Developmental Relations between Depression and Externalizing Behavior Among Maltreated Adolescents

Background and Purpose: Maltreated children commonly exhibit depression and externalizing behavior problems. Understanding the developmental course and relationship between these domains could help focus our intervention efforts. One explanation for the positive association between depression and externalizing behavior is that previous difficulties of adaptation cascade and cause others forms of distress. Evidence exists suggesting that earlier externalizing behavior is related both to later externalizing behavior but also to subsequent depression. Untangling the developmental relations between these forms of distress remains an important research goal. This study evaluated the manner in which depression and externalizing problems in maltreated adolescents predicted future depression and externalizing problems over a period of three years.

Methods: An ethnically diverse urban sample of 303 adolescents with a documented history of maltreatment was recruited. The mean age of the sample was 10.9 years at the first measurement point. Adolescents completed the Children's Depression Inventory and the Youth Self-Report at three time points separated by 1.5 years. Latent variable cross-lagged panel analyses were conducted with demographic covariates to examine the longitudinal stability of depression and externalizing behavior and the relations between the constructs. Multiple-group structural equation models were fit to determine if the patterns of risk are similar for maltreated boys and maltreated girls.

Results: Preliminary analyses suggest that the meaning of the constructs was stable over time and similar for boys and girls. Models fit the data well. Consistent with previous evidence, depression evidenced greater stability amongst boys than girls. Externalizing behavior showed moderate stability and was consistent for both genders. Among maltreated boys, there were no cross-lagged effects for any time point, suggesting that depression and externalizing behavior do not exert a causal impact on one another. Among maltreated females, earlier externalizing behavior was an important predictor of subsequent depression (standardized beta = .44; unstandardized regression weight = .89.; p = .001), which in turn predicted an increase in subsequent externalizing behavior (standardized beta = 33.; unstandardized regression weight = .194.; p = .01), after controlling for autoregressive effects and relevant covariates.

Conclusions and Implications: Results suggest that during this developmental phase, maltreated boys and girls exhibit moderate and similar stability in externalizing behavior. Boys evidence high stability in depression while girls' depression is powerfully impacted by other factors. Notably, among maltreated girls, early externalizing behavior appears to have a cascade effect: subsequent escalations of depression in turn lead to exacerbation of externalizing behavior. This finding illustrates the important prognostic value of early externalizing behavior among maltreated girls, partially explains the co-occurrence of depression and externalizing behavior and highlights a strategic target for intervention