Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

199

Psychology and Psychotherapy: Theory, Research and Practice (2006), 79, 199214 q 2006 The British Psychological Society

The British Psychological Society

www.bpsjournals.co.uk

Family and coping factors in the differentiation of childhood anxiety and depression
-Prtoric * and Ivana Macuka Anita Vulic
Department of Psychology, University of Zadar, Croatia
The purpose of this investigation was to explore whether specic contextual (perception of family relationships) and personal (coping strategies) factors are more likely to be associated with anxiety or depression. The research was conducted on a sample of 331 children and adolescents ranging in age from 10 to 16 years who completed measures of the anxiety symptoms, depressive symptoms, coping strategies, and family interactions. Data were analysed according to gender differences. Among family variables, perceived father rejection was found to be best predictor of anxiety, and father and mother rejection, together with family satisfaction, was best predictor for the depression. Avoidance is a coping strategy that best predicts anxiety, and expressing feelings is a signicant predictor of depression. This research strongly indicates that problems in family interactions are more associated and better predictors of depression than anxiety. Results support the argument that the two disorders are distinct and that they are characterized by unique coping and family proles. Knowledge that anxiety and depression could be distinguished on the basis of family and coping variables may facilitate clinical assessment and treatment planning.

Developmental psychopathology is dened as the study of the origins and the course of individual patterns of behavioural maladaptation (Sroufe & Rutter, 1984, p. 18). Contemporary approaches in developmental psychopathology endorse two currently popular etiological ideas concerning these patterns: multideterminism and interaction. According to those ideas, psychopathologies have multiple causes that interact with one another as well as changing over time. This continual and progressive interaction among variables is transactional in nature (Sameroff, 2000). Advances in this eld are made especially according to the phenomenon of co-occurrence of different disorders in the same individual. The issue of co-occurrence or comorbidity or multipathology has become the avour of the moment in developmental psychopathology (Rutter & Sroufe, 2000; Sameroff, 2000). Comorbidity refers to the coexistence of two or more disorders in the same person. The most common comorbid forms of child and adolescent internalizing problems are

-Prtoric , Department of Psychology, University of Zadar, 23000 Zadar, * Correspondence should be addressed to Anita Vulic Croatia (e-mail: avulic@unizd.hr).
DOI:10.1348/147608305X52676

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

200

-Prtoric and Ivana Macuka Anita Vulic

anxiety and depression. It is very hard to draw a clear boundary between symptoms of anxiety and depression. Comorbidity rates for anxiety and depressive disorders range as high as 70%, with rates from 20% through 50% (see reviews by Bernstein, 1991; Brady & Kendall, 1992; Zahn-Waxler, Klimes-Dougan, & Slattery, 2000). Correlations between scores on anxiety and depression inventories are usually very high. For example, in the study of the representative community sample of children and adolescents (857 participants aged 1018) correlation coefcients among depression and anxiety ratings extended from .47 (for separation anxiety and depression) to .64 (for the worry and depression). About 10% subjects in this study evaluated on both, anxiety and depression -Prtoric & Macuka, 2004). The high ratings, were over the cut-off scores (Vulic concordance of anxiety and depressive disorders, as well as the overlap between the two symptom presentations, has led some researches to question whether these disorders can and should be distinguished (Brady & Kendall, 1992). The systematic analysis of comorbid disorders is important for the more valid classication of the subtypes of psychopathologies and further for the better understanding of the diverse conditions that contribute to the emergence, progression and amelioration of the psychological problems over time. Links between depression and anxiety include different directions: comorbidity may indicate the presence of single underlying dimension (such as negative affectivity and attachment processes), or anxiety and depression may be considered as separate and distinct disorders. Comorbidity can be viewed as the conceptual and measurement problem indicating methodological inability of categorical systems to reliably describe the disorders (Zahn-Waxler et al., 2000). According to the Clark and Watson tripartite model of overlapping and distinct features, anxiety and depression appear to share a common distress factor called negative affectivity (Bedford, 1997; Clark, 1989; Finch, Lipovsky, & Casat, 1989; Watson et al., 1995; Watson & Kendall, 1989). Negative affectivity is conceptualized as a stable, heritable and general trait dimension, representing the relationship between temperamental sensitivity to negative stimuli and anxiety and depression. In that sense, various mechanisms could describe the association between negative affectivity and psychological problems. For example, difcult child temperament could inuence parents reactions to the infants needs and signals, and on the other hand, could affect the degree to which the infant requires such reactions. In that sense, anxiety and depression may co-occur because of common temperament and attachment factors that increase vulnerability to both types of problems. Recent research on risk and protective factors affecting development indicated a fussy/demanding temperament in infancy to predict psychiatric symptoms in adolescence (Chess & Thomas, 1991; Teerikangas, Aronen, Martin, & Huttunen, 1998) and avoidant/ambivalent attachment associated with different internalizing and externalizing symptoms (Muris & Meesters, 2002; Warren, Huston, Egeland, & Srouge, 1997). On the other hand, an easy temperament, secure parentchild attachment, and authoritative parenting are central protective factors and resilience in the face of stress. A large body of research in this eld has indicated that child psychopathology generally needs to be understood in the context of family interaction patterns (see for overview, Cummings, Davies, & Campbell, 2000). In particular, anxiety and depression appears to be associated with family environments characterized by an absence of supportive and facilitative interactions, and conversely, by elevated levels of conict and angry situations (Carr, 1999; Harrington, 1993). The most widely reported nding is that depression and anxiety are inversely related to the level of support and approval

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression

201

provided by the family environment. This nding has been reported in both community and clinical samples (Rohner & Britner, 2002). Theory that attempts to predict and explain major personality or mental-healthrelated consequences with perceived parental acceptance and rejection is parental acceptancerejection theory (PART) conceptualized by Ronald P. Rohner (Rohner, Rohner, & Roll, 1984; Rohner, 1999). This dimension in the PART is viewed from two perspectives: from the subjective perception of a child (such as in presented research) or parents and as objectively observable behaviour. Accepting parents are described as those who show their love and affection towards children and induced the child to feel loved and accepted. Rejecting parents in the PART are those who dislike, disapprove of, or resent their children, which is manifested in two principal ways: in the form of hostility and aggression and in the form of parental indifference and neglect. The results are childs feelings of being unloved or rejected. Research results in this eld show that all aspects of internalized and externalized problems are signicantly related to perceived mother and father rejection (Kuterovac & Kerestes , 1997; Rohner & Britner, 2002; Vulic -Prtoric , 2000, 2002b). Jagodic Once psychological problems have developed, they may be maintained by different personal factors. A number of personal maintaining psychological characteristics have been found to play an important role; in particular, self-efcacy beliefs, cognitive distortions, dysfunctional attributions, immature defence mechanisms, and dysfunctional coping strategies (Carr, 1999). Coping strategies are assumed to be consciously and deliberately used methods for regulating negative emotions or to manage situations in which there is a perceived discrepancy between stressful demands and available resources. A distinction is made between problem- and emotion-focused coping strategies or between functional and dysfunctional strategies (Fields & Prinz, 1997). Active ways of coping such as problem-solving, cognitive distraction, self-calming, and asking for help from others, contribute to better adaptation and decrease depressive and anxiety symptoms, in contrast to the more passive ways of coping such as avoidance and social isolation (Compas, Malcarne, & Fondacaro, 1988). Parental behaviour and child rearing practices contribute to the childs development of a perception and appraisal of the life events and ways of coping with stressful situations (Kortlander, Kendall, & Panichelli-Mindel, 1997). Overprotective, anxious, or aggressive, disapproving parents provoke low coping in children. Clinically depressed and anxious children use less efcient coping strategies that eventually increase their problems (Fields & Prinz, 1997; Goodyer, Herbert, Tamplin, Secher, & Pearson, 1997; -Prtoric , 2001). Spirito, Francis, Overholser, & Frank, 1996; Vulic Contemporary theories in developmental psychopathology conceptualize both the anxiety and depression in children and adolescents as the nal common pathway for the reciprocal inuence of different personal and contextual factors that predispose children to developing psychological difculties or to maintain them once they have developed (Rutter, 2000). Although there is empirical support for the association of coping and family variables with depression and anxiety during childhood and adolescence, there is not enough research directed to possible contributions of these variables to the differentiation of depressed from anxious children. This is especially important because of the high comorbidity rates among children with anxiety and depression. The present study was designed to identify which personal and family variables would differentiate depressed from anxious children. Accordingly, family and personal variables were examined as distinctive and overlapping factors in anxiety and depression.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

202

-Prtoric and Ivana Macuka Anita Vulic

The investigation was conducted with the aim of determining the specic contextual (family interactions) and personal (coping strategies) variables that are related to depression and anxiety in children. The quality of family interactions is operationalized as general family satisfaction and perceived father and mother acceptance and rejection. Coping strategies were operationalized as seven strategies that children use under stress situations. It was hypothesized that different family relations and specic coping strategies would be associated with depression and anxiety in children. It was further hypothesized that these processes would be helpful in the differentiation between childrens anxiety and depression. Although it is not within the scope of this study, it is worth mentioning that the assessment of childrens problems often requires that information is obtained from multiple sources. The correspondence of the parent and child reports about childrens problems disagree and published data has found that internalizing symptoms are more often reported by children while externalizing symptoms are reported by parents (see, for overview, Harrington, 1993; Weems, Hammond-Laurence, Silverman, & Ginsburg, 1998; Zaenah, Boris, & Larrieu, 1997). The ndings show very low levels of agreement, with correlations ranging from .20 to .30 (Achenbach & McConaughy, 1997; Compas, & Grant, 1993; Rosenbaum & Ronen, 1997). Although each informant provides a unique, nonredundant source of information, for the purposes of this investigation only childrens reports and their assessments of internalizing, coping, and family variables were used.

Method
Participants The participants studied here represent a subsample from an ongoing study of psychosocial aspects of psychopathology in children and adolescence in eight cities in Croatia. For the purposes of the present study we concentrate attention on the community sample of 331 children (168 males and 163 females) in primary school in Zadar, Croatia. Ages ranged from 10 to 16 years (M 13:07, SD 1:14). The participants completed the questionnaires during a regularly-scheduled classroom period. Measures The four self-report questionnaires used in this study were originally developed in Croatia and were used with community and clinical samples of children and adolescents for the last 5 years. The anxiety and depression scales are designed and modied so that they correspond with DSM-IV diagnostic categories for anxiety and depressive disorders to permit clinical and research utility. (1) The Fear and Anxiety Scale for Children and Adolescents (SKAD-62) is a 62-item self report measure developed to assess anxiety and specic fears in children and adolescents, and it has Croatian norms. It is designed for use with children and adolescents aged between 9 and 18 years. Data on age and sex norms are available. The scale is divided into eight subscales each tapping into a specic aspect of child and adolescent anxiety (separation anxiety, social anxiety, test anxiety, specic fears and phobias, obsessive-compulsive symptoms, worry scale, anxiety sensitivity, somatization, total score). Items required respondents to rate how true each item was with respect to their usual feelings. Items were scored on a 5-point scale from

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression

203

(2)

(3)

(4)

1 not true for me at all to 5 absolutely true for me. In this research the total fear and anxiety score was analysed. The SKAD-62 has been evaluated in several studies in Croatia and it has been shown to have satisfactory internal reliability in different samples. In a study of 2,438 children and adolescents the SKAD-62 has been found to have high internal consistency (Cronbachs a :95; see Table 1). It was found that the scale distinguished between child psychiatric out-patients given a clinical DSM-IV diagnosis of anxiety disorder (N 42) and out-patients who have other disorders diagnosed (N 156) and ability to differentiate children and adolescents with -Prtoric , 2004). anxiety disorders from non-anxious controls (Vulic The Depression Scale for Children and Adolescents (SDD) has 26 items related to different depressive symptomathology (like sadness, insomnia, loss of appetite, interpersonal relationships, etc.) described in DSM-IV. It is designed for use with children and adolescents aged between 9 and 18 years. Data on age and sex norms are available. Items required respondents to rate how true each item was with respect to their usual feelings. Items were scored on a 5-point scale from 1 not true for me at all to 5 absolutely true for me. This inventory of depression has been shown across numerous studies to have high internal consistency. In the community study of 2,225 children and adolescents the SDD was found to have high internal consistency (Table 1). It was found that the SDD distinguished between children with a clinical DSM-IV diagnosis of depressive disorder (N 20) and outpatients with other disorders (N 136) and children and adolescents with depressive disorders from non-depressive controls. There was a high correlation with scores on CDI (r :56), scores on the Hopelessness scale (r :51), Coopersmith Self-Eseem Inventory (r 2:59), and -Prtoric , 2003). other measures of associated psychological constructs (Vulic The Quality of Family Interactions Scale (KOBI) is a 55-item questionnaire designed to assess childrens perceptions of the family climate as well as their parents behaviour towards them, along ve subscales (Table 1). Besides the general climate dimensions, each scale asked for mother and father with the same number and same kind of items. Subjects were asked to assess, on a 5-point scale, satisfaction with their family climate and parental behaviour on two dimensions (according to the PART theory): acceptance and rejection. Reliability coefcients were obtained in -Prtoric , 2002b). If larger, earlier studies in Croatia and ranged from .86 to .89 (Vulic the participant did not live with both parents, only the behaviour of the parent with whom the child lived was assessed. Therefore, we collected data for the behaviour assessment of 326 mothers and 317 fathers. The Coping Strategies Inventory for Children and Adolescents (SUO) is the 58-item self-report instrument that measures the frequency and effectiveness of coping strategies used by children and adolescents in response to stressful events. This scale is divided into seven subscales. Scale development began with a small group discussion of 112 pupils aged 1117 years. Participants were asked to identify the kinds of things they do when experiencing stress. A list of 317 coping strategies was generated. Three experts in the eld of child development and psychopathology then sorted them into 11 conceptually distinct coping categories described in the work of Ayers, Sandler, West, and Roosa (1996). A 64-item instrument was developed and pilot tested in the sample of 291 11- to 18-year-old children. The children scored each coping strategy for frequency of use in their efforts to deal with stress situation (Frequency scale) and then for degree of helpfulness (Effectiveness

204

Table 1. Item examples and main psychometrics of the instruments used in this research No. of items 62 136.3 36.02 .95 M SD a Example items

Measures

SKAD-62

The Fear and Anxiety Scale for Children and Adolescents

-Prtoric and Ivana Macuka Anita Vulic

SDD

The Depression Scale for Children and Adolescents

26

54.8

16.47

.89

I suddenly start to tremble or shake when there is no reason for this I worry that something bad will happen to my parents I think I would do much better in school test if I am not so afraid I feel I am worthless It is hard for me to get to sleep at night I wish if I could oversleep this part of my life

KOBI 11 10 10 12 12 58 21.5 21.2 7.79 7.75 .86 .85 42.2 7.63 .89 46.3 39.2 7.92 8.09 .89 .90

The Quality of Family Interactions Scale 1. Family satisfaction 2. Father acceptance

55

3. Mother acceptance

4. Father rejection 5. Mother rejection

I feel like a stranger in my family My father is full of understanding for my problems I have the feeling that my mother would sacrice everything for me My father has no time for me It seems to me that my mother would be much happier without me

SUO

Copyright The British Psychological Society

The Stress Coping Scale for Children and Adolescents 1. Problem-solving 9 8 11 7.3 13.2 4.39 5.73 .77 .79 16.6 5.31 .83

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

2. Expressing feelings 3. Avoidance

Think about the problem and see what is the best way to handle it Pick a quarrel with someone Think about something else in order to forget what is bothering me

Table 1. (Continued) No. of items 10 6 6 8 10.6 4.34 .74 7.3 3.98 .77 8.2 4.11 .80 11.6 5.07 .68 M SD a Example items

Measures

4. Distraction

5. Social supportfriends

6. Social supportfamily

Copyright The British Psychological Society

7. Cognitive restructuring

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Go bicycle riding and feel much better afterwards Ask someone how she/he felt in situations like this Think about how my parents will comfort me Tell myself that I have coped with worse situations so Ill somehow manage this one too.

Childhood anxiety and depression 205

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

206

-Prtoric and Ivana Macuka Anita Vulic

scale). A 4-point Likert scale was used for the ratings: from 0 never to 3 very often for Frequency scale and from 0 not helpful at all to 3 very helpful for Effectiveness scale. Factor analysis of the data produced seven discrete coping strategies (Table 1). Only items loaded more than .30 were retained and the 58-item instrument was developed. The factor pattern was conrmed in the sample of 573 children aged from 11 to 18 years, and it was the same across grade and sex. Internal reliability for the seven subscales was moderate to high (see Table 1). Up to the present, the SUO was used in 14 -Prtoric , researches in community and clinical samples of children and adolescents (Vulic 2002a). For the purposes of this study, only Frequency scale data were used.

Procedure
Self report scales were group administered, during a regularly scheduled classroom period. The study presented here is part of a larger project research (in 3 year period from 2002 to 2005) that was organized in collaboration with 11 schools and ve hospitals in Croatia, and was approved by the Ethical Committee of the University of Zadar and was carried out according to the ethic principles of the Croatian Psychological Society, American Psychological Association, and the British Psychological Society. The questionnaires presented in this paper were part of the broader battery of instruments dealing with psychopathology in childhood and adolescence, as well as different personal and contextual risk and protective factors. The administration of all questionnaires lasted approximately 1 hour.

Results
The results are presented in four steps. First, to examine gender differences in anxiety, depression, family relationships, and coping strategies ratings, a univariate ANOVA (ANOVA) was performed. Second, correlations among anxious and depressive symptoms, coping strategies, and quality of family interactions were calculated for boys and girls separately. Third, multiple regression analyses were performed to determine which specic coping strategies or family factors better predicted anxiety and depression in children and adolescents and in girls and boys. The ANOVA was used to assess gender differences on the four measures: anxiety (SKAD-62), depression (SDD), quality of family interactions (KOBI), and coping strategies (SUO). Results are presented in Table 2. No differences in anxiety and depression scores were found, although girls had slightly higher anxiety scores than boys (Table 2). However, signicant gender differences were found for the other two variables. In consideration of the perception of the family relationships it was found that, in comparison to boys, girls rated both their parents as being more emotionally warm and accepting and less rejective. They also perceived their family climate as more pleasant. Amongst seven coping variables signicant differences were found in four: in stress situations an overt expression of feelings and distraction were more common in boys, and seeking support from friends and family were more common in girls. Correlations among variables were used in testing the hypotheses on different relations with family and coping variables between anxiety and depression. Data are summarized in Table 3. The Pearson correlation coefcients were calculated between anxiety (SKAD-62) and the depression (SDD) total score, coping strategies and family

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression Table 2. Gender differences on main measures (N 331) M boys Anxiety Depression Family relationships Family satisfaction Father acceptance Mother acceptance Father rejection Mother rejection Coping strategies Problem-solving Expressing feelings Avoidance Distraction Social supportfriends Social supportfamily Cognitive restructuring N 118.3 53.8 44.9 38.5 40.1 22.8 22.7 16.0 7.3 13.6 12.5 6.8 7.6 9.7 168 M girls 123.8 52.0 47.6 39.9 44.4 20.3 19.68 16.0 5.6 12.8 10.3 8.8 8.5 10.3 163 F(1, 329) 2.19 1.04 10.20 2.78 32.53 10.83 13.51 0.00 12.69 1.51 14.00 24.10 4.11 2.02 P .139 .308 .001* .096 .000* .001* .000* .974 .000* .218 .000* .000* .044* .156

207

interactions subscales among the male sample (N 121) and female sample (N 137) separately. With regard to the family variables, in contrast to depression, anxiety signicantly correlated with less family variables. But in the case of coping variables, only a few signicant correlations were found with both anxiety and depression, mostly in the girls sample.
Table 3. Pearson correlations between coping strategies, family interactions, and anxiety and depression in boys (N 121) and girls (N 137) Anxiety Family relationships Family satisfaction Father acceptance Mother acceptance Father rejection Mother rejection Coping strategies Problem-solving Expressing feelings Avoidance Distraction Social supportfriends Social supportfamily Cognitive restructuring *p , :05: Boys 2 .16 2 .17 2 .14 .32* .24* .10 .12 .24* .09 .15 .09 .13 Girls 2 .21* 2 .06 2 .13 .27* .24* .09 .39* .38* .21* .10 .15 .18* Depression Boys 2 .37* 2 .31* 2 .28* .43* .40* 2 .09 .18 .09 .08 .08 2 .04 2 .04 Girls 2 .59* 2 .31* 2 .43* .53* .50* .11 .50* .33* .14 .08 2 .05 .09

Multiple regression analysis was performed to test the predictive values both of the family and coping variables. Results are presented in Tables 4 and 5.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

208

-Prtoric and Ivana Macuka Anita Vulic

Table 4. Summary of multiple regression analysis for family and coping variables predicting anxiety and depression in boys (nal step) Dependant variable Anxiety Depression Predictors Father rejection Avoidance Mother rejection Family satisfaction Expressing feelings R2 .089 .064 .288 .042 F 13.147 9.148 29.150 6.306 df 1,133 1,133 2,144 1,145 b 0.299 0.254 0.353 2 0.263 0.204 t 3.626 3.025 4.328 2 3.218 2.511 p .000 .003 .000 .002 .013

Table 5. Summary of multiple regression analysis for family and coping variables predicting anxiety and depression in girls (nal step) Dependant variable Anxiety Predictors Father rejection Avoidance Expressing feelings Father rejection Family satisfaction Expressing feelings R2 .073 .218 .445 .194 F 11.303 19.957 60.109 36.290 df 1,144 2,143 2,150 1,151 b 0.269 0.301 0.268 0.333 2 0.422 0.440 t 3.362 3.812 3.394 4.546 2 5.762 6.024 p .000 .000 .000 .000 .000 .000

Depression

When the anxiety total score was used as the dependant variable in both the female and male sample, the predictive value of the father rejection was higher than the predictive value of the other four family variables, which remained non-signicant. Perceived father rejection signicantly predicted anxiety symptoms explaining 8.9% of criterion variance in males and 7.3% in females. When the depression total score was used as the dependant variable, the mother rejection and family satisfaction acted as signicant predictors in males, together explaining 28.8% of the variance of criterion variables in males. Father rejection and family satisfaction were signicant predictors in the female sample, together explaining 44.5% of the variance of criterion variables. For coping strategies, avoidance appeared a signicant predictor for anxiety, explaining 6.4% of criterion variance in males, together with the expressing feelings 21.8% of the variance of criterion variables in females. For depression as the dependant variable, the predictive value of expressing feelings was higher than the predictive value of the other six coping variables, explaining 4.2% in males and 19.4% of the variance of criterion variables in females.

Discussion
The primary objectives of this study were to determine which variables associated with depression and anxiety in children could be used to discriminate between depressed and anxious subjects and to determine the relative contribution of each of these variables to the prediction of anxiety and depression.

Gender differences
The rst step in the statistical analysis was to determine the possible gender differences in anxiety and depression scores, as it is well known that these differences play

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression

209

a signicant role in the emergence of psychopathology symptoms. The existence of major gender differences in rates of anxiety and depression in adulthood has been well documented, although during childhood these results were not so consistent. In regard to the results in this study, there are no sex differences in the anxiety and depression ratings (participants aged 1116). Girls had slightly higher scores on anxiety than boys, but this result was not statistically signicant. Results found in this study are similar with the results in some other investigations with the same or other anxiety and depression questionnaires. In previous studies with SKAD-62 and SDD in large community samples it was found that in prepubertal children, anxiety and depressive symptoms are just as -Prtoric & Macuka, 2003; Vulic -Prtoric & Soric , 2001). common in boys and girls (Vulic But at some point between age 13 and 14 girls start showing a marked increase in prevalence of anxiety and depression symptoms. In most studies this critical period was found to be between the ages of 13 and 15, or even later (Lewinson et al., 1993; Cicchetti & Toth, 1998; Harrington, 1993; Nolen-Hoeksema & Girgus, 1994). Nelson, Politano, Finch, Wendel, and Mayhall (1987) did not nd gender differences in depressive symptom intensity in a large sample of participants aged between 6 and 18. According to the other two variables (perception of family relationships and coping strategies) gender differences emerged.

Perception of family interactions

Results of the ANOVA indicated gender differences in the perception of family variables (Table 2). Girls perceive both their parents as being more accepting, which refers to the warmth, affection, care, concern, nurturance, and support towards their children. They also perceived their family climate as more pleasant. On the other hand, boys perceived more parental rejection, which is marked by the cold and unaffectionate, hostile and aggressive, indifferent and neglecting patterns of parental behaviour towards their children. The correlation coefcients show that all coefcients considering family variables show a higher correlation with depression (especially in the girls sample). Among all the family variables, father rejection had highest correlations with anxiety and depression in both boys and girls, and was the best and only predictor of their anxiety. Family satisfaction was found to be a signicant predictor for both anxiety and depression scores, but explaining much more variance (together with mother rejection) of boys depression than (together with father rejection) girls depression. Results in this study indicated that both anxiety and depression are strongly correlated with perceived parental rejection, but it appears that depressive children compared with anxious children perceive their families to be less pleasant to live with, and particularly, their parents to be less accepting, supporting, and approving and more rejecting and controlling. These ndings have been largely supported by numerous studies showing that families of children with depressive or anxiety disorders are characterized by less cohesion and more conict (Cummings et al., 2000). Moreover, these families are less open to expression of feelings, they are less democratic, and engage their members in fewer pleasant activities (Stark, Humphrey, Laurent, Livinston, & Christopher, 1993). Consequently, it contributes to the childs pervasive sense of disappointment and dissatisfaction with family life. Family relationships are in the focus of interpersonal theories of depression and anxiety (Gotlib & Hammen, 1996; Rudolph, Hammen, & Burge, 1994). Results in this study are in keeping with the ndings from some family studies showing that although disturbed family relationships are a strong predictor and risk factor for the development of anxiety symptoms, they are more often considered in the explanation of

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

210

-Prtoric and Ivana Macuka Anita Vulic

depressive processes (Kendall, Panichelli-Mindel, Sugarman, & Callahan, 1997; Kortlander et al., 1997; Siqueland, Kendall, & Steinberg, 1996; Warren et al., 1997). After multiple regression analysis was performed results indicated that perception of the parents rejective behaviour seems to have a particular impact on the appearance of both anxiety and depression, but generally accounted for more of the variance of the depressive symptoms. These results are consistent with some previous ndings showing that quality of family relationships play a crucial role in the aetiology and maintenance of depression in children (Birmaher et al., 1996). Chiarello and Orvaschel (1995) proposed two dominant descriptors of parent-depressive child communications: anger and rejection. In the Stark et al. (1993) study of 59 children with depressive and anxiety disorders it was found that children with a depressive disorder, relative to children with an anxiety disorder, reported a less positive view of self, world, and future. The interesting nding was that messages they received from their fathers about self, world, and future, were less positive. It appears that the role the father have in the specic aspects of offspring development and adjustment was neglected, but has been well documented in the recent studies. In the overview of the numerous investigations, Rohner and Veneziano (2001) show that father love explains as much or more of the variance in specic child and adult outcomes as does mother love. But in some psychological and behavioural problems (especially anxiety and depression) of adolescents, father love was the sole signicant predictor.

Coping strategies
According to the coping variables, signicant gender differences were found in four of seven strategies: in stress situations an overt expression of feelings and distraction were more common in boys while seeking support from family and friends were more common in girls. Male anxiety is mostly correlated with an avoidance coping strategy and it is the only signicant coping predictor of anxiety in boys. Female anxiety was signicantly correlated with expressing feelings, distraction, avoidance, and cognitive restructuring. For the depressive symptoms coping strategies show no signicant relations in the boys sample, but in the girls sample two signicant correlations appeared with expressing feelings and avoidance. Depression showed the highest correlations with expressing feelings (the only signicant coping predictor of depression). Other coping strategies show no signicant relations. It appears that depressive and anxious children usually prefer these dysfunctional, passive ways of dealing with stress situations that even elicit symptoms of different psychological problems (Compas et al., 1988; Fields & Prinz, 1997; Herman-Stahl, Stemmler, & Petersen, 1995). Avoidance is an emotion-focused coping response representing cognitive attempts to avoid thinking about the problem. It includes the use of fantasy, wishful thinking or imagining that the situation was better. Avoidance permits the regulation of negative mood states that arise from exposure to stress situation and does little to alter the source of the stress. It is a well-documented strategy for dealing with anxiety, and more than that, avoidant behaviours are an important part of the anxiety clinical picture (Spielberger & Rickman, 1990). Anxious children used more internal dialogue than depressed children in the attempt to control emotional tension and embarrassment (Lodge & Tripp, 1995). That internal dialogue can serve for the reduction of anxiety through self-encouragement, but also as the strategy of directing attention from stress events to internal processes.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression

211

On the other side, depression scores are signicantly correlated and better predicted with expressing feelings, and this strategy explains most of the variance for depression. Expressing feelings is a coping strategy that is described as the overt expression of emotions, venting of feelings either by an action or verbal expression. It is a solitary activity. In the SUO questionnaire, this strategy is conceptualized as a dysfunctional coping strategy that may lead to the short-term relief, but in the long-term tends to maintain rather than resolve a childs problem. Depressed children are more prone to be angry, aggressive, act out, vent their rage on others, and quarrel with and yell at others when they are under stress. But these behaviours usually elicit more feelings of guilt and social problems, all resulting in an increase in depressive feelings (Weiss & Catron, 1994). Children who regularly displace anger towards parents or their siblings inevitably damage their relationship with their family. It is worth mentioning that the explanation of comorbidity between aggression and depression in childhood is offered in the scope of specic relationships that the child is developing with his/her environment. Depressive children perceive their parents as more rejecting, cold, and indifferent, and it makes them frustrated and humiliated, and consequently more depressive (Weiss & Catron, 1994). Since they perceive their parents as more rejective, in the times of stress they do not ask for help and support, but rather express their feelings in an inappropriate manner using expressing feelings as a coping strategy. This coping strategy represents a more impulsive and angry style of interacting, and one that elicits a corresponding pattern of rejection in others that reinforces the depression. Results of the investigation presented in this study are in concordance with ndings that have important relevance for planning psychological intervention programmes for children and adolescents with anxiety and depression (Shochet & Dadds, 1997). Results suggest that depression can be distinguished from anxiety on the basis of ratings of family variables depressed children perceived their parents (especially fathers) as more rejecting but also on the basis of coping strategies depressed children used more dysfunctional coping strategies in dealing with stressful situations. In short, these ndings support the argument that anxiety and depression are distinct and that they are characterized by unique coping and family proles.

Acknowledgements
Results from this study were presented on the sixth Alpe-Adria Conference of Psychology, Italy, 2002. This research was supported by the Croatian Ministry of Science, Education and Sport grant no. 0070012 Psychosocial aspects in the childhood and adolescent psychopathology to Anita -Prtoric , Department of Psychology, University of Zadar, Croatia. Vulic

References
Achenbach, T. M., & McConaughy, S. H. (1997). Empirically based assessment of child and adolescent psychopathology. London: Sage. Ayers, T. S., Sandler, I. N., West, S. G., & Roosa, M. W. (1996). A dispositional and situational assessment of childrens coping: Testing alternative models of coping. Journal of Personality, 64(4), 924958. Bedford, A. (1997). On Clark-Watsons tripartite model of anxiety and depression. Psychological Reports, 80, 125126. Bernstein, G. A. (1991). Comorbidity and severity of anxiety and depressive disorders in a clinic sample. Journal of American Academy of Child and Adolescent Psychiatry, 30(1), 4350.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

212

-Prtoric and Ivana Macuka Anita Vulic

Birmaher, B., Ryan, N. D., Williamson, D. E., Brent, D. A., Kaufman, J., Dahl, R. E., Perel, J., & Nelson, B. (1996). Childhood and adolescent depression: A review of the past 10 years. Part I. Journal of American Academy of Child and Adolescent Psychiatry, 35(11), 14271439. Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111(2), 244255. Carr, A. (1999). The handbook of child and adolescent clinical psychology. London: Routledge. Chess, S., & Thomas, A. (1991). Temperament. In M. Lewis (Ed.), Child and adolescent psychiatry (pp. 145161). Baltimore, MD: Williams and Wilkins. Chiariello, M. A., & Orvaschel, H. (1995). Patterns of parent-child communication: Relationship to depression. Clinical Psychology Review, 15(5), 395407. Cicchetti, D., & Toth, S. L. (1998). The development of depression in children and adolescents. American Psychologist, 53(2), 221241. Clark, L. A. (1989). The anxiety and depressive disorders: Descriptive psychopathology and differential diagnosis. In P. C. Kendall & D. Watson (Eds.), Anxiety and depression: Distinctive and overlapping features (pp. 83130). New York: Academic Press. Compas, B. E., Ey, S., & Grant, K. E. (1993). Taxonomy, assessment and diagnosis of depression during adolescence. Psychological Bulletin, 114(2), 323344. Compas, B. E., Malcarne, V. L., & Fondacaro, K. M. (1988). Coping with stressful events in older children and young adolescents. Journal of Consulting and Clinical Psychology, 56(3), 405411. Cummings, E. M., Davies, P. T., & Campbell, S. B. (2000). Developmental psychopathology and family process. New York: Guilford Press. Fields, L., & Prinz, R. J. (1997). Coping and adjustment during childhood and adolescence. Clinical Psychology Review, 17(8), 937976. Finch, A. J., Lipovsky, J. A., & Casat, C. D. (1989). Anxiety and depression in children and adolescents: Negative affectivity or separate constructs? In P. C. Kendall & D. Watson (Eds.), Anxiety and depression: Distinctive and overlapping features (pp. 171219). New York: Academic Press. Goodyer, I. M., Herbert, J., Tamplin, A., Secher, S. M., & Pearson, J. (1997). Short-term outcome of major depression: II. Life events, family dysfunction and friendship difculties as predictors of persistent disorder. Journal of American Academy of Child and Adolescent Psychiatry, 36(4), 474480. Gotlib, I. H., & Hammen, C. L. (1996). Psychological aspects of depression. New York: Wiley. Harrington, R. (1993). Depressive disorder in childhood and adolescence. New York: Wiley. Herman-Stahl, M. A., Stemmler, M., & Petersen, A. C. (1995). Approach and avoidant coping: Implications for adolescent mental health. Journal of Youth and Adolescence, 24(6), 649665. Kendall, P. C., Panichelli-Mindel, S. M., Sugarman, A., & Callahan, S. A. (1997). Exposure to child anxiety: Theory, research and practice. Clinical Psychology: Science and Practice, 4(1), 2939. Kortlander, E., Kendall, P. C., & Panichelli-Mindel, S. M. (1997). Maternal expestations and attributions about coping in anxious children. Journal of Anxiety Disorders, 11(3), 297315. , G., & Kerestes , G. (1997). Perception of parental acceptancerejection and Kuterovac-Jagodic ivanja, 3031(45), 477491. tvena Istraz some personality variables in young adults. Drus Lewinsohn, P. M., Gotlib, I. H., Lewinsohn, M., Seeley, J. R., & Allen, N. B. (1998). Gender differences in anxiety disorders and anxiety symptoms in adolescents. Journal of Abnormal Psychology, 107(1), 109117. Lodge, J., & Tripp, G. (1995). Anxiety in children: Testing the role of cognition. New Zealand Journal of Psychology, 24(2), 2936. Muris, P., & Meesters, C. (2002). Attachment, behavioural inhibition and anxiety disorders symptoms in normal adolescents. Journal of Psychopathology and Behavioral Assessment, 24(2), 97106.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

Childhood anxiety and depression

213

Nelson, W. M., Politano, P. M., Finch, A. J., Wendel, N., & Mayhall, C. (1987). Childrens depression inventory: Normative data and utility with emotionally disturbed children. Journal of American Academy of Child and Adolescent Psychiatry, 26(1), 126129. Nolen-Hoeksema, S., & Girgus, J. S. (1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 115, 424443. Rohner, E. C., Rohner, R. P., & Roll, S. (1984). Perceived parental acceptancerejection and childrens reported behavioral disposition. Journal of Cross-Cultural Psychology, 11(2), 221225. Rohner, R. P. (1999). Acceptance and rejection. In D. Levinson, J. Ponzetti & P. Jorgensen (Eds.), Encyclopedia of human emotions (Vol. 1, pp. 614). New York: Macmillan Reference. Rohner, R. P., & Britner, P. A. (2002). Worldwide mental health correlates of parental acceptance rejection: Review of cross-cultural and intracultural evidence. Cross-Cultural Research, 36, 1647. Rohner, R. P., & Veneziano, R. A. (2001). The importance of father love: History and contemporary evidence. Review of General Psychology, 5, 382405. Rosenbaum, M., & Ronen, T. (1997). Parents and childrens appraisals of each others anxiety while facing a common threat. Journal of Clinical Child Psychology, 26(1), 4352. Rudolph, K. D., Hammen, C., & Burge, D. (1994). Interpersonal functioning and depressive symptoms in childhood: Addressing the issues of specicity and comorbidity. Journal of Abnormal Child Psychology, 22(3), 355371. Rutter, M. (2000). Psychosocial inuences: Critiques, ndings and research needs. Development and Psychopathology, 12, 375405. Rutter, M., & Sroufe, L. A. (2000). Developmental psychopathology: Concepts and challenges. Development and Psychopathology, 12, 265296. Sameroff, A. J. (2000). Developmental systems and psychopathology. Development and Psychopathology, 12(3), 297312. Shochet, I., & Dadds, M. (1997). Adolescent depression and the family: A paradox. Clinical Child Psychology and Psychiatry, 2(2), 307312. Siqueland, L., Kendall, P. C., & Steinberg, L. (1996). Anxiety in children: Perceived family environments and observed family interactions. Journal of Clinical Child Psychology, 25(2), 225237. Spielberger, C. D., & Rickman, R. L. (1990). Assessment of state and trait anxiety. In N. Sartorius, et al. (Eds.), Anxiety: Psychobiological and clinical perspectives (pp. 6983). New York: Hemisphere Publishing. Spirito, A., Francis, G., Overholser, J., & Frank, N. (1996). Coping, depression and adolescent suicide attempts. Journal of Clinical Child Psychology, 25(2), 147155. Sroufe, L. A., & Rutter, M. (1984). The domain of developmental psychopathology. Child Development, 55, 1729. Stark, K. D., Humphrey, L. L., Laurent, J., Livinston, R., & Christopher, J. (1993). Cognitive, behavioral and family factors in the differentiation of depressive and anxiety disorders during childhood. Journal of Consulting and Clinical Psychology, 61(5), 878886. Teerikangas, O. M., Aronen, E. T., Martin, R. P., & Huttunen, A. O. (1998). Effects of infant temperament and early intervention on the psychiatric symptoms of adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 37(10), 10701076. -Prtoric , A. (2000). Somatization tendencies and quality of family interactions in children and Vulic adolescents. Medica Jadertina, 30(12), 2131. -Prtoric , A. (2001). Strategies of coping with stress and depression in children and Vulic adolescents. Suvremena Psihologija, 4(12), 2539. -Prtoric , A. (2002a). Manual for the coping strategies inventory for children and Vulic adolescents SUO. Naklada Slap, Croatia: Jastrebarsko. -Prtoric , A. (2002b). The quality of family interaction and psychopathological symptoms in Vulic children and adolescents. Suvremena Psihologija, 5(1), 3151.

Copyright The British Psychological Society

Reproduction in any form (including the internet) is prohibited without prior permission from the Society

214

-Prtoric and Ivana Macuka Anita Vulic

-Prtoric , A. (2003). Manual for the depression scale for children and adolescents SDD. Vulic Naklada Slap, Croatia: Jastrebarsko. -Prtoric , A. (2004). Manual for the fear and anxiety scale for children and adolescents Vulic SKAD-62. Naklada Slap, Croatia: Jastrebarsko. -Prtoric , A., Macuka, I. (2003, October) Anxiety in childhood and adolescence: Gender and Vulic age differences. Paper presented at the 11th Croatian Psychology Conference, Zadar, Croatia. -Prtoric , A., & Macuka, I. (2004). Anxiety and depression: Phenomenology of comorbidity. Vulic Suvremena Psihologija, 7(1), 4564. -Prtoric , A., & Soric , I. (2001). Taxonomy of depression in childhood and adolescence: Sex Vulic and age differences and similarities. Medica Jadertina, 31(34), 115140. Warren, S. L., Huston, L., Egeland, B., & Sroufe, L. A. (1997). Child and adolescent anxiety disorders and early attachment. Journal of American Academy of Child and Adolescent Psychiatry, 36(5), 637644. Watson, D., Clark, L. A., Weber, K., Assenheimer, J. S., Strauss, M. E., & McCormick, R. A. (1995). Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult and patient samples. Journal of Abnormal Psychology, 104(1), 1525. Watson, D., & Kendall, P. C. (1989). Understanding anxiety and depression: Their relation to negative and positive affective states. In P. C. Kendall & D. Watson (Eds.), Anxiety and depression: Distinctive and overlapping features (pp. 326). New York: Academic Press. Weems, C. F., Hammond-Laurence, K., Silverman, W. K., & Ginsburg, G. S. (1998). Testing the utility of the anxiety sensitivity construct in children and adolescents referred for anxiety disorders. Journal of Clinical Child Psychology, 27(1), 6977. Weiss, B., & Catron, T. (1994). Specicity of the comorbidity of aggression and depression in children. Journal of Abnormal Child Psychology, 22(3), 389401. Zaenah, C. H., Boris, N. W., & Larrieu, J. A. (1997). Infant development and developmental risk: A review of the past 10 years. Journal of American Academy of Child and Adolescent Psychiatry, 36(2), 165178. Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M. J. (2000). Internalizing problems of childhood and adolescence: Prospects, pitfalls and progress in understanding the development of anxiety and depression. Development and Psychopathology, 12, 443466. Received 12 June 2003; revised version received 10 March 2005