Learner Name:
Debate Preparation and Summary Worksheet
To prepare for the debate in Unit 5, use this worksheet to synthesize what you have learned
from your research on the causes of depression. Complete Section 1 Debate Preparation to
organize your position, arguments, and evidence for the debate.
You will then complete Section 2 Debate Summary following the debate, and will turn the full
worksheet in at the end of the Unit 6 for grading as a summary of the debate.
Section 1 - Debate Preparation
•
Your Position Statement
In the space below, construct a position statement that reflects your perspective on the cause of
depression. Your position should include the following:
•
A description of the perspective you are taking (either biological or cognitive behavioral).
•
Write your position statement.
•
A brief summary of each argument that you will present to support your position (you
should construct three arguments for your position).
•
Your Summary of the Arguments that Support Your Position and the
Evidence From Research to Support Those Arguments. (Please include
appropriate in-text citations for your evidence and then include the full reference in the
reference list - #5 below). Include evidence from research for each argument.
Supporting Argument 1:
Evidence, example, illustration 1:
Evidence, example, illustration 2:
Evidence, example, illustration 3:
Supporting Argument 2:
Evidence, example, illustration 1:
Evidence, example, illustration 2:
Evidence, example, illustration 3:
Supporting Argument 3:
Evidence, example, illustration 1:
Evidence, example, illustration 2:
Evidence, example, illustration 3:
Add additional supporting arguments as needed. (If you have more than three arguments, place
them in the same format as the others here):
Section 2 - Debate Summary
•
Counter Arguments to Your Position and Your Rebuttals – With what counter
arguments did others challenge your position? How did you reply to challenge their
counter arguments (these are your rebuttals).
What opponents said to counter your
arguments (paraphrase your
understanding of their counter
arguments—do not copy and paste
them).
Your rebuttals to the counter arguments
that they made to you or could have
made to you based on their positions.
(Please cite any sources you used):
Note: If you did not receive any counter
arguments directly to your post, think about
counter arguments presented to your
peers that could also apply to yours. You
may also use counter arguments that you
have read in the literature.
•
Summary and Conclusion Section (use this section as a way to summarize the
debate)
•
From the information from above, in one or two well-developed paragraphs, summarize
in your own words the counter arguments opposing your position:
•
In one or two well-developed paragraphs, summarize your rebuttals to the counter
arguments that opposed your position:
•
Write a statement and conclusion of why your position is the most valid and reasonable:
•
APA Reference List – Journal articles go in the following format:
Author last name, initials of first and middle names (if provided). (Year of publication). Title of
the article. Title of the Journal, volume(issue), page numbers. doi number if the article has one.
Example of a reference for a journal article:
Klassen, R. M., Perry, N. E., & Frenzel, A. C. (2012). Teachers’ relatedness with students:
An underemphasized component of teachers’ basic psychological needs. Journal
of Educational Psychology, 104(1), 150–165. doi: 10.1037/a0026253
Use this area below to format the references you used in the debate.
References
Journal of Abnormal Psychology
2013, Vol. 122, No. 2, 339 –352
© 2013 American Psychological Association
0021-843X/13/$12.00 DOI: 10.1037/a0031994
Rumination as a Mechanism Linking Stressful Life Events to Symptoms of
Depression and Anxiety: Longitudinal Evidence in
Early Adolescents and Adults
Louisa C. Michl and Katie A. McLaughlin
Kathrine Shepherd
Boston Children’s Hospital, Harvard Medical School
Kent State University
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Susan Nolen-Hoeksema
Yale University
Rumination is a well-established risk factor for the onset of major depression and anxiety symptomatology in both adolescents and adults. Despite the robust associations between rumination and internalizing
psychopathology, there is a dearth of research examining factors that might lead to a ruminative response
style. In the current study, we examined whether social environmental experiences were associated with
rumination. Specifically, we evaluated whether self-reported exposure to stressful life events predicted
subsequent increases in rumination. We also investigated whether rumination served as a mechanism
underlying the longitudinal association between self-reported stressful life events and internalizing
symptoms. Self-reported stressful life events, rumination, and symptoms of depression and anxiety were
assessed in 2 separate longitudinal samples. A sample of early adolescents (N ⫽ 1,065) was assessed at
3 time points spanning 7 months. A sample of adults (N ⫽ 1,132) was assessed at 2 time points spanning
12 months. In both samples, self-reported exposure to stressful life events was associated longitudinally
with increased engagement in rumination. In addition, rumination mediated the longitudinal relationship
between self-reported stressors and symptoms of anxiety in both samples and the relationship between
self-reported life events and symptoms of depression in the adult sample. Identifying the psychological
and neurobiological mechanisms that explain a greater propensity for rumination following stressors
remains an important goal for future research. This study provides novel evidence for the role of stressful
life events in shaping characteristic responses to distress, specifically engagement in rumination,
highlighting potentially useful targets for interventions aimed at preventing the onset of depression and
anxiety.
Keywords: rumination, stress, internalizing symptoms, depression, anxiety
& Frederickson, 1993; Nolen-Hoeksema, Parker, & Larson, 1994),
heightened risk for new onsets of major depression (Abela &
Hankin, 2011; Just & Alloy, 1997; Nolen-Hoeksema, 2000; Robinson & Alloy, 2003), and greater chronicity of depressive episodes (Robinson & Alloy, 2003). Rumination is also associated
with elevated risk for anxiety symptomology (Fresco, Frankel,
Mennin, Turk, & Heimberg, 2002; Harrington & Blankenship,
2002; Mellings & Alden, 2000; Nolen-Hoeksema, 2000; NolenHoeksema & Morrow, 1991). In addition, experimentally inducing
rumination in distressed individuals prolongs both depressed and
anxious mood compared with inducing distraction (Blagden &
Craske, 1996; McLaughlin, Borkovec, & Sibrava, 2007; NolenHoeksema et al., 1993).
Despite the fact that rumination is among the most robust risk
factors for depression and anxiety (Aldao, Nolen-Hoeksema, &
Schweizer, 2010), we know very little about the factors that predict
the development of a ruminative response style. Identifying such
factors would not only improve our understanding of the etiology
of a ruminative response style but also have important implications
for designing preventive interventions. One factor that may increase engagement in rumination is the experience of stress, that is,
social and environmental circumstances that require psychological
Rumination involves repetitive and passive focus on the causes
and consequences of one’s symptoms of distress without engagement in active coping or problem solving to alleviate dysphoric
mood (Nolen-Hoeksema, 1991). Numerous studies suggest that the
tendency to ruminate is associated prospectively with increases in
depressive symptoms (Nolen-Hoeksema & Davis, 1999; NolenHoeksema, Larson, & Grayson, 1999; Nolen-Hoeksema, Morrow,
Louisa C. Michl, Boston Children’s Hospital, Harvard Medical School;
Katie A. McLaughlin, Department of Pediatrics & Psychiatry, Boston
Children’s Hospital, Harvard Medical School; Kathrine Shepherd, Department of Psychology, Kent State University; Susan Nolen-Hoeksema, Department of Psychology, Yale University.
Louisa C. Michl is now at the Department of Psychology, University of
Rochester.
We are deeply saddened that Susan Nolen-Hoeksema passed away
before this article went to press. In addition to being a tremendous scholar,
she was an inspiring, generous, and insightful collaborator. We will miss
her terribly.
Correspondence concerning this article should be addressed to Katie A.
McLaughlin, 21 Autumn Street, Boston, MA 02115. E-mail: katie
.mclaughlin@childrens.harvard.edu
339
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
340
MICHL, MCLAUGHLIN, SHEPHERD, AND NOLEN-HOEKSEMA
and physiological adaptation over time by the organism (Monroe,
2008). The stress process involves a dynamic interaction between
the organism and environment that changes over time in response
to external challenges, perceptions of those challenges, and the
coping resources that are activated following social and environmental challenges (Monroe, 2008). Conceptual models regarding
the etiology of rumination argue that the experience of stressful
life events might lead to rumination not only about those events
but also about many areas of an individual’s life (NolenHoeksema, 1994; Nolen-Hoeksema et al., 1999). The current report examines this possibility.
Control theories (Carver & Scheier, 1981; Martin & Tesser,
1996) provide the most direct explanation for how stressful experiences might lead to rumination (cf. Watkins, 2008). Negative
events can create discrepancies between goals or desired states and
one’s current state and lead to rumination about how to reduce
such discrepancies (Carver & Scheier, 1981; Martin & Tesser,
1996). For example, receiving an unexpectedly low grade on a
term paper may create a discrepancy with a student’s goal of doing
well in a course, which in turn leads to rumination about this
discrepancy. If the rumination leads to resolution of the discrepancy (e.g., the student decides the course is too difficult and
decides to drop it), then the rumination will stop. If the discrepancy
cannot be resolved, the individual may continue to ruminate about
it. Uncontrollable or chronic stressors may be especially likely to
lead to rumination because they create discrepancies between the
individual’s current state and his or her goals or desired states (e.g.,
happiness) that cannot be resolved (Watkins, 2008). Indeed, one
study of bereaved adults found that those who reported greater
chronic stress showed increased rumination over time (NolenHoeksema et al., 1994). Similarly, in an experience sampling study
of individuals facing stigma-related stressors due to race or sexual
orientation, engagement in rumination was higher on days when
stigma-related stressors were experienced (Hatzenbuehler, NolenHoeksema, & Dovidio, 2009).
Stress may also induce rumination by undermining selfregulation, or the capacity to engage in self-control over one’s
behavior (Baumeister, Gailliot, DeWall, & Oaten, 2006; Inzlicht, McKay, & Aronson, 2006). Limited regulatory abilities
may impair an individual’s ability to engage in problem solving
or active coping and increase the likelihood of engagement in
rumination. Indeed, various studies have shown that active
coping strategies such as problem solving are negatively correlated with rumination (see review by Nolen-Hoeksema,
Wisco, & Lyubomirsky, 2008). A variety of other cognitive
mechanisms might also increase the likelihood of rumination
following stressful life events, including attention to negative
thoughts and feelings, autobiographical memory for previous
negative events, and negative self-schema activation (Scher,
Ingram, & Segal, 2005; Segal & Ingram, 1994).
Slavich’s psychobiological theory of depression (Slavich,
O’Donovan, Epel, & Kemeny, 2010) provides an additional
conceptual framework linking experiences of stress—particularly interpersonal stressors involving social rejection—to engagement in rumination. This theory proposes that social rejection stressors elicit a coordinated pattern of cognitive,
emotional, and neurobiological responses that culminate in
heightened risk for depression (Slavich, O’Donovan, et al.,
2010). In particular, social rejection is associated with activa-
tion in brain regions involved in emotional awareness and
emotion regulation (Beauregard, Lévesque, & Bourgouin, 2001;
Lane et al., 1998; Ochsner & Gross, 2005; Slavich, Way,
Eisenberger, & Taylor, 2010; Somerville, Heatherton, & Kelley, 2006) that are activated during self-reflection (Johnson et
al., 2006). Thus, brain regions that are sensitive to social
rejection stressors are also centrally involved in the core selfreflective process that underlies rumination, suggesting a potential neurobiological mechanism linking interpersonal stressors to increased engagement in rumination.
Like rumination, stressful life events consistently predict the
onset of major depression and anxiety disorders (Brown, 1993;
Hammen, 2005; Kendler, Hettema, Butera, Gardner, & Prescott,
2003; Kendler, Karkowski, & Prescott, 1999), and it is possible
that rumination represents a mechanism that explains the relationship between stress exposure and the onset of internalizing
psychopathology. Early studies with individuals who had experienced stressors such as a natural disaster (Nolen-Hoeksema
& Morrow, 1991) or bereavement (Nolen-Hoeksema et al.,
1994) found that those who were prone to ruminate had more
severe and longer periods of negative mood following these
events than those not prone to ruminate. However, these studies
did not directly examine rumination as a mechanism linking
stress to internalizing symptoms. More recently, evidence from
an experience sampling study suggested that engagement in
rumination partially mediates the association between negative
life events and negative affect (Moberly & Watkins, 2008).
Similarly, rumination was found to mediate the relationship
between stigma-related stressors and psychological distress
(Hatzenbuehler et al., 2009). Yet, the extent to which rumination explains the association between stressful events and symptoms of psychopathology is not well understood.
The purpose of the current study was twofold: (a) to examine
the role of self-reported stressful life events as a predictor of
changes in rumination over time, and (b) to determine whether
rumination is a mechanism linking self-reported stressful life
events to subsequent increases in symptoms of depression and
anxiety. We expected that self-reported stress exposure would
be associated prospectively with increases in rumination, such
that individuals reporting greater stress exposure would show
greater increases in rumination over time than those reporting
less stress exposure. We additionally predicted that increases in
rumination following self-reported exposure to stress would
mediate the relationship between reported stressful life events
and increases in symptoms of depression and anxiety over time.
To evaluate these hypotheses, we examined the association
between self-reported stressful life events, rumination, and
symptoms of depression and anxiety in two longitudinal studies: one using a school-based sample of early adolescents and
one based on a community sample of adults. Finally, given
substantial gender differences in rumination (Nolen-Hoeksema,
1991) and in the prevalence of symptoms of depression and
anxiety beginning in adolescence (Hankin et al., 1998; NolenHoeksema & Girgus, 1994; Twenge & Nolen-Hoeksema, 2002),
we examined whether the relationships between self-reported
stressful life events, rumination, and symptoms of depression
and anxiety varied by gender.
STRESS AND RUMINATION
Study 1
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Method
Participants and procedure. Adolescents were recruited
from the total enrollment of two middle schools (Grades 6 – 8) in
central Connecticut that agreed to participate in the study, excluding students in self-contained special education classrooms and
technical programs who did not attend school for the majority of
the day. The schools were located in a small urban community
(metropolitan population of 71,538). Schools were selected for the
study on the basis of demographic characteristics of the school
district and their willingness to participate.
The parents of all eligible children (N ⫽ 1,567) in the participating middle schools were asked to provide active consent for
their children to participate in the study. Parents who did not return
written consent forms to the school were contacted by telephone.
Twenty-two percent of parents did not return consent forms and
could not be reached to obtain consent, and 6% of parents declined
to provide consent. Adolescent participants provided written assent. The overall participation rate in the study at baseline was
72%.
The baseline sample included 51.2% (n ⫽ 545) boys and 48.8%
(n ⫽ 520) girls. Participants were evenly distributed across grade
level (mean age ⫽ 12.2 years, SD ⫽ 1.0). The race/ethnicity
composition of the sample was as follows: 13.2% (n ⫽ 141)
non-Hispanic White, 11.8% (n ⫽ 126) non-Hispanic Black, 57.3%
(n ⫽ 610) Hispanic/Latino, 2.3% (n ⫽ 24) Asian/Pacific Islander,
0.2% (n ⫽ 2) Native American, 0.8% (n ⫽ 9) Middle Eastern,
9.4% (n ⫽ 100) biracial/multiracial, and 4.2% (n ⫽ 45) other
racial/ethnic groups. Several students (n ⫽ 8, 0.8%) did not provide information on race/ethnicity. Twenty-seven percent (n ⫽
293) of participants reported living in single-parent households.
The participating middle schools reside in a predominantly lower
socioeconomic status community, with a per capita income of
$18,404 (Connecticut Department of Education, 2006, based on
data from 2001). School records indicated that 62.3% of students
qualified for free or reduced lunch in the 2004 –2005 school year.
There were no differences across the two schools in demographic
variables.
Two additional assessments took place after the baseline assessment. Of the participants who were present at baseline, 221
(20.8%) did not participate at the Time 2 assessment, and 217
(20.4%) did not participate at the Time 3 assessment, largely due
to transient student enrollment in the district. Over the 4-year
period from 2000 to 2004, 22.7% of students had left the school
district (Connecticut Department of Education, 2006). Participants
who completed the baseline but not both follow-up assessments
(n ⫽ 1,065) were more likely to be girls, 2(1) ⫽ 6.85, p ⬍ .01,
but did not differ in grade level, race/ethnicity, or being from a
single-parent household (ps ⬎ .10). Participants who did not
complete at least one of the follow-up assessments did not differ
from participants who completed all three assessments on levels of
rumination or symptoms of depression or anxiety symptoms at
baseline (ps ⬎ .10).
Participants completed study questionnaires during their homeroom period. All questionnaires used in the present analyses were
administered at Time 1 and Time 3, and the rumination measure
was additionally administered at Time 2. Four months elapsed
341
between the Time 1 (November 2005) and Time 2 (March 2006)
assessments, and 3 months elapsed between Time 2 and Time 3
(June 2006) assessments. This timeframe was chosen to allow the
maximum time between assessments to observe changes in internalizing symptoms while also ensuring that all assessments occurred within the same academic year to avoid high attrition.
Participants were assured of the confidentiality of their responses
and the voluntary nature of their participation. The study was
approved by the Institutional Review Board at Yale University.
Measures.
Self-reported stressful life events. The Life Events Scale for
Children (Coddington, 1972) is composed of 25 items, each of
which represents a stressful life event (e.g., “Your parents got
divorced” and “You got suspended from school”). Participants are
asked to indicate which events they had experienced in the prior 6
months. Life events checklists are the most commonly used instruments to assess adolescent stress (Grant, Compas, Thurm, &
McMahon, 2004). Good test–retest reliability over 1- to 2-week
intervals has been reported for life event checklists in adolescents
(Cohen, Burt, & Bjork, 1987; Compas, 1987), as well as convergent validity with maternal reports of exposure to stressful life
events in young adolescents (Cohen et al., 1987) and roommate
reports in older adolescents (Compas, 1987).
Rumination. The Children’s Response Styles Questionnaire
(CRSQ; Abela, Brozina, & Haigh, 2002) is a 25-item scale that
assesses the extent to which children respond to sad feelings with
rumination (defined as self-focused thought concerning the causes
and consequences of depressed mood), distraction, or problem
solving. The measure is modeled after the Response Styles Questionnaire (Nolen-Hoeksema & Morrow, 1991) that was developed
for adults. For each item, youths are asked to rate how often they
respond in that way when they feel sad on a 4-point Likert scale
ranging from 1 (almost never) to 4 (almost always). The Rumination subscale includes 13 items that are summed to generate a
score ranging from 13 to 42. Sample items include “Think about a
recent situation wishing it had gone better” and “Think ‘Why can’t
I handle things better?’” The reliability and validity of the CRSQ
have been demonstrated in samples of early adolescents (Abela et
al., 2002). The CRSQ rumination scale demonstrated good reliability in this study (␣ ⫽ .86).
Depressive symptoms. The Children’s Depression Inventory
(CDI; Kovacs, 1992) is a widely used self-report measure of
depressive symptoms in children and adolescents. The CDI includes 27 items consisting of three statements (e.g., “I am sad once
in a while,” “I am sad many times,” “I am sad all the time”)
representing different levels of severity of a specific symptom of
depression. The CDI has sound psychometric properties, including
internal consistency, test–retest reliability, and discriminant validity (Kovacs, 1992; Reynolds, 1994). The item pertaining to suicidal ideation was removed from the measure at the request of
school officials and the human subjects committee. The 26 remaining items were summed to create a total score ranging from 0 to 52.
The CDI demonstrated good reliability in this sample (␣ ⫽ .82).
Anxiety symptoms. The Multidimensional Anxiety Scale for
Children (MASC; March, Parker, Sullivan, Stallings, & Conners,
1997) is a 39-item measure of child anxiety. The MASC assesses
physical symptoms of anxiety, harm avoidance, social anxiety, and
separation anxiety and is appropriate for children ages 8 to 19
years. Each item presents a symptom of anxiety, and participants
MICHL, MCLAUGHLIN, SHEPHERD, AND NOLEN-HOEKSEMA
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342
indicate how true each item is for them on a 4-point Likert scale
ranging from 0 (never true) to 3 (very true). A total score, ranging
from 0 to 117, is generated by summing all items. The MASC has
high internal consistency and test–retest reliability across 3-month
intervals and established convergent and divergent validity (Muris,
Merckelbach, Ollendick, King, & Bogie, 2002). The MASC demonstrated good reliability in this sample (␣ ⫽ .88).
Data analysis. Structural equation modeling was used to perform all analyses in MPlus software (Muthén & Muthén, 1998).
Analyses were conducted using the full information maximum
likelihood estimation method, which estimates means and intercepts to handle missing data. Multiply indicated latent variables
were created for depression, anxiety, and rumination using three
methods: (1) including scale items as observed variables; (2)
creating parcels of items using the domain representative approach, such that each parcel included items from each of the
subscales of the relevant measures (Little, Cunningham, Shahar, &
Widaman, 2002); and (3) creating parcels of items using the
within-domain approach, such that each parcel included items
from one and only one of the subscales of each measure. We
compared these three methods because the value of using parcels
to model constructs as latent factors remains debated. Although
using parcels as opposed to an observed variable representing a
total scale score confers a number of psychometric advantages
including greater reliability, reduced error variance, and increased
efficiency (Coffman & MacCallum, 2005; Kishton & Widaman,
1994; Little et al., 2002), there are also limitations to parceling.
Drawbacks include the possibility of model misspecification if
constructs are multidimensional and items load onto an additional
latent factor that is not included in the model and reduced interpretability of scales that have established norms (Little et al.,
2002). Because the field has not reached consensus regarding the
use of parcels or the most advantageous method for constructing
parcels, we compared these three approaches to determine which
provided the best fit to our data. Subscales used to create parcels
were drawn from the established lower order factors of each
construct based on prior research and exploratory factor analysis in
our data. Subscales of rumination included brooding, reflection,
and dysphoria (Treynor, Gonzalez, & Nolen-Hoeksema, 2003);
subscales of depressive symptoms included internalizing (dysphoria, self-deprecation, and social problems) and externalizing
(school problems and aggression/disobedience) dimensions
(Craighead, Smucker, Craighead, & Ilardi, 1998); and subscales of
anxiety symptoms included physical symptoms, social anxiety,
harm avoidance, and separation anxiety (March et al., 1997).
After comparing the three measurement models, each of which
included all latent constructs modeled simultaneously, we conducted analyses to examine the role of rumination as a mediator of
the longitudinal associations between self-reported stressful life
event exposure and symptoms of depression and anxiety. Standard
tests of statistical mediation were employed. We first examined
each of the steps in the mediation pathway: (1) the association
between Time 1 self-reported life events and Time 3 symptoms of
depression and anxiety, controlling for symptom levels at Time 1;
(2) the association between self-reported life events at Time 1 and
rumination at Time 2, controlling for Time 1 rumination; (3) the
association between Time 2 rumination and Time 3 symptoms,
controlling for Time 1 symptoms and rumination; and (4) the
attenuation in the association between self-reported stressful life
events at Time 1 and symptoms at Time 3 after accounting for
changes in rumination from Time 1 to Time 2. We tested the
significance of the mediator using a bootstrapping approach that
provides confidence intervals around the indirect effect (Preacher
& Hayes, 2008). Confidence intervals that do not include zero
indicate significant mediation. This analysis provides a stringent
test of mediation, which allowed us to investigate whether Time 1
self-reported stressful life events predicted changes in rumination
and whether those changes predicted subsequent increases in
Table 1
Means and Standard Deviations of Stressful Life Events, Rumination, and Symptoms of Depression and Anxiety
Total sample
Measure
Adolescent sample
Stressful life events
Time 1 CRSQ rumination
Time 1 CDI depression
Time 1 MASC anxiety
Time 2 CRSQ rumination
Time 3 CRSQ rumination
Time 3 CDI depression
Time 3 MASC anxiety
Adult sample
Stressful life events
Time 1 RSQ rumination
Time 1 BDI depression
Time 1 BAI anxiety
Time 2 RSQ rumination
Time 2 BDI depression
Time 2 BAI anxiety
Males
Females
Mean
SD
Mean
SD
Mean
SD
Gender difference
t
5.10
10.94
9.67
40.19
10.84
10.18
10.63
34.80
3.33
7.65
6.44
15.39
7.65
8.07
8.15
18.05
5.09
9.40
9.11
36.67
8.72
8.25
9.70
31.64
3.47
7.12
6.37
14.98
6.66
7.31
8.18
18.51
5.12
12.53
10.25
43.95
12.24
11.43
10.73
37.49
3.19
7.84
6.47
14.95
8.17
8.35
7.74
17.22
t(999)⫽0.15
t(1045)⫽6.77ⴱ
t(1052)⫽2.87ⴱ
t(1058)⫽7.92ⴱ
t(835)⫽6.85ⴱ
t(830)⫽5.83ⴱ
t(852)⫽1.90ⴱ
t(853)⫽4.79ⴱ
1.98
1.88
4.58
0.33
38.81
3.97
0.30
1.77
0.48
4.35
0.35
10.23
4.08
0.32
1.85
1.82
4.11
0.29
37.35
3.51
0.25
1.73
0.45
4.0
0.32
9.51
3.83
0.29
2.09
1.91
5.0
0.37
40.05
4.35
0.34
1.79
0.49
4.60
0.38
10.65
4.25
0.35
t(1325)⫽2.55ⴱ
t(1325)⫽3.65ⴱ
t(1325)⫽3.74ⴱ
t(1241)⫽4.00ⴱ
t(1130)⫽4.47ⴱ
t(1131)⫽3.50ⴱ
t(1131)⫽5.00ⴱ
Note. CRSQ ⫽ Children’s Response Styles Questionnaire; CDI ⫽ Children’s Depression Inventory; MASC ⫽ Multidimensional Anxiety Scale for
Children; RSQ ⫽ Response Styles Questionnaire; BDI ⫽ Beck Depression Inventory; BAI ⫽ Beck Anxiety Inventory.
ⴱⴱ
Significant at the .01 level, 2-sided test.
STRESS AND RUMINATION
(RMSEA) ⫽ .05 (90% CI [.04, .06]). The model constructed using
within-domain parcels (three parcels for rumination, two for depression, and four for anxiety) did not fit the data well, 2(24) ⫽
332.0, p ⬍ .001; CFI ⫽ .99; TLI ⫽ .99; RMSEA ⫽ .10 (90% CI
[.90, .10]), nor did the model constructed using observed variables,
2(2846) ⫽ 8480.7, p ⬍ .001; CFI ⫽ .69; TLI ⫽ .68; RMSEA ⫽
.04 (90% CI [.04, .04]).
Stressful life events and rumination. Self-reported exposure
to stressful life events was associated with rumination at Time 2,
controlling for Time 1 rumination,  ⫽ .08, p ⫽ .007. The
relationship between stressful life events and rumination at Time 2
remained significant after additional controls for internalizing
symptoms at Time 1 were added to the model,  ⫽ .07, p ⫽ .030.
Longitudinal mediation analyses. After documenting a prospective association between self-reported stress exposure and
engagement in rumination, we examined the role of rumination as
a mediator of the longitudinal associations between self-reported
stressors and symptoms of depression and anxiety. We examined
two longitudinal mediation models, one predicting depression and
one predicting anxiety.
Self-reported exposure to stressful life events at Time 1 was
marginally associated with depressive symptoms at Time 3, controlling for Time 1 depression,  ⫽ .06, p ⫽ .053. As noted above,
Time 1 self-reported life events were associated with Time 2
rumination, controlling for rumination at Time 1. Time 2 rumination was associated with Time 3 depressive symptoms, controlling
for Time 1 symptoms and rumination,  ⫽ .19, p ⬍ .001. In the
final mediation model, Time 1 self-reported stressful life events
were not associated significantly with Time 3 depressive symptoms, controlling for Time 1 depression and rumination, when
Time 2 rumination was added to the model,  ⫽ .03, p ⫽ .393. The
indirect effect of self-reported life events on depressive symptoms
through rumination was not statistically significant (point
estimate ⫽ .01; 95% CI [⫺.01, .03]). The final mediation model
symptoms of depression and anxiety. Multigroup analyses were
conducted to examine whether the process of mediation was moderated by gender. Each of the mediation paths was constrained to
be equal for boys and girls, and the difference in model fit was
examined using a chi-square test. Finally, we conducted a sensitivity analysis to determine whether the longitudinal association
between stressful life events at Time 1 and rumination at Time 2
was driven entirely by those individuals with high rumination at
Time 1. We evaluated this possibility by examining whether Time
1 stressful life events interacted with Time 1 rumination to predict
Time 2 rumination.
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343
Results
Descriptive statistics. Table 1 displays the means and standard deviations of all measures at each time point, separately for
boys and girls. Girls reported higher levels of rumination and
symptoms of depression and anxiety than boys; no gender difference was observed in the number of self-reported stressful life
events. Table 2 provides the zero-order correlations among selfreported stressful life events, rumination, and symptoms of depression and anxiety. As expected, rumination was positively associated with depression and anxiety symptoms, which were positively
associated with one another. Self-reported stressful life events
were associated positively with rumination and with symptoms of
anxiety and depression.
Measurement models. Three measurement models were
tested, each of which included latent variables for adolescent
depressive symptoms, anxiety symptoms, and rumination. Of the
three approaches to constructing the latent variables, only the
domain representative approach (using four parcels for each of
the three constructs) provided a good fit to the data. All fit indices
indicated that the measurement model fit the data well: 2(51) ⫽
173.8, p ⬍ .001; comparative fit index (CFI) ⫽ .98; Tucker–Lewis
index (TLI) ⫽ .98; root mean square error of approximation
Table 2
Correlations Between Stressful Life Events, Rumination, and Symptoms of Depression and Anxiety
Measure
Adolescent sample
1. LES-C stressful life events
2. CRSQ rumination Time 1
3. CDI depression Time 1
4. MASC anxiety Time 1
5. CRSQ rumination Time 2
6. CRSQ rumination Time 3
7. CDI depression Time 3
8. MASC anxiety Time 3
Adult sample
1. HDL stressful life events
2. RSQ rumination Time 1
3. BDI depression Time 1
4. BAI anxiety Time 1
5. RSQ rumination Time 2
6. BDI depression Time 2
7. BAI anxiety Time 1
1
2
3
4
5
6
7
8
—
.18ⴱⴱ
.29ⴱⴱ
.10ⴱⴱ
.18ⴱⴱ
.16ⴱⴱ
.20ⴱⴱ
.14ⴱⴱ
—
.42ⴱⴱ
.55ⴱⴱ
.57ⴱⴱ
.48ⴱⴱ
.23ⴱⴱ
.35ⴱⴱ
—
.28ⴱⴱ
.39ⴱⴱ
.35ⴱⴱ
.54ⴱⴱ
.24ⴱⴱ
—
.43ⴱⴱ
.41ⴱⴱ
.13ⴱⴱ
.53ⴱⴱ
—
.48ⴱⴱ
.33ⴱⴱ
.44ⴱⴱ
—
.44ⴱⴱ
.69ⴱⴱ
—
.33ⴱⴱ
—
—
.27ⴱⴱ
.21ⴱⴱ
.24ⴱⴱ
.24ⴱⴱ
.14ⴱⴱ
.20ⴱⴱ
—
.50ⴱⴱ
.46ⴱⴱ
.67ⴱⴱ
.37ⴱⴱ
.39ⴱⴱ
—
.60ⴱⴱ
.44ⴱⴱ
.60ⴱⴱ
.50ⴱⴱ
—
.38ⴱⴱ
.47ⴱⴱ
.63ⴱⴱ
—
.50ⴱⴱ
.46ⴱⴱ
—
.61ⴱⴱ
—
Note. LES-C ⫽ Life Events Scale for Children; CRSQ ⫽ Children’s Response Styles Questionnaire; CDI ⫽ Children’s Depression Inventory; MASC ⫽
Multidimensional Anxiety Scale for Children; HDL ⫽ Health and Daily Living Form; RSQ ⫽ Response Styles Questionnaire; BDI ⫽ Beck Depression
Inventory; BAI ⫽ Beck Anxiety Inventory.
ⴱⴱ
Significant at the .01 level, 2-sided test.
344
MICHL, MCLAUGHLIN, SHEPHERD, AND NOLEN-HOEKSEMA
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Discussion
Figure 1. Final mediation model for anxiety symptoms in the adolescent
sample. Numbers represent standardized path coefficients (). All paths
shown are significant (p ⬍ .05), except those drawn with broken lines. All
constructs were modeled as latent variables other than stressful life events.
Given space constraints, indicator variables are not displayed.
accounted for the covariance between symptoms of depression,
rumination, and self-reported life events. Fit indices indicated that
the model fit the data well: 2(112) ⫽ 420.7, p ⬍ .001; CFI ⫽ .97;
TLI ⫽ .96; and RMSEA ⫽ .05 (90% CI [.04, .05]).
Self-reported exposure to stressful life events at Time 1 was
associated with anxiety symptoms at Time 3, controlling for Time
1 anxiety,  ⫽ .10, p ⫽ .002. Time 2 rumination was associated
with Time 3 anxiety symptoms, controlling for Time 1 symptoms
and rumination,  ⫽ .37, p ⬍ .001. In the final mediation model,
Time 1 self-reported stressful life events were no longer associated
significantly with Time 3 anxiety symptoms, controlling for Time
1 anxiety and Time 1 rumination, when Time 2 rumination was
added to the model,  ⫽ .06, p ⫽ .183 (see Figure 1), and the
indirect effect of self-reported stressful life events on anxiety
through rumination was statistically significant (point estimate ⫽
.12; 95% CI [.02, .24]). The covariance between symptoms of
anxiety, rumination, and self-reported stressful life events was
accounted for in the final model. Fit indices indicated that the
model fit the data well: 2(112) ⫽ 332.7, p ⬍ .001; CFI ⫽ .98;
TLI ⫽ .98; and RMSEA ⫽ .04 (90% CI [.03, .04]).
Moderation by gender. Finally, we examined whether the
role of rumination as a mediator of the relationship between
stressful life events and changes in internalizing symptoms was
moderated by gender. When the mediation paths of interest (see
Figure 1) were constrained to equivalence across male and female
adolescents, the model fit did not significantly worsen for depression, 2(3) ⫽ 1.53, p ⫽ .68, or anxiety, 2(3) ⫽ 3.43, p ⫽ .33.
Sensitivity analysis. We examined whether self-reported
stressful life events interacted with rumination at Time 1 to predict
rumination at Time 2 to evaluate whether the association between
self-reported stressful life events and later rumination was driven
entirely by those individuals with high rumination at Time 1. This
interaction was not significant,  ⫽ .04, p ⫽ .396, indicating that
changes in rumination following self-reported stressful life events
did not occur only among those with high levels of rumination at
Time 1.
Study 1 results indicate that self-reported exposure to stressful
life events is associated with increased engagement in rumination
over time in adolescents. Self-reported stress at Time 1 predicted
increases in rumination at a 4-month follow-up, suggesting lasting
changes in the degree to which participants were engaging in
rumination following a self-reported stressful life event. Findings
further indicate that increases in rumination, in turn, significantly
mediated the relationship between self-reported stress exposure
and subsequent increases in anxiety over a 7-month period. Although a similar pattern of findings emerged regarding the role of
rumination as a mediator of the association between self-reported
stressors and changes over time in depressive symptoms, the
indirect effect was not statistically significant. We observed no
gender differences in the role of rumination as a mechanism
linking self-reported stressful life events to internalizing symptoms
in adolescents.
Study 2
Method
Participants and procedure. Adults living in the greater San
Francisco Bay Area were recruited using random-digit-dial telephone calls to households in San Francisco, San Jose, and Oakland, California. These specific communities were chosen to increase the racial/ethnic diversity of the sample. One adult from the
household was recruited for the study. Participants provided written informed consent.
Of the 1,789 individuals identified as eligible for participation,
1,317 completed a baseline interview (22.6% declined participation and 3.7% agreed to participate but did not return calls to
schedule the interview). The mean age was 47.0 years old (SD ⫽
15.2) and the proportion female was 45.5%. The racial/ethnic
composition of the sample was as follows: 72% non-Hispanic
White, 9% Hispanic/Latino, 7% Black, 6% Asian/Pacific Islander,
and 6% multiracial or other race/ethnicity. The majority of the
sample (54%) was married or cohabiting, 18% were single, 16%
were separated or divorced, 9% were widowed, and 3% were in a
committed relationship but not cohabiting. The sample was diverse
in regards to educational attainment, with 19% of respondents
having a high school degree or less education, 27% with some
college, 26% with a college degree, 8% with some postgraduate
education, and 21% with a graduate or professional degree. The
median income of the sample in 1994 was $40,000 to $50,000.
Of the 1,317 baseline respondents, 1,132 (85.9%) completed a
second interview 1 year later. Respondents who did not complete
a second interview had significantly higher interview-rated and
self-reported depressive symptoms than respondents who completed both interviews (p ⬍ .05). The analyses include only the
1,132 respondents who completed both interviews.
Respondents were interviewed in person by an extensively
trained clinical interviewer at both the baseline interview and
follow-up interview 1 year later. Most interviews were conducted
in the respondents’ homes. Interviews lasted approximately 90
min. Interviewers read the instructions aloud to the respondent for
each measure and recorded the responses. Respondents were given
a card with response options for all items that required the use of
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STRESS AND RUMINATION
a Likert scale or involved a choice between groups of possible
answers. The study was approved by the Institutional Review
Board at Stanford University.
Measures.
Stressful life events. We used a revised version of the Stressful Life Circumstances Index of the Health and Daily Living Form
(Moos, Cronkite, Billings, & Finney, 1986) to evaluate stress in
adults. The original index consists of 42 items that each describes
an undesirable life change event (e.g., “Serious illness or injury of
a family member” and “Divorce”). Respondents are asked to
indicate which events they, or someone close to them, had experienced during the previous 6 months. Six of the 42 items are
specific to women. We revised the original index by removing 10
items that were inconsistent with our definition of stressful life
events (i.e., undesirable social and environmental events requiring
adaptation by the respondent). Items that were removed included
events that would likely be experienced by most as positive and
not require significant adaptation (e.g., “Income increased substantially [20%]”) or experiences that captured qualities of the respondent’s behavior rather than social or environmental events (e.g.,
“Alcohol or drug problems”). The remaining 32 items were
summed to calculate a total life events score. Only events that
happened directly to the respondent in the previous 6 months were
included in the total score. Adequate test–retest reliability has been
found for this measure over a 6-month period (Nolen-Hoeksema et
al., 1994).
Rumination. The Response Styles Questionnaire (RSQ;
Nolen-Hoeksema & Morrow, 1991) was administered to assess
participants’ tendencies to ruminate in response to dysphoric
mood. The Ruminative Responses scale of the RSQ includes 22
items describing responses that are self-focused (e.g., “I think,
‘Why do I react this way?’”), symptom focused (e.g., “I think
about how hard it is to concentrate”), and focused on the possible
consequences and causes of negative mood (e.g., “I think, ‘I won’t
be able to do my job if I don’t snap out of this’”). Respondents rate
each item on a scale from 1 (almost never) to 4 (almost always).
The Ruminative Responses scale demonstrated good internal consistency in this sample (␣ ⫽ .90). Scores on this scale ranged from
22 to 76 at baseline and from 22 to 75 at the follow-up. Previous
studies have documented acceptable convergent and predictive
validity of this scale (Butler & Nolen-Hoeksema, 1994; NolenHoeksema & Morrow, 1991).
Depression. Participants completed the 13-item form of the
Beck Depression Inventory (BDI; Beck & Beck, 1972), a selfreport measure of current depressive symptoms. The BDI is one of
the most widely used self-report instruments for detecting depressive symptoms. The BDI demonstrated good internal consistency
in this sample (␣ ⫽ .82). Scores on the BDI ranged from 0 to 29
at baseline and from 0 to 26 at the follow-up. A meta-analysis of
the psychometric properties of the BDI documented good internal
consistency and test–retest reliability across intervals ranging up to
1 month, as well as excellent convergent and discriminant validity
(Beck, Steer, & Carbin, 1988).
Anxiety. The Beck Anxiety Inventory (BAI; Beck & Steer,
1990) was used to assess anxiety symptoms. The BAI has 21 items
assessing the severity of anxiety symptoms using a 4-point scale
ranging from 0 (not at all) to 3 (severely/could barely stand it).
Beck and Steer (1991) reported strong concurrent validity of the
BAI with clinical ratings of anxiety. The BAI demonstrated good
345
internal consistency in this sample (␣ ⫽ .88). Scores on the BAI
ranged from 0 to 52 at baseline and from 0 to 41 at the follow-up.
Data analysis. We followed the same procedures for constructing the latent variables and testing the measurement models
as described in Study 1. Subscales of rumination included brooding, reflection, and dysphoria (Treynor et al., 2003); subscales of
depressive symptoms included somatic-affective and cognitive
(Steer, Ball, Ranieri, & Beck, 1999); and subscales of anxiety
symptoms included neurophysiological, subjective, panic, and autonomic (Osman, Kopper, Barrios, Osman, & Wade, 1997).
Because the adult sample included only two time points, we
followed the procedure for evaluating mediation in a halflongitudinal design (Cole & Maxwell, 2003). Specifically, we
examined (a) the association between Time 1 self-reported stressful life events and Time 2 symptoms of depression and anxiety,
controlling for Time 1 symptoms; (b) the association between
stressful life events at Time 1 and rumination at Time 2, controlling for Time 1 rumination; (c) the association between Time 1
rumination and Time 2 symptoms of depression and anxiety,
controlling for Time 1 symptoms; and (d) the attenuation in the
association between self-reported stressful life events at Time 1
and Time 2 symptoms of depression and anxiety after accounting
for rumination at Time 1. The significance of the indirect effect
was tested using the standard bootstrapping method (Preacher &
Hayes, 2008). Multigroup analysis to test moderation and sensitivity analysis were conducted using the same procedures as in
Study 1.
Results
Descriptive statistics. Table 1 displays the means and standard deviations of all measures at each time point, separately for
men and women. Higher levels of rumination, symptoms of depression and anxiety, and stressful life events were reported by
women compared with men. Table 2 provides the zero-order
correlations among self-reported stressful life events, rumination,
and symptoms of depression and anxiety. Rumination was positively associated with depression and anxiety symptoms, which
were positively associated with one another. Self-reported stressful
life events were associated positively with rumination and with
symptoms of anxiety and depression.
Measurement models. Three measurement models were
tested, each of which included latent variables for depressive
symptoms, anxiety symptoms, and rumination. Of the three approaches to construct the latent variables, only the domain representative approach (using four parcels for each of the three constructs) fit the data well: 2(51) ⫽ 215.9, p ⬍ .001; CFI ⫽ .98;
TLI ⫽ .98; RMSEA ⫽ .05 (90% CI [.04, .06]). Poor model fit was
observed for the model constructed using within-domain parcels
(three parcels for rumination, two for depression, and four for
anxiety), 2(24) ⫽ 374.8, p ⬍ .001; CFI ⫽ .92; TLI ⫽ .89;
RMSEA ⫽ .11 (90% CI [.10, .11]), and the model constructed
using observed variables, 2(1536) ⫽ 8405.2, p ⬍ .001; CFI ⫽
.74; TLI ⫽ .73; RMSEA ⫽ .06 (90% CI [.06, .06]).
Self-reported stressful life events and rumination. In the
adult sample, greater self-reported exposure to stressful life events
at Time 1 was associated with greater rumination at Time 2,
controlling for rumination at Time 1,  ⫽ .06, p ⫽ .012. The
longitudinal relationship between stressful life events and rumina-
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346
MICHL, MCLAUGHLIN, SHEPHERD, AND NOLEN-HOEKSEMA
tion remained significant even after controls for internalizing
symptoms at Time 1 were added to the model,  ⫽ .07, p ⫽ .032.
Longitudinal mediation models. Self-reported stressful life
events at Time 1 were marginally associated with Time 2 depression, controlling for Time 1 depression,  ⫽ .05, p ⫽ .061. As
noted above, self-reported life events were associated longitudinally with rumination. Rumination at Time 1 was associated with
Time 2 depressive symptoms, controlling for Time 1 depression,
 ⫽ .40, p ⬍ .001. In the final mediation model, Time 1 selfreported stressful life events were not a significant predictor of
Time 2 depressive symptoms, controlling for Time 1 depression,
when Time 1 rumination was added to the model,  ⫽ .02, p ⫽
.217; the covariances between Time 1 self-reported stressful life
events, rumination, and symptoms of depression were also modeled. The indirect effect of self-reported stressful life events on
depression through rumination was significant (point estimate ⫽
.05; 95% CI [.02, .09]). Fit indices indicated that the model fit the
data adequately: 2(112) ⫽ 840.4, p ⬍ .001; CFI ⫽ .95; TLI ⫽
.94; and RMSEA ⫽ .06 (90% CI [.06, .07]).
We next examined the extent to which rumination mediated the
association between self-reported stressful life events and subsequent anxiety symptoms. Stressful life events at Time 1 predicted
anxiety symptoms at Time 2, controlling for Time 1 anxiety,  ⫽
.06, p ⫽ .010. Stressful life events were also associated with
rumination at Time 2, as noted above. Rumination at Time 1 was
associated significantly with Time 2 anxiety symptoms, controlling for anxiety at Time 1,  ⫽ .18, p ⬍ .001. In the final
mediation model, self-reported stressful life events at Time 1 were
no longer a significant predictor of Time 2 anxiety symptoms,
controlling for Time 1 anxiety, when Time 1 rumination was added
to the model,  ⫽ .01, p ⫽ .736. The indirect effect of selfreported stressful life events on anxiety through rumination was
statistically significant (point estimate ⫽ .04; 95% CI [.02, .07]).
This model included terms to account for the covariance between
Time 1 self-reported stressful life events, rumination, and symptoms of anxiety at Time 1. Fit indices indicated that the model
provided adequate fit to the data: 2(112) ⫽ 829.6, p ⬍ .001; CFI
⫽ .95; TLI ⫽ .94; and RMSEA ⫽ .07 (90% CI [.06, .07]).
Moderation by gender. No gender differences were observed
in the mediating role of rumination in the association between
self-reported stressful life events and symptoms of depression,
2(3) ⫽ 3.47, p ⫽ .33, or anxiety, 2(3) ⫽ 4.82, p ⫽ .19.
Sensitivity analysis. We examined whether self-reported
stressful life events interacted with rumination at Time 1 to predict
rumination at Time 2 to determine whether the association between self-reported stressful life events at Time 1 and rumination
at Time 2 occurred only in individuals with high rumination at
Time 1. This interaction was not significant,  ⫽ .04, p ⫽ .698.
Discussion
In a longitudinal community-based sample of adults, selfreported exposure to stressful life events predicted increases in
rumination 1 year later. Heightened rumination was a significant
mediator of the association between self-reported stressful life
events and subsequent increases in symptoms of both depression
and anxiety in adults. The role of rumination as a mediator of the
longitudinal association between stressful life events and depression and anxiety symptoms did not vary by gender in adults.
General Discussion
Although rumination is a well-established risk factor for emotional disorders, little is known about vulnerability factors for a
ruminative response style. The purpose of this study was first to
examine exposure to stressful life events as a vulnerability factor
for rumination. As predicted, self-reported stressful life events
were associated with increased engagement in rumination over
time. Self-reported stressful life events were associated with higher
levels of rumination in both adolescents and adults over follow-up
periods ranging from several months to a year, suggesting that
these life events are associated with changes in depressive rumination that are maintained for prolonged periods of time. The
second objective was to determine whether rumination served as a
mechanism linking stressful life events to later increases in symptoms of depression and anxiety, and our findings largely support
this idea. Rumination was a mediator of the longitudinal association between self-reported stressful life events and anxiety symptoms among adolescents and adults and both males and females. In
addition, rumination significantly mediated the relationship between self-reported stressful life events and increases in depressive
symptoms in adults, but not in adolescents. Together, these findings highlight the importance of social environmental experiences
in shaping responses to distress and the role of rumination as a
mechanism underlying stress-related internalizing psychopathology.
Our finding that self-reported stressful life events predicted
increases in subsequent engagement in rumination suggests that
events perceived as stressful may lead to changes in responses to
distress that generalize to many areas of an individual’s life. The
measures of rumination used in this study evaluated the degree to
which respondents engaged in ruminative responses to feeling sad,
down, or dysphoric, rather than engagement in rumination specifically in response to stressors. Given the length of follow-up
between our assessment of life events and rumination, the persisting elevation in rumination among those who reported greater
exposure to stressful life events suggests a potentially lasting
change in characteristic styles of responding to distress. This
finding is consistent with a previous study of bereaved adults in
which greater stress burden following the death of a loved one was
associated with later increases in rumination (Nolen-Hoeksema et
al., 1994).
Why might experiences of stress increase engagement in rumination? A variety of cognitive and neurobiological mechanisms are
likely to underlie this relationship. One possible explanation is that
negative events increase self-focused rumination as an attempt to
reduce discrepancies between goals or desired states and current
states (Carver & Scheier, 1981; Martin & Tesser, 1996; Watkins,
2008). Rumination on discrepancies following negative events
may persist if it focuses on the causes and/or consequences of
those events or on the distress/negative affect associated with
stressful events, rather than on actions aimed to resolve the discrepancies (Watkins, 2008). Exposure to stressful life events might
also hinder one’s ability to engage in active coping or problem
solving (Baumeister et al., 2006; Inzlicht et al., 2006). Specifically,
the cognitive and emotional effort required to manage the negative
affect elicited by stressful experiences may reduce regulatory
resources needed to engage in adaptive coping. Efforts to suppress
thoughts about negative events may also increase ruminative
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STRESS AND RUMINATION
thinking (Wenzlaff, Wegner, & Roper, 1988). Stressful life events
may also increase attention to negative thoughts and feelings,
heighten memory for previous negative events, lead to negative
expectations of the future, and activate existing negative selfschemas (Scher et al., 2005; Segal & Ingram, 1994). Activation of
negative schemas may be particularly likely when stressors occur
in life domains considered central to one’s self-concept (Hammen
& Goodman-Brown, 1990). Each of these cognitive processes may
contribute to increased engagement in rumination following stressful events.
Finally, exposure to interpersonal stressors, particularly social
rejection, activates brain regions that are centrally involved in
self-reflection and emotion regulation (Eisenberger, Lieberman, &
Williams, 2003; Slavich, Way, et al., 2010; Somerville et al.,
2006), including regions involved in emotional awareness
(McRae, Reiman, Fort, Chen, & Lane, 2008) as well as in directing
attention toward salient environmental cues and monitoring conflict (Botvinick, Cohen, & Carter, 2004; Weissman, Gopalakrishnan, Hazlett, & Woldorff, 2005). As such, activation of these brain
regions following interpersonal stressors may result in heightened
attention both to the social and environmental changes associated
with a negative life event, goal discrepancies associated with these
changes, and attention to one’s emotional state. These processes
may ultimately result in increased engagement in rumination.
Our findings also suggest that rumination may act as a mechanism linking stress exposure to increases in internalizing psychopathology. In adolescents, rumination served as a mediator between self-reported exposure to stressful life events and increases
in anxiety over time, and in adults, rumination mediated the
association between self-reported life events and symptoms of
both depression and anxiety. Rumination may be more strongly
associated with anxiety than depression among early adolescents
because they have yet to pass through the period of adolescence
associated with greatest risk for onset of depression (Hankin et al.,
1998). Previous studies have found that adolescents experiencing
a negative event (academic failure or hearing that a parent was
diagnosed with cancer) who engaged in more rumination had
higher levels of depressed mood than adolescents who did not
ruminate (Compas & Grant, 1993; Compas, Malcarne, & Fondacaro, 1988), but these studies did not test rumination as a mediator
between negative events and depressed mood. More recently,
Moberly and Watkins (2008) found that engagement in rumination
partially mediated the association between negative events and
negative affect in an experience sampling study. Our results expand on those of Moberly and Watkins, suggesting that rumination
serves as a psychological pathway linking negative social environmental experiences to risk for symptoms of anxiety in adolescents and both depression and anxiety in adults. This pattern is
similar to results observed recently in another experience sampling
study documenting that rumination mediated the association between stressful life events and depressive symptoms among adolescents with low dispositional levels of traits central to mindfulness, including nonreactivity, nonjudgment, and awareness
(Ciesla, Reilly, Dickson, Emanuel, & Updegraff, 2012).
Rumination may lead to negative mood after stressful life events
because it is associated with reduced capacity to disengage attention from negative emotional information (Joormann, 2006). In
addition, rumination is associated with difficulties in generating
good solutions to problems (Donaldson & Lam, 2004; Lyubomir-
347
sky & Nolen-Hoeksema, 1995; Ward, Lyubomirsky, Sousa, &
Nolen-Hoeksema, 2003; Watkins & Moulds, 2005; Watkins &
Baracaia, 2002) and decreased willingness to engage in moodlifting activities (Lyubomirsky, Kasri, Chang, & Chung, 2006;
Lyubomirsky & Nolen-Hoeksema, 1993). Thus, rumination after
stressful events could undermine individuals’ attempts to solve
their problems or to engage in other more positive coping activities, leading to depressive and anxiety symptoms.
The role of rumination as a mechanism linking self-reported life
events to increases in internalizing symptoms did not vary by
gender. There are well-established gender differences in trait rumination and in the prevalence of depression and anxiety symptomatology beginning in adolescence and continuing throughout
adulthood (Nolen-Hoeksema, 2001; Nolen-Hoeksema & Girgus,
1994; Twenge & Nolen-Hoeksema, 2002). Despite these gender
differences in average levels of rumination and symptoms of
depression and anxiety, however, there is little reason to expect
gender differences in the relationship between rumination and
psychopathology. Indeed, previous research suggests a lack of
gender difference in this relationship in both adolescents and
adults (Hilt, McLaughlin, & Nolen-Hoeksema, 2010; NolenHoeksema & Aldao, 2011), and such a difference was not predicted theoretically (Nolen-Hoeksema, 2001; Nolen-Hoeksema et
al., 1999).
Our results also show no gender differences in the relationship
between stressful life events and rumination. Although females
and males may be equally likely to engage in rumination following
stressful life events, females may be more likely than males to
experience certain types of stressors that lead to rumination,
namely uncontrollable interpersonal stressors (e.g., sexual abuse,
harassment at work; Nolen-Hoeksema, 1994). We found no gender
difference in reports of stressful life events in our adolescent
sample, but did find that women reported a significantly greater
number of stressful life events than men in the adult sample (see
also Nolen-Hoeksema et al., 1999).
The findings of this study point to several promising areas of
future inquiry. Although rumination is typically conceptualized as
a stable trait, our findings suggest that perceived changes in the
social environment can increase engagement in rumination. Given
the potent role that rumination plays in the etiology of major
depression and anxiety pathology, identifying factors associated
with the development of a ruminative response style is critical to
facilitate the targeting of interventions toward adolescents and
adults at high risk for the development of psychopathology.
Some studies have found that rumination interacts with stressful
life events to predict depression, such that individuals high in
rumination are more likely to experience depression following
stressors than those who do not ruminate (e.g., Driscoll, Lopez, &
Kistner, 2009; Robinson & Alloy, 2003). Our findings suggest that
the relationship between stressful life events and depression might
be more complicated. Specifically, exposure to stressful life events
might lead to increased engagement in rumination, regardless of
one’s level of trait rumination at the time of the stressor, which in
turn increases risk for internalizing psychopathology. Although
risk for depression is likely to be particularly heightened among
those already prone to ruminate, our findings suggest that increases
in rumination are not confined to those with high trait rumination.
In sensitivity analyses conducted in both of our samples, we found
that increases in rumination following stressful life events did not
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348
MICHL, MCLAUGHLIN, SHEPHERD, AND NOLEN-HOEKSEMA
occur exclusively among those with high levels of rumination at
baseline. These findings are important because they suggest that
engagement in rumination might represent a global response to
experiences of stress that underlies the strong relationship between
stressful life events and internalizing psychopathology. This possibility warrants further investigation in future research.
An alternative interpretation of our findings is that the negative
affect generated by exposure to stressful life events, rather than the
experiences themselves, is the factor that results in heightened
levels of rumination following stressors. Our finding that perceived stressful life events are associated prospectively with rumination even after controlling for internalizing symptoms assessed at the same time point as the perceived life events argues
against this interpretation. Nevertheless, inclusion of measures of
perceived distress following stressors will allow these relationships to be disentangled to a greater degree than was possible in
the current studies.
Identifying mechanisms linking stress and psychopathology is
critical to develop interventions aimed at preventing the onset of
stress-related mental disorders. Our findings suggest that rumination is a promising target for such interventions in both adolescents
and adults who have experienced recent stressors. One example of
a relevant intervention is rumination-focused cognitive– behavioral
therapy (RFCBT; Watkins et al., 2007). The goal of RFCBT is to
help individuals identify their ruminative thoughts and help them
to shift into more effective thinking styles. Watkins and colleagues
(2011) found that RFCBT was a beneficial treatment for persistent
depression in adults compared with treatment as usual. Although
RFCBT has also been examined as a treatment for adolescents
with posttraumatic stress disorder in a small pilot study (Sezibera,
Van Broeck, & Philippot, 2009), the effectiveness of ruminationfocused interventions for the treatment of adolescent disorders
remains unknown. More critically, the extent to which the techniques used in RFCBT could be applied in preventive interventions aimed at reducing risk for anxiety and depression following
social environmental stressors has yet to be examined empirically.
This remains an important goal for future research. Mindfulness
mediation and other interventions focusing on emotional experience have also been shown to reduce engagement in rumination
among previously depressed individuals (Jain et al., 2007; Kingston, Dooley, Bates, Lawlor, & Malone, 2007; Ramel, Goldin,
Carmona, & McQuaid, 2004). Mindfulness is therefore another
promising technique that might be useful in interventions aimed at
preventing the onset of internalizing problems among individuals
exposed to stressful life events.
Study findings should be interpreted in light of several key
limitations. First, our measures of stress in both the adult and
adolescent samples relied on stressful life events questionnaires.
Questionnaire checklists are limited both by recall failure and bias
as well as misclassification problems (Dohrenwend, 2006; Raphael, Cloitre, & Dohrenwend, 1991). Interview methods have
been developed that largely overcome these methodological problems with checklists (Hammen, 2008). Given their time intensive
nature, however, we were not able to use this approach in the
current study. The primary concern about use of a life events
checklist is that individuals vary widely in the degree to which
they experience negative affect in response to stressors, and those
who are experiencing low mood or are already engaging in high
levels of rumination might be most likely to perceive and report
stressful life events. This concern is partially mitigated by the
longitudinal design of our studies; rumination was measured between 4 and 12 months after the assessment of stressful life events.
This time lag makes it less likely that the relationship between
rumination and reports of stressful life events is explained entirely
by greater propensity for perceiving or reporting stressors among
those with high levels of rumination. Moreover, the nature of our
statistical models takes into account, at least in part, the influence
that both rumination and internalizing symptoms have on the
perceptions/reports of stress because Time 1 rumination was a
covariate in all longitudinal models and the relationship between
perceived life events and rumination remained significant after
controlling for Time 1 internalizing symptoms. Finally, the relationship between perceived stressful life events and rumination
remained significant when we removed several events from each
scale (e.g., items involving interpersonal conflicts) to ensure that
only relatively objective events (e.g., divorce, illness of a family
member) were retained. Nevertheless, the possibility that personality traits or other factors that are stable over time across individuals influenced reports of both stressful life events and rumination remains a possibility. Replication of the relationship
between stress and rumination in studies that use more rigorous
interview-based measures of stress exposure is therefore required.
Second, our analysis focused on self-reported symptoms of
depression and anxiety. Although the association between rumination and onset of clinician-identified depressive episodes is well
established (Abela & Hankin, 2011; Just & Alloy, 1997; NolenHoeksema, 2000; Robinson & Alloy, 2003), the role of rumination
as a risk factor for the later onset of anxiety disorders requires
further empirical examination. As such, future studies would benefit from the use of a clinical interview to establish the relationship
between rumination and the onset of anxiety disorders. Third, we
used a domain representative parceling approach to construct our
latent variables. The issue of whether or not to use parcels to model
latent variables in structural equation models is a controversial and
hotly debated topic, with most studies noting both advantages and
limitations of the approach (Bagozzi & Edwards, 1998; Bandalos,
2002; Coffman & MacCallum, 2005; Kishton & Widaman, 1994;
Little et al., 2002). Drawbacks of using parcels include the possibility of model misspecification if constructs are multidimensional
and items load onto an additional latent factor that is not included
in the model and reduced interpretability of scales that have
established norms (Little et al., 2002). As such, we empirically
examined different methods for constructing the latent variables
used in this study and found that the domain representative parceling approach provided the best fit to our data. However, because the constructs examined in the current study are multidimensional, it is possible that the lower order factors would have
behaved differently than the higher order constructs used in our
models. Although we did not have specific hypotheses about these
lower order factors, examining the role of rumination as a mechanism linking stressful life events to specific types of anxiety and
depressive symptoms is an important direction for future research.
Fourth, although the longitudinal design allowed us to establish
the temporal ordering of stressful life events, rumination, and
changes in internalizing symptoms, the relationships between
stress and internalizing psychopathology and between internalizing psychopathology and rumination are almost certainly reciprocal. Consistent evidence suggests that individuals with depression
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STRESS AND RUMINATION
and anxiety contribute to the generation of stress in their lives
(Hammen, 1991; Rudolph et al., 2000). In addition, although
rumination clearly predicts increases in symptoms of depression
and anxiety, experience sampling evidence suggests that negative
affect is also associated with later increases in rumination
(Moberly & Watkins, 2008). A final limitation of the current study
is the use of only two assessment time points in the adult sample,
making our mediation analysis of this population more limited. A
preferable approach is to use multiwave data to establish that the
exposure predicts changes in the mediator that precede changes in
the outcome (Cole & Maxwell, 2003; Maxwell & Cole, 2007), as
we were able to do in the adolescent sample. To more rigorously
test the conceptual model in adults, a prospective study with three
waves of data is required.
Rumination is among the most robust vulnerability factors for
the development of internalizing psychopathology (Aldao et al.,
2010). Although extensive research has examined the consequences of engagement in rumination, few studies have sought to
identify vulnerability factors for rumination itself. Our findings
suggest that self-reported stressful life events are associated with
subsequent increases in ruminative responses to distress among
both adolescents and adults. Moreover, results indicate that rumination is an important psychological mechanism linking perceived
stress exposure to symptoms of depression and anxiety. These
findings have important implications for guiding the development
of prevention programs aimed at reducing vulnerability to internalizing problems and stress-related psychiatric morbidity.
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Received July 16, 2012
Revision received January 22, 2013
Accepted January 24, 2013 䡲
Causes of Depression Issue Analysis Worksheet
Causes of Depression Issue Analysis Worksheet
Purpose: The Causes of Depression Analysis Worksheet’s purpose is to guide your steps in analyzing the resources from the
resource list in the Unit 4 studies and Capella Library regarding the cause of depression from the perspective you have chosen to
research. This worksheet will lead you through the research process by providing a systematic way to analyze the resources you
have chosen to research. As you review resources, you will use the worksheet to analyze the authors’ positions on the issue and the
arguments they present to support their positions. To fill out the worksheet, work your way down through the analysis components for
each individual article and record your analysis for each component in the cell under the title of the article you are reviewing. You will
submit your Causes of Depression Analysis Worksheet to the Unit 4 assignment.
Learner Name: Francesca Wilson
Name of Perspective: Causes of Depression.-Cognitive behavior
Causes of Depression Research Articles
Analysis Components
APA reference for article:
Michl, L. C., McLaughlin, K. A., Shepherd,
K., & Nolen-Hoeksema, S. (2013).
Rumination as a mechanism linking
stressful life events to symptoms of
depression and anxiety: Longitudinal
evidence in early adolescents and adults.
Journal of abnormal psychology, 122(2),
339.
APA reference for article:
Ma, Z. W., Quan, P., & Liu, T. (2014).
Mediating effect of social support on the
relationship between self-evaluation and
depression. Social Behavior and
Personality: an international
journal, 42(2), 295-302.
The main purpose of this article is:
[State as accurately as possible the
author’s purpose for writing the article.
The authors wrote the article for two main
purposes. Firstly, they intended to
establish whether exposure of a person to
stressful events increased their risks of
The author seeks to find the mediating
effect held by social support based on the
relationship that exists between
depression and self-evaluation.
1
Causes of Depression Issue Analysis Worksheet
What is the author’s position or point of
view?]
The main arguments that the author
is making are: [Determine the main
arguments the author makes to support
their position.]
The evidence or facts the author
uses in this article to support their
arguments are: Identify the facts, data,
or resources the author uses to support
his or her argument.
rumination. They also set out to found out
if rumination mediated or contributed to the
positive association between stressful life
events and increases in symptoms of
anxiety and depression.
The authors viewed that exposure to
stressful life events related to increased
rumination response style and that
rumination was a mediator of the linkage
between stressful events and depression
and anxiety symptoms.
The author notes that the positive
correlation between stressful situations
and increased rumination cases can be
attributed to various neurobiological
sys...
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