Negative Cognitions and Attributional Style in Depressed Adolescents: An Examination of Stability and Specificity

Transcription

1 Journal of Abnormal Psychology Vol. 102, No. 4, Copyright 1993 by the American Psychological Association, Inc. 002I-843X/93/S3.00 Negative Cognitions and Attributional Style in Depressed Adolescents: An Examination of Stability and Specificity Ian H. Gotlib, Peter M. Lewinsohn, John R. Seeley, Paul Rohde, and Julie E. Redner Despite recent findings that the prevalence of unipolar depression is as high in adolescents as it is in adults, relatively little is known about the applicability of cognitive theories of depression to adolescents. The present study examined the nature, specificity, and stability of cognitive dysfunction in male and female depressed, remitted, and psychiatric control adolescents. Factor analysis of a diverse set of measures yielded two factors, labelled Negative Cognitions and Attributional Style. Scores on both these factors were related to a current diagnosis of depression. Results also indicated that there may not be complete recovery of cognitive functioning (or of depressed mood) with diagnostic remission of depression. Finally, whereas elevated scores on the Negative Cognitions factor appeared to be specific to depression, the depressed and psychiatric control adolescents did not differ with respect to their scores on the Attributional Style factor. Of all the psychiatric disorders, depression is by far the most common, annually affecting more than 100 million people worldwide. During the course of a lifetime, it is estimated that between 8% and 18% of the general population will experience at least one clinically significant episode of depression (Karno et al., 1987). Moreover, for approximately 15% of these individuals, the depressive episode will result in suicide. It is clear, therefore, that the problem of depression is considerable, and its consequences potentially lethal. A number of investigators assessing psychological aspects of depression have focused on the cognitive functioning of depressed persons. Indeed, three major psychological theories of depression accord central importance to cognitive functioning in the onset of this disorder. Beck (1976) focused on the "cognitive triad," cognitive distortions or faulty information processing, and the negative self-schemata of depressed persons. Beck postulated that depressed individuals exhibit a negative view of themselves, their experiences, and the future. He suggests further that depressed persons are characterized by systematic errors in thinking, including arbitrary inference, selective abstraction, and all-or-none thinking. Finally, Beck postulated that depressed persons are characterized by negative schemata, cognitive processes that represent a stable characteristic of depressed individuals' personalities and that are present even in the absence of depressive symptoms. These negative schemata are hypothesized to play a causal role in depression by influencing the selection, encoding, and evaluation of stimuli in the environment, which leads subsequently to depressive affect. Ian H. Gotlib, Department of Psychology, Northwestern University; Peter M. Lewinsohn, John R. Seeley, Paul Rohde, and Julie E. Redner, Oregon Research Institute, Eugene, Oregon. Preparation of this article was facilitated by Grant from Health and Welfare Canada to Ian H. Gotlib, and National Institute of Mental Health Research Grants MH35672 and MH40501 to Peter M. Lewinsohn. Correspondence concerning this article should be sent to Ian H. Gotlib, Department of Psychology, 102 Swift Hall, Northwestern University, Evanston, Illinois In a similar model, Rehm (1977) suggested that specific deficits in self-monitoring, self-evaluation, and self-reinforcement may explain the various symptoms of depression. For example, Rehm suggested that depressed individuals selectively attend to negative events that follow their behavior to the relative exclusion of positive events, a cognitive style that might account for the pessimism and gloomy outlook of depressed individuals. Similarly, Rehm postulated that depressed persons set unrealistic and stringent standards for themselves and make inaccurate attributions of causality. Rehm also suggested that depressed individuals are characterized by relatively low rates of self-reinforcement and high rates of self-punishment. Finally, the reformulated learned helplessness model of depression (Abramson, Seligman, & Teasdale, 1978), and the more recent extension of this model, the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) maintains that vulnerability to depression derives from a habitual style of explaining the causes of life events, known as attributional, or explanatory, style. Explanatory style is viewed as a trait that has its origins in early childhood experiences; thus, individuals are expected to exhibit cross-situational and temporal consistency in their causal explanations for events (cf. Brewin, 1985). Individuals with a depressogenic attributional style not only have learned to believe that previous events in their lives were uncontrollable but also expect that future outcomes will similarly be out of their control. The onset of a depressive episode is precipitated by the occurrence of an important negative event that triggers the expectation of the uncontrollability of future negative events. Abramson et al. postulated that persons who are prone to depression tend to attribute negative outcomes to internal, global, and stable factors, even when they are not symptomatically depressed (cf. Sweeney, Anderson, & Bailey, 1986). As in Beck's model, these patterns of attributions are hypothesized to play a causal role in the development of depression. Numerous studies have drawn on these theories in examining the relation between cognitive functioning and depression. This literature has been summarized in several recent reviews (e.g., Gotlib, 1992; Gotlib & McCabe, 1992; Peterson & Selig-

2 608 GOTLIB, LEWINSOHN, SEELEY, ROHDE, REDNER man, 1984), and the interested reader is referred to these articles. In general, the results of investigations in this area offer more consistent support for the formulation that depressed persons demonstrate more negative cognitions and attributions than do nondepressed persons, than they do for the postulate that these negative cognitions are stable aspects of depressed persons' functioning that play a causal role in the onset of depression. For example, investigators have found that, while in an episode, depressed individuals exhibit more dysfunctional cognitions, attentional allocation, and attributions than do nondepressed persons (e.g., Buchwald, 1977; Gotlib & Cane, 1987; Sweeney et al., 1986). In contrast, although there have been exceptions (e.g., Eaves & Rush, 1984), the findings of most longitudinal studies assessing the stability of cognitive functioning in depression suggest that the dysfunctional attitudes, the increased attention to negative stimuli, and the negative attributional style that characterize individuals while they are depressed decrease or normalize following symptomatic recovery; remitted depressed adults typically do not differ from nondepressed controls with respect to their cognitive functioning (e.g., Fennell & Campbell, 1984; Gotlib & Cane, 1987; Hami Iton & Abramson, 1983; Lewinsohn, Steinmetz, Larson, & Franklin, 1981; Rohde, Lewinsohn, & Seeley, 1990). Virtually all of these studies have been conducted with depressed adults; little is known about the cognitive functioning of depressed children and adolescents, despite the documentation in recent investigations of the high prevalence of depression during adolescence (e.g., Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993; Whitaker et al., 1990). Moreover, data from the Epidemiological Catchment Area (EGA) study indicate that, for both males and females, the highest hazard rates for unipolar major depression occur between the ages of 15 and 19 (Burke, Burke, Regier, & Rae, 1990). Finally, early onset of depression not only has been found to predict a more pernicious course of the disorder (e.g., Bland, Newman, & Orn, 1986; Hammen, Davila, Brown, Ellicott, & Gitlin, 1992) but also has been associated with poor academic performance in children and adolescents (e.g., Cole, 1990). Thus, depression appears to be a disorder of relatively early onset, with particular and critical risk in adolescence. Although it is tempting to simply extrapolate findings of studies examining the cognitive processing of depressed adults to depressed children and adolescents, there are significant developmental differences among these populations that preclude a simple downward extension of adult findings (cf. Cicchetti & Schneider-Rosen, 1986; Digdon & Gotlib, 1985). Indeed, Gotlib and Hammen (1992) reviewed evidence indicating that there are significant differences between depressed adults and depressed children and adolescents with respect to the nature of their symptomatology, their biological functioning, and their responsivity to pharmacotherapy (e.g., Carlson & Kashani, 1988; Kashani, Rosenberg, & Reid, 1989; Puig-Antich et al., 1989), thereby also raising concerns about the comparability of cognitive processing in depressed adults and adolescents. Whereas some investigators have reported an association between depression in children and negative cognitive functioning (e.g., Asarnow & Bates, 1988), other researchers have failed to demonstrate this relation (e.g., Cole & Rehm, 1986), or have reported an association between depression and attributional style for positive but not for negative events (e.g., Curry & Craighead, 1990). A primary objective of the present study, therefore, was to examine the nature of cognitive dysfunction in a large group of adolescents who were carefully diagnosed with major depression or dysthymia. To accomplish this goal, it was important initially to assess a broad range of measures of cognitive functioning. Typically, investigators assess depressed persons' responses to only one cognitive measure, such as the Dysfunctional Attitudes Scale (A. N. Weissman & Beck, 1978), the Automatic Thoughts Questionnaire (Hollon & Kendall, 1980), or the Attributional Style Questionnaire (Peterson et al., 1982). Because of the use of these different measures in different samples, it is virtually impossible to make meaningful direct comparisons across these studies, leading a number of theorists to call for a more explicit examination of higher order cognitive constructs (cf. Ingram, 1990; Shaw & Katz, 1990). Indeed, Reno and Halaris (1989) recently reported the results of a factor analysis of five measures of cognitive functioning in a small sample of adult psychiatric inpatients, and Gotlib, Lewinsohn, Seeley, and Rohde (1991) factor analyzed the responses of a large sample of adults to several measures of cognitive functioning. In the present study, therefore, we examined the factor structure of a set of measures of cognitive dysfunction, derived from the three theories discussed earlier, in a large sample of adolescents, We also assessed three additional issues in this study. First, we addressed the issue concerning the cognitive functioning of remitted depressed adolescents. Both Beck's (1976) and Abramson et al.'s (1978) models suggest that remitted depressives should, at some level, be characterized by stable dysfunctional cognitions. As we noted earlier, whereas some investigators have found that remitted depressives exhibit more problematic cognitive functioning than do nondepressed controls (e.g. Eaves & Rush, 1984), a significant number of investigators have failed to replicate this result (e.g., Fennell & Campbell, 1984; Gotlib & Cane, 1987; Rohde et al., 1990). Most notably, Asarnow and Bates (1988) and McCauley, Mitchell, Burke, and Moss (1988) recently reported that a negative attribution style was not evident in children whose depression had remitted, leading these investigators to suggest that negative cognitions are related to mood state. Indeed, on the basis of a comprehensive review of relevant studies, Barnett and Gotlib (1988) offered a similar conclusion that negative cognitions may represent an aspect of depressive functioning that covaries with depression state. In the present study, therefore, we compared the cognitive functioning of currently depressed adolescents with that of adolescents who were not currently depressed but who had experienced previous depressive episodes. Second, we assessed the specificity to depression of deficits in cognitive functioning. Although considerable evidence supports the importance of maladaptive cognitions for depression, little research has addressed their specificity to this disorder (cf. Clark, 1988). Moreover, the investigations that have been conducted comparing the cognitive functioning of depressed and nondepressed psychiatric patients have yielded equivocal results, both with adults and with children (e.g., Asarnow & Bates, 1988; Curry & Craighead, 1990; Eaves & Rush, 1984; Hollon,

3 DEPRESSED ADOLESCENTS 609 Kendall, & Lumry, 1986; McCauley et al., 1988). Nonspecificity of cognitive functioning to depression would have important implications for cognitive models of depression. Although nonspecificity of cognitive functioning would not necessarily imply that cognitions do not play a causal role in depression (cf. Garber & Hollon, 1991), it would nevertheless raise questions concerning why depression and not other forms of psychopathology is the consequence of dysfunctional cognitions. To examine this issue, we included in this study a group of adolescents who were not depressed but were exhibiting other significant psychiatric symptomatology. Finally, numerous investigators have examined gender differences in the incidence and prevalence of depression both in adults (e.g., M. M. Weissman & Klerman, 1977) and in children and adolescents (e.g., Anderson, Williams, McGee, & Silva, 1987). One of the most consistent findings in the adult depression literature is that the prevalence of depression among women is 1.6 to 2 times as high as it is among men. Similar findings have been reported in samples of depressed children and adolescents. Kandel and Davies (1982), for example, reported higher rates of depressive symptoms in adolescent girls compared with boys rates that persisted into early adulthood (Kandel & Davies, 1986). More recently, Lewinsohn et al. (1993) found that girls had more than twice the rates of major depressive disorder, both currently and lifetime, than did boys. Despite these gender differences in the incidence and prevalence of depression among adolescents, we know little about possible gender-related differences in cognitive functioning in this age group, differences that might help to explain the elevated prevalence of depression among girls. Therefore, a final goal of this study was to assess cognitive functioning in a large sample of both male and female depressed adolescents. Subjects Method The sample consisted of 1,710 adolescents (ages years) who participated in a diagnostic interview. The adolescent participants were randomly selected from nine senior high schools that represented urban and rural districts in western Oregon; the sampling was proportional to the size of the school, grade within school, and gender within grade. The interviews took place between 1987 and 1989, with a participation rate of 61%. Approximately half of the sample was female (53%). The vast majority was Caucasian (91%), and most adolescents resided in two-parent homes (71%). The average age of the adolescent participants was 16.6 years (SD = 1.2). To assess the representativeness of the adolescent sample, we conducted several analyses. First, demographic characteristics of the sample were compared with those of the population in each of the school districts and with the 1980 census information for each county. Second, when a family declined participation, minimal information was received on several key demographic variables. Finally, by offering more money, we collected data on 100 subjects who had initially refused to participate. All analyses indicated that the magnitudes of the differences between our adolescent sample and the larger population, and between the participants and those who had refused to participate, were very small. A more detailed description of this sample is given by Lewinsohn et al. (1993). Assessment of Depression and Other Psychopathology Diagnoses of all current and past episodes of depression and other mental disorders were based on information obtained through standardized semistructured interviews. Diagnoses were based on information obtained with a form of the Schedule for Affective Disorders and Schizophrenia for School-Aged-Children (K-SADS) that combined the epidemiologic (Orvaschel, Puig-Antich, Chambers, & Johnson, 1982) and the present episode versions. The adaptation, which was developed with the assistance of Joaquim Puig-Antich, provided information on the presence of specific symptoms for a reliable diagnosis of past and current episodes of depression and other psychiatric disorders according to the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-HI-R; American Psychiatric Association, 1987). All subjects also completed the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977), a self-report measure of the frequency of occurrence of 20 depressive symptoms designed for use with general community samples. The CES-D has been demonstrated as a valid screening instrument in both adult and adolescent samples (e.g., Roberts, Lewinsohn, & Seeley, 1991). Diagnostic interviewers were carefully selected and trained. They all completed a 70-hr didactic and experiential course in diagnostic interviewing. Details about the training of the interviewers and other specific aspects of the procedures are described elsewhere (Lewinsohn et al., 1993). All interviews were either audio- or videotaped. Approximately 20% of the interviews were randomly selected and independently rated by reliability coders. Interrater agreement was evaluated by means of the kappa statistic (Cohen, 1960). With the exception of anxiety disorder (jc =.60), kappas for individual disorders were consistently greater than.80, comparable with results reported by Spitzer, Endicott, and Robins (1978). Although quite similar, the diagnosis of major depression as per the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robins, 1978) is somewhat more stringent than the diagnosis as per the DSM- III-R. The RDC diagnoses of intermittent depression and minor depression (of 2 years duration) had been previously reviewed and converted to either dysthymia or depression not otherwise specified as per DSM-HI-R criteria (see Lewinsohn, Rohde, Seeley, & Hops, 1991, for details). For the present study, depression was therefore defined as major depression and dysthymia. Four diagnostic groups were formed from the 1,710 adolescents who were interviewed: (a) adolescents with a current diagnosed episode of depression (the depressed group; n = 50); (b) adolescents not currently depressed but with a past history of depressive disorder (the remitted group; n = 298); (c) adolescents with a current disorder other than depression (the psychiatric control group; «= 54); and (d) adolescents with no diagnoses of current or past depression (the never-depressed group; n = 1,308). The diagnosis of depression took precedence over diagnoses of other mental disorders (e.g., if a subject met criteria for current major depression and past substance abuse, she or he would be classified as depressed; similarly, if a subject met criteria for past dysthymia and current phobia, she or he would be classified as remitted). Almost half of the depressed adolescents (22 out of 50) also had a secondary diagnosis, reflecting the comorbidity of depression with other disorders (anxiety disorders, 18%; psychoactive substance use disorders, 16%; disruptive behavior disorders, 8%; eating disorders, 4%). Among the psychiatric control adolescents, the most common disorders were psychoactive substance use disorders (37%), disruptive behavior disorders (37%), and adjustment disorder (19%). Thirty percent of the remitted subjects had received some form of treatment, ranging from talking with a school counselor to seeing a psychiatrist. Eight percent of the remitted adolescents received a current diagnosis of anxiety disorder, and 4% received a diagnosis of substance abuse.

4 610 GOTLIB, LEWINSOHN, SEELEY, ROHDE, REDNER Finally, 18% of the never-depressed adolescents had past diagnoses of anxiety disorder, substance abuse disorder, disruptive behavior disorder, or adjustment disorder. Mean CES-D scores for adolescents in each of the four groups are presented in Table 1. The coefficient alpha for the CES-D in this sample was.89. A Group X Gender analysis of variance (ANOVA) conducted on the CES-D scores yielded significant main effects for group, F(3,1702) = 81.95, p <.001, and gender, F(l, 1702) = 8.85, p<.005, as well as a significant Group X Gender interaction, ^(3,1702) = 3.32, p <.05. As shown in Table 1, post hoc Scheffe tests indicated that, for both girls and boys, adolescents in the depressed group obtained significantly higher scores on the CES-D than did adolescents in the three nondepressed groups; in addition, never-depressed adolescents obtained significantly lower scores than did subjects in the other three groups. The main effect for gender reflected the higher CES-D scores ofgirls(a/= 18.l4)relativetoboys(A/= 15.71), although, as evidenced by the significant Group X Gender interaction, this difference was found to be significant only in the group of remitted subjects, r(296) = 3.68, p<.001. Cognitive Variables Assessed Measures of cognitive functioning were selected that assessed aspects of the models of depression formulated by Beck (1976), Rehm (1977), and Abramson et al. (1978,1989). On the basis of several extensive pilot studies involving four high schools, all of the cognitive measures except the perceived control and attributions of causality measures were abbreviated with factor analytic techniques (for more details see Andrews, Lewinsohn, Hops, & Roberts, 1991). All subjects completed all of the measures at Time 1; as an assessment of test-retest reliability, 88% of the subjects completed all of the measures again one year later. Dysfunctional attitudes. Nine items from the Dysfunctional Attitudes Scale (DAS; A. N. Weissman & Beck, 1978) were administered to measure the tendency of adolescents to endorse dysfunctional attitudes postulated by Beck (1976) to be associated with depression (e.g., "I should be able to please everybody"). Items are scored on a 5-point scale of agreement. The coefficient alpha of this scale in this study was.76; one-year test-retest reliability was.59. Expectations of positive outcomes. The Subjective Probability Questionnaire (SPQ; Munoz & Lewinsohn, 1976) was designed to operationalize Beck's (1976) cognitive triad by having subjects rate the probability of occurrence of positive outcomes. On the basis of pilot work, five items were selected that most strongly discriminated between depressed and nondepressed persons (Lewinsohn, Munoz, & Larson, 1982). Subjects rated the probability of occurrence of each event on a 5-point scale (e.g., "I'll be able to make friends with the kind of people 1 really like"). The obtained coefficient alpha for this scale was.83, and the one-year test-retest reliability was.40. Self-reinforcement. The Frequency of Self-Reinforcement Attitudes Questionnaire (Heiby, 1982) is a 30-item questionnaire measuring attitudes and beliefs about self-reinforcement, a central aspect of Rehm's (1977) self-control model of depression. On the basis of pilot work, this measure was abbreviated to 10 items (e.g., "I silently praise myself even when others do not praise me"), which were answered true or false. The coefficient alpha was.62; test-retest reliability over a one-year interval was.56. Self-esteem. On the basis of pilot work, three items from the Rosenberg Self-Esteem Scale (Rosenberg, 1965) were administered to assess self-esteem (e.g., "I feel I have a number of good qualities"). Subjects rate degree of agreement on a 4-point scale. Coefficient alpha was.86; test-retest reliability over a one-year interval was.69. Perceived control. Three items, answered with a 5-point response format, were selected from an original set of seven items (Lewinsohn, 1971) designed to assess perceptions of control over one's life (e.g., "I have little control over the things that happen to me"). Coefficient alpha was.62; one-year test-retest reliability was.38. Attributions of causality. The 48 items of the Kastan Attributional Style Questionnaire for Children (Kastan CASQ; Kaslow, Tanenbaum, & Seligman, 1978) were administered to measure attributional style along the internal-external, stable-unstable, and global-specific dimensions described by Abramson et al. (1978). Adolescents were presented with an event (e.g., "You get very g r 3d grades") and chose between one of two explanations for the event (e.g., "School work is simple" versus "I am a hard worker"). As Peterson (1991) recommended, two scores were derived from this measure: (a) a positive attributions score, based on the subjects' responses to 24 positive events (e.g., "A friend tells you that you look nice") that are attributed to unstable, external, and specific causes (a =.45, one-year test-retest r =.48); and (b) a negative attributions score, based on responses to 24 negative events (e.g., "You have a fight with a friend") that are attributed to stable, internal, and global causes (a =.58, one-year test-retest r =.54). Results The cognitive measures used in this study were selected on the basis of their theoretical links with Beck's (1976), Rehm's (1977), and Abramson et al.'s (1978, 1989) cognitive formulations of depression. In a previous study with a large sample of adults, Gotlib et al. (1991) found that a cross-validated factor analysis conducted on similar measures yielded two factors: a Table 1 Group Means and Standard Deviations for CES-D Scores Gender Boys Girls Total Depressed Remitted Group Never depressed M SD M SD M SD , b 23.1 l b b , C C M b b b Psychiatric controls SD Note. Within rows, means with different subscripts differed significantly in the Scheffe post hoc test. CES-D = Center for Epidemiological Studies Depression Scale

5 DEPRESSED ADOLESCENTS 611 factor labelled Negative Cognitions, composed essentially of measures assessing Beck's and Rehm's formulations, and a factor labelled Attributional Style, composed of measures assessing Abramson et al.'s model of depression. To determine whether this factor structure would be applicable in the sample of adolescents examined in the present study, we conducted confirmatory factor analytic procedures using EQS (Bentler, 1989) to examine the appropriateness of the two-factor model of cognitions (i.e., Negative Cognitions and Attributional Style). The covariances of the seven cognitive measures were specified such that five cognitive measures (dysfunctional attitudes, subjective probabilities, perceived control, self-esteem, and self-reinforcement) were constrained to load only on the Negative Cognitions factor, and the two attributional measures (positive and negative subscales of the Kastan CASQ) were constrained to load only on the Attributional Style factor. Using a maximum likelihood method of estimation, we obtained a model x 2 (13, N= 1,710) = 84.04, p <.001. However, because the chi-square statistic is influenced by sample size (i.e., trivial differences may be detected with large sample sizes), the Bentler-Bonett normed fit index (NFI; Bentler & Bonett, 1980) and the comparative fit index (CFI; Bentler, 1990) were used to assess the fit of the model. The obtained goodness-of-fit indices (NFI =.953; CFI =.960) indicate an acceptable fit of the twofactor model. In addition, all of the cognitive measures had sufficient standardized loadings (i.e., all >.4) on their respective factors. Thus, the factor structure obtained in a previous study with a sample of adults was found to be robust in the present sample of adolescents. Moreover, the two factors had one-year test-retest reliabilities ranging from.68 for subjects in the depressed group to.35 for psychiatric control subjects (testretest reliabilities for the entire sample were.61 for the Negative Cognitions factor and.55 for the Attributional Style factor). Adolescents' scores on each of the seven measures were standardized and factor composites were created by summing the standardized scores for the measures constituting each factor. Group means and standard deviations for factor scores on the two cognitive factors are presented in Table 2. To examine differences among the four groups of adolescents with respect to the factor composites, as well as possible gender differences, we conducted a two-way (Group X Gender) multivariate analysis of variance (MANOVA) on the two factors. This analysis yielded only a main effect for group, F(6, 3402) = 21.59, p <.001; neither the main effect for gender, F(2,1701) < 1, nor the Group X Gender interaction, F(6, 3402), p >. 10, was significant. Subsequent univariate ANOVAs yielded significant main effects for group for both cognitive factors: Negative Cognitions, F(3, 1702) = 37.14; Attributional Style, F(3,1702)= 25.57; both ps <.001. Scheffe post hoc tests indicated that, on the Negative Cognitions factor, the currently depressed adolescents differed significantly from the remaining subjects, and the never-depressed adolescents differed from subjects in all of the other groups. On the Attributional Style factor, the depressed adolescents differed from the remitted depressives and from the never-depressed subjects; they did not differ significantly, however, from the psychiatric controls. In addition, the never-depressed adolescents differed from subjects in all of the other groups. It is possible that the significant difference between the never-depressed adolescents and adolescents in the psychiatric control and remitted groups on the two factors was due to elevated CES-D scores in the samples of psychiatric control and remitted subjects. To examine this possibility, we conducted a multivariate analysis of covariance on these data, comparing scores of the three groups of nondepressed adolescents on the two cognitive factors, covarying their CES-D scores. This analysis yielded a nonsignificant effect for group, F(4, 3310) = 1.92, p >. 1. Thus, differences in scores on the Negative Cognitions and Attributional Style factors among the three groups of nondepressed adolescents appear to be attributable to elevated levels of depressive symptoms in the remitted and the psychiatric control subjects. Finally, to examine whether the depressed and the remitted adolescents who also had other diagnosed disorders (comorbid subjects) differed significantly from the pure depression and pure remitted depressed adolescents with respect to their scores on the two cognitive factors, we conducted MANO\As on the factor scores within the depressed and remitted groups. The results of both analyses were nonsignificant: depressed group, F(2, 47) < 1; remitted group, F(2, 295) = 2.45, p>.05. Therefore, comorbid subjects did not obtain scores on the two cognitive factors that were significantly different from the scores of their "pure" depressed counterparts. Discussion Three major issues were addressed in this study. First, we examined both the nature of the cognitive constructs assessed by a number of measures of cognitive functioning in depressed adolescents and the functioning of depressed adolescents with respect to these constructs. Second, we assessed the cognitive functioning of remitted depressed adolescents. Finally, we evaluated the specificity to depression of negative cognitions. The results of previous investigations examining the cognitive functioning of depressed persons have been equivocal (cf. Barnett & Gotlib, 1988; Coyne & Gotlib, 1983). Whereas some investigators have found negative cognitive functioning to be specific to depression, or to normalize following symptomatic improvement, other researchers have not replicated these findings. In an effort to bring greater uniformity to research in this area, several theorists and investigators have called for studies delineating higher order cognitive constructs (e.g., Ingram, 1990; Reno & Halaris, 1989; Shaw & Katz, 1990). The present investigation confirmed, in a sample of adolescents, the results of a previous factor analysis of several diverse measures of cognitive functioning in an adult sample that yielded two factors assessing negative cognitions and attributional style. This confirmed factor analysis indicates that, given similar measures, the structure of cognitive functioning may be comparable in adolescents and adults. Moreover, secondary analyses indicated that comorbid current and remitted depressives did not differ from their pure-depression counterparts with respect to their cognitive functioning. Given the relative independence of the literatures examining Beck's (1976), Rehm's (1977), and Abramson et al.'s (1978,1989) formulations of depression, it is noteworthy that the factor anal-

6 612 GOTLIB, LEWINSOHN, SEELEY, ROHDE, REDNER Table 2 Group Means and Standard Deviations for Factor Scores on the Two Cognitive Factors Group Depressed Remitted Never depressed Psychiatric controls Gender M SD SD M SD M SD Boys Girls Total Boys Girls Total , Negative Cognitions b C h Attributional Style C b ab Note. test. In the two total rows, means with different subscripts differed significantly in the Scherfe post hoc ysis confirmed an empirical separation of the constructs discussed in these models. It appears, therefore, that Beck's and Rehm's emphasis on the negative outlook of depressed persons and Abramson et al.'s and Rehm's focus on the attributional style of depressed individuals may represent two relatively distinct constructs. In the present study, negative outlook or expectations of events were separated from attributions for the causes of events. An individual's attributional style, therefore, appears to be distinct from his or her level of optimism or pessimism. Given the robustness of this factor structure and the theoretical importance of the distinction between outlook and explanation (cf. Bandura, 1989), it is critical that future research examining the cognitive functioning of depressed persons include separate measures of negative thinking and attributions, and evaluate the independent contributions made by these two constructs to the onset and maintenance of depression. Two related findings from the present study also warrant comment here. First, the currently depressed adolescents, both male and female, differed from the formerly depressed, or remitted, subjects and from the never-depressed adolescents on both cognitive factors. This pattern of results (and, in particular, the difference between the depressed and remitted subjects on both cognitive factors) is consistent with findings reported by other investigators who, using a variety of measures and methods, have also demonstrated differences in cognitive functioning between currently and formerly depressed subjects. For example, a number of studies examining responses to the DAS or the Attributional Style Questionnaire (or both) have found that scores normalize as depression remits, both in adults and in children and adolescents (e.g., Asarnow & Bates, 1988; Fennell & Campbell, 1984; Hamilton & Abramson, 1983; Hollon et al., 1986; McCauley et al., 1988; Persons & Rao, 1985), although there have also been exceptions to this pattern (e.g., Eaves & Rush, 1984). Dobson and Shaw (1987) assessed depressed subjects longitudinally and found that when these subjects were remitted their performance on a self-referent encoding task also normalized; virtually identical results were reported by Gotlib and Cane (1987). This pattern of results suggests, therefore, that negative cognitive functioning may be a concomitant of depression rather than a stable aspect of depression-prone adolescents' functioning. This conclusion is further supported by the finding in the present study that the initial differences between the remitted and the never-depressed adolescents were no longer significant when depressive symptoms were partialled out, indicating that cognitive dysfunction may be related to elevated negative mood (see Barnett & Gotlib, 1988, and Gotlib & McCabe, 1992, for more extensive reviews of this literature and discussions of this issue). Nevertheless, these results must be replicated in prospective longitudinal research comparing the functioning of adolescents during and following depressive episodes. Although negative cognitive functioning was most strongly evident during the depressive episode, we should also note that recent efforts directed at providing evidence of enduring cognitive structures have focused on situations in which the cognitive structures are primed by some event, thereby testing the diathesis-stress aspect of the cognitive models (e.g., Miranda & Persons, 1988). Indeed, Bower (1981) suggested that associative networks may contain emotion nodes, which would allow an individual to access depression-associated constructs when they are in a sad mood but are not actually clinically depressed. We did not assess this formulation in the present study; it would be informative in future research to examine the responses of remitted adolescents on these two cognitive factors under an activation condition. Despite the significant difference between the depressed and the remitted adolescents, the remitted adolescents also obtained significantly higher scores on both cognitive factors than did their never-depressed counterparts. Moreover, this difference appeared to be due in large part to differences between

7 DEPRESSED ADOLESCENTS 613 these two groups with respect to their scores on the CES-D. This finding suggests that there may not be a complete return to a nondepressed state or complete recovery (or normalization) of cognitive functioning with remission of a depressive episode. Unfortunately, the present data do not permit an examination of the temporal relation between depression and cognitive dysfunction in adolescence. It is possible, for example, that experiencing an episode of depression early in an individual's life may result in long-term changes in cognitive functioning. Alternatively, the differences between the ever-depressed and the never-depressed adolescents with respect to cognitive functioning (and elevated depressed mood) may have existed prior to the onset of the first episode. In any case, it is clear that further research is required to address this issue more explicitly. The final objective of this study involved an examination of the specificity of negative cognitions to depression. Although there is agreement concerning the importance of cognitive functioning in depression, there is a paucity of research examining the specificity of negative cognitions to this disorder. The inclusion in the present study of adolescents who did not meet diagnostic criteria for depression but who were exhibiting other significant psychiatric symptomatology allowed us to examine the specificity to depression of negative cognitive functioning. The results of this study with respect to the issue of specificity were mixed: in the analysis of the Negative Cognitions factor, the depressed adolescents demonstrated significantly more negative cognitive functioning than did the psychiatric controls, suggesting that elevated scores on this factor may be specific to depression. In contrast, the depressed and psychiatric control adolescents did not differ with respect to their scores on the Attributional Style factor. Previous studies that have examined the specificity to depression of measures of cognitive functioning in adults have also yielded mixed results. Silverman, Silverman, and Eardly (1984) and Hamilton and Abramson (1983), for example, found that depressed adult patients obtained higher scores on the DAS than did nondepressed psychiatric controls. In contrast, Hollon et al. (1986) failed to replicate this result, although they did find stronger evidence of specificity with the Automatic Thoughts Questionnaire. Similarly, Curry and Craighead (1990) found that in a patient sample of depressed and nondepressed adolescents, attributional style for positive events, but not for negative events, was specific to depression. 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