted. First, the current findings comport with extensive research linking neuroticism with depression and anxiety disorders in both adults and adolescents. Neuroticism, when characterized as the tendency to react negatively to stressors, is conceptually similar to the concept of systematically elevated appraisals of the negative impact of LEs. However, neuroticism has also been characterized by various other definitions, including a proneness to experience distress, even in the absence of overt stressors (Watson, Pennebaker, & Folger, 1987
), as well as the tendency to experience negative affective states including depression and anxiety (Costa & McCrae, 1980
). Future studies may seek to examine negative impact appraisals and neuroticism simultaneously in the prediction of depression and anxiety disorders to determine if negative impact appraisals predict risk for both disorders beyond the effects of neuroticism. Second, systematic biases in other cognitive-emotional domains, such as attention, interpretation, and memory, have also been linked with depression and anxiety disorders (Mathews & MacLeod, 2005
). The current study not only adds to existing findings of biases in cognitive-emotional processes, it demonstrates an ecologically valid approach to studying cognitive-emotional biases in depression and anxiety disorders. Future research should determine whether systematic biases in stress appraisals, as measured by this approach, are linked to other well-established cognitive-emotional biases.
The current study clarifies a cognitive-emotional bias that increases risk for depression and anxiety disorders suggesting that therapeutic inventions that can modify this bias may be successful in bringing about reductions in depressive and anxiety symptoms. Estimates of the cost of hypothetical negative LEs have been demonstrated to diminish following cognitive-behavioral therapy (CBT) for agoraphobia (McNally & Foa, 1987
) and social phobia (Foa, Franklin, Perry, & Herbert, 1996
). Additionally, Foa et al. demonstrated that reductions in cost estimates for social events mediated improvements in social phobia following CBT. Future studies may seek to determine whether appraisals of the negative impact of actual LEs, as measured by the current approach, also diminish following a course of CBT.
A number of strengths and limitations of the current study should be noted. The longitudinal design permitted a prospective examination of negative impact appraisals on future first onsets which, combined with the examination of remitted and current syndromes, enhanced the ability to make inferences regarding systematically elevated negative impact appraisals as a vulnerability factor for both depression and anxiety disorders. Additionally, the assessment of actual LEs using an interview-based method provided an ecologically-valid approach for examining biased negative impact appraisals in the risk for emotional disorders while isolating dispositional influences on appraisals from the objective characteristics of LEs by controlling for investigator-based ratings. Examinations of negative impact appraisals for actual LEs are restricted, however, by the number of LEs endorsed by respondents. As a result, participants’ appraisal scores may be based on a limited number of events (M = 3.21, SD = 2.04 in the current study) which may restrict the degree to which appraisal scores reliably and validly reflect systematic tendencies in the appraisal of the negative impact of LEs. This potential limitation was balanced in the current study by the large sample size which facilitated the detection of the hypothesized associations despite numerous statistical controls. Additionally, participants who did not endorse any LEs could not be included in the current analyses. These participants were shown to vary systematically from the included sample in terms of gender and risk for both depression and anxiety disorders which may limit the generality of the current findings.
The generality of the current study was further limited by characteristics of the current sample which was predominantly Caucasian, largely lower middle to low socioeconomic status, and all age 15 at the time of the assessment of negative impact appraisals. Some studies have demonstrated that ethnicity moderates the risk of psychopathology following negative LEs in adolescence (see Grant et al., 2006
). Additionally, ethnic, cultural, and socioeconomic factors have been found to influence appraisals of the negative impact of LEs (Muldoon, 2003
; Newcomb et al., 1986
), though a high degree of resemblance in the appraisals of the negative impact of LEs among youth across different countries have also been found (Yamamoto, Soliman, Parsons, Davies, 1987
; Yamamoto et al., 1996
). While the influence of ethnic and cultural factors on negative impact appraisals and risk for emotional disorder are clearly important areas of study, the homogeneity of the current sample prohibited examinations of such factors in the current study. Future research should seek not only to replicate the current findings in a more ethnically and culturally diverse sample, but should also examine whether ethnic and culturally factors moderate the association between negative impact appraisals and depression and anxiety.
In summary, the current study demonstrated that elevated appraisals of the negative impact of LEs are associated with past, current, and future first onsets of clinical syndromes of depressive and anxiety disorders in a mid-adolescent sample. The current findings helped to rule out current mood state effects and consequences of prior clinical syndromes as alternative explanations for elevated appraisals of the negative impact of LEs in at-risk adolescents. Additionally, participants’ appraisals of the negative impact of LEs were statistically adjusted using investigator-based ratings to rule out that elevated appraisals of the negative impact of LEs among depressed and anxious individuals reflect actual differences in the objective severity of experienced LEs. Thus, systematically elevated appraisals of the negative impact of LEs may be viewed as a vulnerability factor for depression and anxiety disorders and may be a specific risk factor for experiencing both disorders. Further examinations of negative impact appraisals for may help to clarify the nature of risk for emotional disorders across various developmental stages.