Interactive models of depression vulnerability: The role of childhood trauma, dysfunctional attitudes, and coping

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Abstract
Objectives This prospective study investigated whether within‐individual relations between depression vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptom trajectories varied as a function of the number of prior major depressive episodes (MDEs) experienced in their lifetime. Design Participants were 68 young adults who varied with regard to their history of depression; 32 were remitted depressed and 36 were never depressed. Methods Depressive symptoms and disorders were assessed using semi‐structured psychiatric interviews conducted twice over a 6‐month period; interviews yielded weekly ratings of depressive symptoms during the follow‐up interval. Childhood trauma, dysfunctional attitudes and coping were assessed with self‐report measures. Data analyses were conducted using time‐lagged multilevel models. Results Individuals with more previous MDEs who reported greater childhood trauma exposure, more dysfunctional attitudes, or greater use of maladaptive coping strategies experienced more rapid increases in depressive symptoms during the follow‐up period. A significant interaction of coping, number of previous MDEs, and time was found indicating that among individuals with less adaptive coping (i.e., lower primary or lower secondary control coping scores), depressive symptoms rating (DSR) increased significantly in relation to number of prior depressive episodes; no change in DSR was observed for never‐depressed individuals. Among individuals with higher primary control coping scores, significant increases in DSR scores were observed for individuals with ≥3 prior MDEs only. Conclusions Findings highlight the need for treatment and prevention programmes that target stress reactivity and coping strategies early in the course of depression. Practitioner points Findings highlight the need to conduct multi‐dimensional assessments of depression vulnerability that examine the interplay among risk factors over time. Relations between vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptoms were stronger for individuals with more prior major depressive episodes (MDEs). Interventions for recurrent depression should focus on secondary control coping strategies that emphasize accommodation to stressful life events. Future studies should assess high‐risk individuals before their first MDE to determine whether vulnerability factors linked with recurrence are pre‐existing and relatively stable, or if they reflect ‘scars’ from MDEs.