Beck´s prominent cognitive vulnerability - stress model posits that dysfunctional attitudes such as “My value as a person depends greatly on what others think of me” or “If I fail at work, then I am a failure as a person” increase risk for depression following the experience of stressful life events 12. Empirical support for Beck´s model has been obtained in child and adolescent samples 34. However, little is known regarding the specificity of the observed effects of dysfunctional attitudes to depression. Establishing the predictive specificity of a putative vulnerability factor is yet crucial for the validation of etiological models, particularly when investigating disorders with very high rates of comorbidity, such as depression 56. While some studies have examined effects of dysfunctional attitudes with regard to anxiety disorders 67, other symptom domains which are also highly comorbid with depression have received little attention. The current study seeks to address this shortcoming by examining associations between dysfunctional attitudes, depressive symptoms, eating disorders and externalizing problems.

Shared risk factors for depression and eating disorders have been reported 8. Preliminary evidence from cross-sectional studies using adult samples suggest that eating disorders may also be associated with elevated levels of dysfunctional attitudes 910, but it remains unclear whether the obtained effects may be attributable to comorbid depressive symptoms 11. Moreover, evidence from younger samples and from longitudinal studies is still missing.

When examining the specificity of a vulnerability factor, it is also important to look at forms of psychopathology which are supposedly unrelated to the vulnerability in question 12. Aggressive behavior, for example, represents such a symptom domain. However, the only findings regarding this domain available to date are those by Hankin and colleagues 7, who did not find associations between dysfunctional attitudes and externalizing symptoms.

At present, evidence for Beck´s vulnerability – stress model is somewhat inconclusive in children and adolescents, which might in part be due to certain methodological aspects. First, some studies implied nonlinear effects of dysfunctional attitudes on depression indicating weak associations in the lower range, but considerably stronger effects at higher levels of dysfunctional attitudes 313. Second, as Dykman and Johll 14 pointed out, effects of dysfunctional attitudes should be investigated in initially asymptomatic samples as Beck´s model was conceptualized to explain how initially asymptomatic but vulnerable individuals become depressed after experiencing stress.

The current study aims to enhance evidence on the specificity of Beck´s vulnerability – stress model to depression by investigating longitudinal effects of dysfunctional attitudes on depressive, eating disorder and aggressive symptomatology during late childhood and adolescence, a particularly crucial period for the initial development of mental disorders. To address potential sources of inconsistent findings in past research, linear and nonlinear methods will be employed using an initially asymptomatic sample, and co-occurring symptoms will be included as covariates in all statistical analyses. In line with existing research, we hypothesize dysfunctional attitudes to show vulnerability effects on future depressive and eating disorder symptoms, but not on aggressive behavior.

Hierarchical linear and nonlinear regression analysis was used to test prospective and unique relations of dysfunctional attitudes, stressful life events and different symptom domains. Separate regression models were run for the prediction of depressive, eating disorder, and aggressive symptoms, respectively. To ensure that potential effects of dysfunctional attitudes would not be an artifact of comorbidity between the investigated symptom domains, comorbid symptoms were controlled for in all analyses.

Linear effects were tested in Steps 1 to 3 of the regression models, with T1 symptoms, T1 comorbid symptoms, age and gender entered in Step 1, dysfunctional attitudes and stressful life events entered in Step 2, and the interaction of dysfunctional attitudes and stressful life events (the diathesis - stress interaction) in Step 3. Nonlinear effects were tested by using squared and cubic values of participants’ dysfunctional attitudes scores. In Steps 4 and 5, quadratic and cubic effects of dysfunctional attitudes were entered, and interactions between squared and cubic values of dysfunctional attitudes were included in Steps 6 and 7.

To obtain initially asymptomatic samples, participants scoring above the cutoff of 14 (85^th percentile in the current sample) were excluded when predicting T2 depressive symptoms 31. Because no validated cutoffs have been reported for our eating disorder and aggressive symptom measures, the 85^th percentile of the respective distribution was set as cutoff so that participants exceeding this criterion were excluded from analyses predicting aggressive behavior or eating disorder symptoms, respectively.

The aim of the current study was to extend knowledge on the specificity of Beck´s vulnerability-stress model of depression by exploring effects of dysfunctional attitudes on the development of depressive, aggressive and eating disorder symptoms in initially asymptomatic children and adolescents. Results show diverse, linear and nonlinear associations between dysfunctional attitudes and all the investigated symptom domains and thus indicate that dysfunctional attitudes in children and adolescents are not uniquely related to depressive symptomatology.

In the model predicting depressive symptoms, dysfunctional attitudes and their interaction with stressful life events were only marginally related to future depressive symptoms when only looking at linear effects. However, tests of nonlinear effects revealed a significant cubic effect of dysfunctional attitudes suggesting a strong impact at higher levels but almost no effect in the lower range of dysfunctional attitudes. This finding is consistent with a threshold view of dysfunctional attitudes, which was also suggested by the results of Lewinsohn and colleagues 3

Eating disorder symptoms in general were marginally predicted by the interaction of dysfunctional attitudes and life events. Analyses of the chEDE-Q subscales revealed that this effect was mainly accounted for by weight concerns, which were significantly predicted by the diathesis-stress interaction, and by eating concerns, which were marginally significantly related to the diathesis-stress interaction. Inspection of the interaction effect on weight concerns showed that dysfunctional attitudes had little effect under low stress conditions but a strong effect when participants experienced many life events.

These results suggest that dysfunctional attitudes in children and adolescents may also lead to increased preoccupation with weight and eating behavior. This seems plausible as perfectionistic standards for self-evaluation conferred by dysfunctional attitudes may also be applied to one´s body and food intake. Moreover, results are in line with previous findings suggesting an association between depression-related cognitions and eating disorder symptomatology 891011. Among other factors, these manifold effects of dysfunctional attitudes may thus represent a possible explanation for the co-occurrence of depression and eating disorders.

With regard to aggressive behavior, the linear analyses did not show any prospective effects of dysfunctional attitudes. So far, our results add to the existing findings suggesting no relationship between externalizing problems and depression-related cognitions 3334. However, a significant nonlinear effect of dysfunctional attitudes, moderated by life events, was revealed, which essentially exhibited an inverted U-shape. Both under low and high stress conditions, children and adolescents with moderate dysfunctional attitudes showed the greatest increase in aggressive behavior while participants with very low and very high dysfunctional attitudes exhibited the smallest increase or even a decrease in aggressive behavior.

To interpret this finding, correlations of single dysfunctional attitudes items with aggressive behavior were calculated 35. Inspection of the correlational pattern revealed some items to be positively associated with change in aggressive behavior while others showed a negative relationship. The dysfunctional attitude exhibiting the strongest positive correlation with aggressive behavior was “In order to be happy, it is important often to be the center of attention”, an attitude suggesting a certain amount of striving for attention and admiration by others. The strongest negative correlation, in turn, was found for the item “I have to be really good at one thing at least in order to be worth something”, which, in contrast, seems to represent a tendency towards critical self-evaluation. It could be hypothesized that participants with an overall moderate score on the dysfunctional attitudes scale are (partly) characterized by the ambition to distinguish themselves and to stand out from peers, which might increase readiness for aggressive acts. In individuals exhibiting overall high dysfunctional attitudes, in contrast, this need for attention seems to be accompanied by a high degree of self-criticism, which may cause them to refrain from behaving aggressively. As indicated by the moderating effect of life events, the difference between individuals showing overall moderate dysfunctional attitudes and those showing low or high dysfunctional attitudes is exacerbated by the experience of stressful life events.

Taken together, our results point to a certain degree of non-specificity of Beck´s vulnerability-stress model. However, types of associations between dysfunctional attitudes and outcomes varied considerably suggesting some degree of specificity in the exact shape of relationships. For example, both depressive symptoms and aggressive behavior were related to depressive symptoms, but while participants with moderate levels of dysfunctional attitudes showed heightened aggressive behavior, participants with high levels of dysfunctional attitudes exhibited heightened depressive symptoms but decreased aggressive behavior. In fact, relations of dysfunctional attitudes with aggression versus depression seem to be inverse to each other once a critical level is exceeded.

Life events were similarly predictive of increases in all investigated symptom domains. This confirms extant evidence suggesting that stressful life events should be understood as an unspecific risk factor for the development of psychopathology (e.g). 6, 24, 36. Interestingly, a life events*age interaction indicated that younger participants experienced higher depressive symptoms following life events than older participants. This is in line with theories suggesting that in younger children, environmental circumstances such as life events may be particularly strongly linked to depression 3738.

Our findings highlight the significance of transdiagnostic models of psychopathology as a way of conceptualizing the high co-occurrence of mental disorders. Recently, structural investigations of psychopathology yielded support for a bifactor model with the two higher-order factors Internalizing and Externalizing 39, which share a common liability, represented by a General Psychopathology dimension (the “p-factor”) 40. As dysfunctional attitudes and life events showed relations to all investigated symptom domains, the current findings might reflect a general association between these variables and the p-factor. Clearly, future research would benefit from linking investigations of specificity of vulnerability factors to structural models of psychopathology. For example, the inverted-U-shape association between dysfunctional attitudes and aggressive behavior found in the current study might be reflective of a positive association between dysfunctional attitudes and the p-factor, but of a negative one with the externalizing factor once p is controlled for.

Strengths of the current study include the use of a large sample, the examination of a variety of symptom domains, and the longitudinal design which, for example, allowed the exploration of longitudinal effects of dysfunctional attitudes on the development of eating disorder symptoms in youth for the first time. This is also the first study to include nonlinear effects in analyses of specificity of dysfunctional attitudes. By using an initially asymptomatic sample, effects of dysfunctional attitudes during the initial development of symptomatology could be assessed so that dysfunctional attitudes truly represented a predisposing factor (and not a symptom or consequence of psychopathology).

At the same time, some limitations should be considered. First, sample selection procedures such as eliminating initially symptomatic participants are controversial, mainly because this might also deplete the sub-sample of participants with high scores on the vulnerability measure and result in an attenuation of statistical associations due to a restriction in range 1441. However, the possibility that differential effects are active in high ranges of vulnerability was directly addressed by our nonlinear analyses.

Second, depressive, aggressive and eating psychopathology were assessed on the level of symptoms instead of clinical diagnoses. The clinical relevance of the obtained results therefore remains unclear. A replication of the present findings by future studies assessing clinical depression, conduct disorder and eating disorders is desirable.

Third, the total number of experienced life events was used as the stress variable in this study without taking into account the severity of each life event. While this is in line with a number of previous studies (e.g.) 3, 4, 12, 30), future studies using more extensive measurement techniques allowing a weighing of events according to their severity would be desirable.

Findings of the present study demonstrate that dysfunctional attitudes in initially asymptomatic children and adolescents prospectively relate to a variety of symptom domains, such as depressive symptoms, weight concerns, or aggressive behavior. However, dysfunctional attitudes showed associations of varying shapes (linear, cubic, inverted U-shape) with different symptom measures indicating that individuals exhibiting different levels of dysfunctional attitudes may be particularly at risk for different symptom domains: For example, children and adolescents showing very high levels of dysfunctional attitudes seem to be primarily at risk of developing depressive symptoms, while children and adolescents with moderate levels of dysfunctional attitudes are more likely to develop externalizing problems following the experience of stress. Considering this diversity in effects of dysfunctional attitudes, including nonlinear effects in future investigations of dysfunctional attitudes as a vulnerability factor seems advisable. Moreover, a replication of results by future studies assessing clinical diagnoses and using elaborate stressful life events measures is desirable.

At present, our findings suggest that dysfunctional attitudes in children and adolescents are not uniquely related to the development of depressive symptomatology and thus emphasize the necessity of scrutinizing the specificity of putatively disorder-specific etiological models. If replicated, the current results can be regarded as an important hint that prevention programs aiming at a modification of dysfunctional attitudes might be useful in reducing vulnerability to a variety of outcomes in children and adolescents.