SRP 2003 Poster

1
Targeted Rejection Predicts Hastened Onset of
Major Depression
George M. Slavich1, Tiffany Thorton1, Leandro D.
Torres1, Scott M. Monroe1, Ian H.
Gotlib2 1Dept. of Psychology, Univ. of Oregon,
Eugene, OR 2Dept. of Psychology, Stanford Univ.,
Stanford, CA
CONCLUSIONS
INTRODUCTION
MEASURES
-- As predicted, individuals who experienced a
severe targeted rejection (TR) event prior to
depression onset became depressed more quickly
than did individuals who experienced a severe
non-targeted rejection event prior to depression
onset. -- This effect of targeted rejection on
time-to-onset did not differ as a function of the
life domain (interpersonal vs. achievement) in
which the severe TR stressor occurred. -- In
addition, those who experienced a severe TR event
and those who experienced a severe non-TR event
prior to depression onset did not differ on
measures of global functioning or depression
severity at intake, as assessed by the SCID and
the BDI-II, respectfully. -- Together, these
findings pinpoint targeted rejection as a marker
of etiologic heterogeneity in depression. They
simultaneously suggest that targeted rejection is
not a marker of class heterogeneity, at least
insofar as global functioning and depression
severity are concerned. -- This work
demonstrates the benefits of progressively
refining our characterization of life stress.
However, additional work is needed to identify
other types of stress. Such efforts would help
elucidate the complex link between life stress
and clinical features of depression7.
-- The association between severe life stress and
depression onset has been well documented12345.
However, very little is known about the
differential effects of stressors within this
general class of stress. Many unanswered
questions thus remain, including What dimensions
of severe stress are useful for predicting timing
of depression onset? -- To address this
question, we examined the association between
timing of depression onset and a specific type of
stress termed targeted rejection (TR), which
involves the active, exclusive, and intentional
social rejection of a targeted individual (e.g.,
being singled out and fired being broken up with
by a significant other). -- Targeted rejection
is characterized by two core features (1)
Targeted The subject is the primary target of
the event.(2) Rejection The most salient
feature of the event is the rejection of the
targeted individual by another person or group of
persons. -- Three additional characteristics of
targeted rejection include (1) Intent to Reject
The subject is intentionally rejected. Events
resulting from inaction or negligence are not
considered TR.(2) Isolated Impact Although
other people may be affected by an event, the
crux of the rejection is experienced only by the
subject.(3) Social Demotion TR involves social
demotion that results from the severing of a
relational tie. Thwarted social promotion is not
TR. -- Given the noxious nature of severe TR
events, we predicted severe TR events to be
associated with faster depression onset than
severe non-TR events. We also predicted that this
effect would not differ as a function of stressor
domain (interpersonal vs. achievement).
Life Stress Assessment Life stress was assessed
from one year prior to onset using the Life
Events and Difficulties Schedule (LEDS)6 -- A
24-page semi-structured interview is used to
inquire about sources of stress explicit rules
and operational criteria are provided for
assessing and defining life stress and a
520-page manual is used for comparing events with
anchors and for rating life stress Targeted
Rejection Events rated as severe were
subsequently reviewed for the purpose of
classifying them as Targeted Rejection (TR) or
Non-Targeted Rejection (Non-TR). Descriptions of
each event were re-read while raters asked
clarifying questions.
ASSESSMENT TIMELINE
Depression Onset
1 yr. Pre-Onset
Assessment
LEDSLife stress from 1 yr. pre-onset up to
interview
SCIDCurrent depressivesymptomatology
RESULTS
REFERENCES
Preliminary Analyses Major demographic variables,
including age, sex, education, income, and
ethnicity, were unrelated to time-to-onset (pgt.4
for all tests).
1 Hammen, C. (2005). Stress and depression.
Annual Review of Clinical Psychology, 1,
293-319.2 Kessler, R. C. (1997). The effects of
stressful life events on depression. Annual
Review of Psychology, 48, 191- 214.3 Mazure,
C. M. (1998). Life stressors as risk factors in
depression. Clinical Psychology Science and
Practice, 5, 291-313.4 Monroe, S. M.,
Hadjiyannakis, K. (2002). The social environment
and depression. In I. H. Gotlib and C. L.
Hammen (Eds.), Handbook of depression (pp.
314-340). New York Guilford Press.5 Paykel, E.
S. (2003). Life events and affective disorders.
Acta Psychiatrica Scandinavica, 108, 61-66.6
Brown, G. W., Harris, T. O. (1978). Social
origins of depression A study of psychiatric
disorder in women. New York The Free Press.7
Brown, G. W., Harris, T. O., Hepworth, C.
(1995). Loss, humiliation and entrapment among
women developing depression A patient and
non-patient comparison. Psychological Medicine,
25, 7-21.
Targeted Rejection and Time to Depression Onset
TR EventsM 32.3 days (SD 35.8)
PARTICIPANTS
56 SevereEvents
15 TR Events

• -- 100 adults diagnosed with MDD, 75 females and
  25 males, with a mean age of 33.87 years (range
  18-58 years)
• -- Diagnosis based on Diagnostic and Statistical
  Manual (DSM-IV), using Structured Clinical
  Interview for DSM-IV (SCID-I)
• -- Inclusion Criteria
• -- No reported history of brain injury
• -- No reported lifetime history of primary
  psychotic ideations
• -- No reported substance abuse within the past
  six months
• -- No behavioral indications of possible impaired
  mental status
• -- Relatively acute onset of major depressive
  disorder

t(11.84) 2.35, p .037
11 Non-TR Events
Non-TR EventsM 107.5 days (SD 101.4)
ACKNOWLEDGEMENTS
Time to Depression Onset by Stressor
Domain Interpersonal achievement events did not
differ on time-to-onset (pgt.6).
We thank Lauren Anas, Erica Aronson, Kathryn
Dingman, and Danielle Keenan-Miller for helping
to conduct the life stress interviews, and Faith
Brozovich and Lisa Talbot for assisting with data
management.
Targeted Rejection, Global Functioning, and
Depression Severity GAF score, BDI-II score, and
SCID severity rating were unrelated to the
presence of a severe TR event prior to onset
(pgt.35 for all tests).
SUPPORT
This research was supported by National Institute
of Mental Health (NIMH) Grant MH-60802 awarded to
Scott M. Monroe and by NIMH Grant MH-59259
awarded to Ian H. Gotlib.