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Risk factors for depression in early adolescence.

Depression is considered by some to be one of the most serious forms of childhood psychopathology due to the prevalence, chronicity, co-morbidity, and pervasive consequences associated with this disorder (Cicchetti & Toth, 1998). In order to design effective prevention initiatives that aim to "inoculate" children against the negative impact of depressive disorders, an understanding of the salient childhood risk factors becomes a crucial starting point.

Current Knowledge of Risk Factors

A review of the literature published in the recent past reveals that there is currently a large group of risk factors implicated in the development of depression. Specifically, parental depression (Diego, Sanders, & Field, 2001; Hammen, Shih, Altman, & Brennan, 2003), negative life events/life stress (Ge, Lorenz, Conger, Elder, & Simons, 1994; Rudolph et al., 2000), problematic peer relationships (Garland & Fitzgerald, 1998; Rudolph, Hammen, & Burge, 1994), negative parental rearing behavior (Lau & Kwok, 2000; Liu, 2003), low self-esteem (Marcotte, Fortin, Potvin, & Papillon, 2002; Muris, Schmidt, Lambrichs, & Meesters, 2001), negative body-image (Kovacs, Obrosky, & Sherrill, 2003; Siegel, 2002), pubertal status (Ge et al., 2003), low SES (Frigeroni, Pesenti, Molteni, & Battaglia, 2001), conduct problems (Merikangas & Avenevoli, 2002), and attention regulation difficulties (Bird, Gould, & Staghezza, 1993), are among the variables most consistently associated with depression across studies.

Researchers have typically examined a few risk variables (for example, 3 to 4) at a single point in time in their studies of risk factors for depression. Hence, the current body of knowledge is rather fragmented, with no empirical evidence about what the most significant risk factors of depression would be among a large common group of predictors. Furthermore, given the impracticality of designing prevention efforts aimed at a large pool of risk factors, it seems that prevention programs would be best informed by the identification of those risk factors that most strongly predict depression. The inclusion of many different risk factors into one analysis is viewed by many working in this domain to be the next logical step in understanding depression etiology (see Bennett, Bendersky, & Lewis, 2002; Kessler, Avenevoli, & Merikangas, 2001; Muris et al., 2001).

Additionally, researchers have not typically examined the impact of these common risk factors by gender in their studies. The female predominance in depression rates after childhood is considered one of the most robust findings to date in the field of epidemiological research (Wade, Cairney, & Pevalin, 2002). As such, many researchers in the field have identified a need for more studies that investigate gender-specific pathways to depression (Cicchetti & Toth, 1998; Connell & Goodman, 2002; Jacobson & Rowe, 1999).

Although there is considerable ambiguity regarding the impact of risk factors by gender, some patterns can be noted from previous research. For example, some researchers have found that problematic interpersonal relationships are more closely tied to depression in girls than in boys (Hankin & Abrahmson, 2001; Rudolph et al., 2000). In regard to parental rearing behavior, some researchers have found that females demonstrate more depressive symptoms in the face of problematic parental behavior than do males (Ge, Lorenz, Conger, Elder, & Simons, 1994; Liu, 2003). Pubertal status, self-esteem, and body image have also been related to depression in girls more strongly than in boys, although these findings have not been consistent (Adams, Katz, Beauchamp, Cohen, & Zavis, 1993; McCauley Ohannessian, Lerner, Lerner, & von Eye, 1999).

Potential Mediators of Risk

As the knowledge of risk factors for childhood depression grows, so does the need to move into an examination of mediational pathways of risk (Garber & Flynn, 2001). However, to date, the research evidence with respect to the mediating variables of childhood depression is sparse and inconsistent. For example, prior research findings indicate that the relationship between parental rearing behavior and depression may be partially mediated by self-esteem (Lau & Kwok, 2000; Muris et al., 2001). As well, pubertal status may exert its strongest influence on depression not directly, but rather through its negative effects on self-esteem and body image (Franko & Striegel-Moore, 2002; Marcotte, Fortin, Potvin, & Papillon, 2002). Finally, some researchers have asserted that SES is likely to have its most consistent impact on depression in children through parenting practices, which have been found to be more problematic among parents of lower socioeconomic status (Kim & Ge, 2000; McLoyd, 1998).

Purpose and Focus of the Current Study

This study is designed to address the issues outlined above. The purpose of the study is to identify, for a group of early adolescents, the most significant risk factors for depression among a large group of common predictors, with consideration of gender differences, and possible mediational variables. Specifically, the questions to be addressed and hypotheses to be tested in this study are:

Question 1: What risk factors are the best predictors of depression? The following variables were tested for their unique contribution to depression scores: perceived quality of peer relationships, perceived parental rearing behavior (both parental nurturance and parental rejection), self-esteem, body image, pubertal status, SES, conduct problems, and attention regulation problems. It was hypothesized that when all nine risk factors are examined as a group, interpersonal relationships, perceived parental rearing behavior (both parental nurturance and parental rejection), and self-esteem would significantly predict depression scores, given that these three variables appear to have had the most consistent and well-demonstrated associations with depression in children and adolescents across recent studies reviewed by the authors.

Question 2: Do the risk factors have differential importance for males and females? The nine variables listed above were tested as risk factors for depression in both female and male subsamples in order to investigate potential differences in their salience for each gender. Given that body image and interpersonal relationships appear to have the clearest pattern of gender differences across studies, with females experiencing more depression than males when difficulties in these domains arise (McCauley Ohannessian, Lerner, Lerner, & van Eye, 1999; Seiffge-Krende & Stemmler, 2002; Hankin & Abramson, 2001; Rudolph et al., 2000), it is hypothesized that these variables would be included in the final model for females, but not for males.

Question 3: Does self-esteem mediate the relationship between parental rearing behavior and depression, in both males and females? Self-esteem will be investigated as a mediator of the relationship between parental rearing behavior and depression. Because there is evidence to suggest that the effects of parental rearing behavior may differ by gender (see Sheeber, Hops, & Davis, 2001), boys and girls will be investigated as separate groups. It is hypothesized that self-esteem will be a mediator of the relationship between parental rearing behavior and depression, for both genders.

Question 4: Is the relationship between pubertal status and depression mediated by self-esteem and body-image in both males and females? Self-esteem and body image were examined as potential mediators of the relationship between pubertal status and depression. In light of the mixed evidence regarding gender differences in the effects of pubertal status, self-esteem, and body image on depression (Benjet & Hernandez-Guzman, 2002; Marcotte et al., 2002), boys and girls will be investigated as separate groups. It is hypothesized that both self-esteem and body image will mediate the relationships between pubertal status and depression for both boys and girls.

Question 5: Does parental rearing behavior mediate the relationship between SES and depression in both males and females? As noted previously, some have hypothesized that the effects of SES on depression are mediated by parental rearing behavior. However, empirical data to support this hypothesis is lacking. Given the previous general suggestion that risk factors may have differential gender effects, separate investigations will be conducted for boys and girls. It is hypothesized that parental rearing behavior will mediate the relationship between SES and depression in both males and females.

METHOD

Participants

A sample of 2,014 boys and girls, aged 12 and 13 years, was selected for inclusion in this study from the National Longitudinal Survey of Children and Youth (NLSCY), Cycle 2 (Statistics Canada, 1999). The NLSCY is a longitudinal project designed to follow a randomly selected representative sample of Canadian children into adulthood, measuring at two-year intervals various factors related to childhood health and well-being. Data were collected from the households either face-to-face, or over the phone using Computer Assisted Interviewing.

The NLSCY sample was allocated so that each of the 10 Canadian provinces contributed the appropriate proportion of participants (Atlantic provinces, 23.9%; Quebec, 19.1%; Ontario, 25.4%; Prairie provinces, 23.9%; British Columbia, 7.6%). The families included in the survey came from varied socioeconomic strata, ranging from unemployed parents with less than a high school education and less than $15,000 yearly income (7.9%) to professional parents with university education and more than $80,000 yearly income (13.4%). Dual-parent families comprised 83.6% of the sample.

Measures

For the NLSCY, children aged 12 to 13 years were asked to respond to a series of self-report questionnaires, abbreviated from well-known and psychometrically sound instruments in order to meet the requirements of brevity necessary for large-scale data collection. The data included in the current study were obtained using these self-report measures.

Depressive symptoms. The Centre for Epidemiological Studies--Depression Scale (CES-D) was designed to measure current levels of depressive symptoms (Radloff, 1977). The CES-D has been shown to have adequate internal consistency, test-retest reliability, and concurrent as well as discriminant validity in both adult and adolescent populations (Radloff, 1977; Roberts, Andrews, Lewinsohn, & Hops, 1990; Skorikov & Vandervoort, 2003).

The CES-D was shortened for use in the NLSCY from the original 20 items to 12 items. Prior studies have reported that shortened versions of the CES-D retain comparable reliability and validity to the original (Andresen, Carter, Malmgren, & Patrick, 1994; Prescott et al., 1998). Higher scores reflect higher levels of depressive symptoms. For the sample used in this study, the internal consistency (Cronbach's alpha) of this scale was found to be .95.

Self-esteem. The items used to measure self-esteem were taken from the General Self scale of the Self-Description Questionnaire (SDQ), created by Marsh, Smith, and Barnes (1983). The SDQ was designed to measure eight different dimensions of self-perception (Marsh et al., 1983). The internal consistency, and convergent and divergent validity of the SDQ has been reported to be adequate across studies (Marsh et al., 1983; Marsh, 1990; Plucker, Taylor, Callahan, & Tomchin, 1997).

The General Self scale of the SDQ was designed to measure how effective and capable adolescents perceive themselves to be, their level of self-confidence and self-respect, and their level of pride in and satisfaction with themselves as individuals (Marsh et al., 1983). For use in the NLSCY, the General Self scale was shortened to include 4 of the original 8 items. This abbreviation is supported by the finding that the General Self scale contains redundancy, and could be shortened to as few as two questions (Flannery, Reise, & Widaman, 1995). Higher scores reflect higher levels of self-esteem. For the sample studied here, the internal consistency (Cronbach's alpha) of this scale was found to be .88.

Body image. The Physical Appearance scale of the SDQ (Marsh et al., 1983; see prior discussion of the psychometric properties of the SDQ) was designed to measure youths' perception of their own physical appeal, how their physical appearance compares with that of their peers, and the way in which their physical appearance is viewed by others (Marsh, 1990). This scale was reduced from the original 8 items to a total of 4 items for use in the NLSCY. Marsh (1994) investigated the use of abbreviated versions of several scales from the SDQ, and reported that the utility of these scales was not significantly reduced. Higher scores reflect a more positive body-image. For the sample included in the current study, the internal consistency (Cronbach's alpha) of the Physical Appearance Scale was found to be .86.

Peer relations. The Peer Relations scale of the SDQ (Marsh et al., 1983; see prior discussion of psychometric properties) was designed to measure adolescents' perceptions of how easily they make friends, how much others want them as friends, and their popularity (Marsh, 1990). This scale was utilized in an abbreviated version, reduced from the original 8 items to 4 items (see Marsh, 1994 for results that support this abbreviation). Higher scores reflect higher quality peer relationships. For the sample included in this study, the internal consistency (Cronbach's alpha) was calculated at .95.

Parental rearing behavior. Two aspects of parental rearing behavior were examined in this study, specifically parental rejection and parental nurturance. The Parental Nurturance (shortened from 14 to 6 items) and Parental Rejection-Orientated Behavior (shortened from 10 to 7 items) scales from the Parenting Questionnaire were abbreviated for use in NLSCY. The Parenting Questionnaire was originally created by Lempers, Clark-Lempers, and Simons in 1989 (Statistics Canada, 1999) to measure adolescents' perceptions of their parents' behavior toward them. Lempers et al. (1989) reported that the reliability and construct validity of this measure were adequate to strong. Lower scores indicate a low degree of the parenting characteristic measured (Statistics Canada, 1999). Factor analysis revealed that these two shortened scales retained their original structure (Statistics Canada, 1999). For the sample included in this study, the internal consistency (Cronbach's alpha) of both the Parental Nurturance and Parental Rejection scales was .90.

Socioeconomic status. The SES of each participant was derived by Statistics Canada from five sources: the level of education attained by the primary caregiver of each child, the level of education attained by the spouse or partner, the prestige of the primary caregiver's occupation, the prestige of the spouse's or partner's occupation, and household income. The final value used to represent each household's SES was created by first standardizing each variable, and then obtaining a mean value (Statistics Canada, 1999).

Conduct problems. The presence of conduct problems was assessed using a 6-item self-report questionnaire complied by researchers knowledgeable in the area. The questions for this scale were taken from previous large-scale Canadian surveys similar to the NLSCY. Higher scores are said to reflect a higher level of conduct problems (Statistics Canada, 1999). The internal consistency of this scale for the sample investigated in the study was found to be .91.

Attention regulation problems. The presence of inattention and hyperactivity was assessed using an 8-item self-report questionnaire compiled by researchers knowledgeable in the area. The questions for this scale were also taken from previous large-scale Canadian surveys. Higher scores are said to reflect higher levels of attention regulation difficulties (Statistics Canada, 1999). The internal consistency of this scale was calculated for the sample used in the current study, and was found to be .87.

Pubertal status. The pubertal status score used in this study was derived from the NLSCY data based on the design of the Pubertal Development Scale (PDS) (Petersen, Crockett, Richards & Boxer, 1988). This score was compiled by Dr. Tale Fung at the University of Calgary at the request of the authors. The PDS was designed as a self-report questionnaire, intended to measure pubertal development in five domains. The following three variables from the NLSCY were used to derive a pubertal status variable for females: body hair growth, breast development, and menstruation. For males, the following were used: voice change, facial hair growth, and body hair growth.

Descriptive Statistics

The mean scores, modes, and minimum and maximum values for each of the nine predictors (peer relations, parental nurturance, parental rejection, self-esteem, body image, pubertal status, SES, conduct problems, and hyperactivity/inattention), and for the dependent variable (depression score), are presented in Table 1. As can be seen from the mean scores, the majority of the sample provided responses that would indicate high levels of positive perceptions/emotions, and low levels of negative perceptions/emotions.

Also evident from an examination of mean scores is that the majority of the sample is pubertal (see Table 1). In fact, only 81 participants indicated that they had experienced no sign of pubertal development, whereas 1,021 participants indicated that pubertal development appeared complete. Further investigation of this variable using one-way ANOVA revealed that females were significantly further along in their pubertal development than males, F(1) = 93.48, p [less than or equal to] .001.

A one-way ANOVA was conducted on the depression scores of boys and girls, with depression score as the dependent variable, and gender as the independent variable. Results revealed a significant difference between the mean depression scores of early adolescent females and males, F(1) = 8.77, p [less than or equal to] .003, with females demonstrating more depressive symptoms than males.

Question 1: What Risk Factors Are the Best Predictors of Depression?

A stepwise regression analysis was conducted using the nine risk variables (peer relations, body image, self-esteem, pubertal status, SES, parental nurturance, parental rejection, conduct problems, and hyperactivity/inattention) as predictors, and depression score as the dependent variable. Missing values were excluded pairwise.

The intercorrelations between the nine predictor variables are summarized in Table 2. Most of the correlations between predictors were low, with the exception of several in the moderate range. Thus, concern about multicollinearity appeared minimal.

Results from the stepwise regression analysis on the entire sample are presented in Table 3. The final regression model included six of the nine predictors, and accounted for 42% of the total variance in depression score, [R.sup.2] = .418, p < .001. The first variable to enter the equation was self-esteem, accounting for 31% of the total variance in depression score (Step 1: [R.sup.2] = .312, p < .001), followed by hyperactivity/inattention, which accounted for an additional 5% of the variance in depression score (Step 2: [R.sup.2] = .364, p < .001). Parental nurturance entered at the third step, accounting for another 3% of unique variance (Step 3: [R.sup.2] = .396, p < .001). Parental rejection entered at the fourth step, and accounted for 2% of variance (Step 4: [R.sup.2] = .412, p < .001), whereas conduct problems (Step 5: [R.sup.2] = .416, p < .001) and peer relations (Step 6: [R.sup.2] = .418, p < .001) each accounted for less than 1% of unique variance in depression score.

Question 2: Do the Risk Factors Have Differential Importance for Males and Females?

Stepwise regression analysis was conducted separately on the subsample of females, and on the subsample of males, using the same dependent and independent variables. Missing values were excluded pairwise.

Female subsample. The intercorrelations between the nine predictor variables for the female subsample were again low, with a few in the moderate range, and as such were not presented again (refer to Table 2). Results from the stepwise regression analysis on the female subsample are presented in Table 4. The final regression model included 5 of the 9 predictors, and accounted for 49% of the total variance in depression score, [R.sup.2] = .486, p < .001. The first variable to enter the equation was self-esteem, accounting for 35% of the total variance in depression score (Step 1: [R.sup.2] = .349, p < .001), followed by hyperactivity/inattention, accounting for an additional 7% of variance (Step 2: [R.sup.2] = .423, p < .001), and parental nurturance, accounting for 4% of unique variance (Step 3: [R.sup.2] = .461, p < .001). Parental rejection entered at the fourth step, accounting for an additional 2% of variance (Step 4: [R.sup.2] = .476, p < .001), followed by conduct problems, which accounted for 1% of the remaining unique variance (Step 5: [R.sup.2] = .486, p < .001).

Male subsample. The intercorrelations between the nine predictor variables for the male subsample were again low, with a few falling in the moderate range. Thus, these values were not presented again (refer to Table 2). Results from the stepwise regression analysis on the male subsample are presented in Table 5. The final regression model included six of the nine predictors, and accounted for 36% of the total variance in depression score, [R.sup.2] = .358, p < .001. The first variable to enter the equation was self-esteem, accounting for 26% of the total variance in depression score (Step 1: [R.sup.2] = .256, p < .001), followed by parental rejection, accounting for an additional 4% of unique variance (Step 2: [R.sup.2] = .299, p < .001), and then parental nurturance, accounting for 2% of variance (Step 3: [R.sup.2] = .324, p < .001). Hyperactivity/inattention entered at the fourth step, accounting for an additional 2% of variance (Step 4: [R.sup.2] = .339, p < .001), followed by peer relations, accounting for 1% of variance (Step 5: [R.sup.2] = .352, p < .001), and then conduct problems, accounting for less than 1% of the remaining unique variance (Step 6: [R.sup.2] = .358, p < .001).

Mediational Models

In order to investigate the mediational models proposed in this study, a series of regression analyses and decision rules were utilized, as suggested by Baron and Kenny (1986). A variable was considered to have mediational effects on a risk variable in relationship to depression if the following conditions, suggested by Baron and Kenny (1986), were satisfied:

1. The risk variable was found to significantly predict depression in a linear regression analysis.

2. The mediator was found to significantly predict depression in a linear regression analysis.

3. The risk variable was found to significantly predict the mediator in a linear regression analysis.

4. When the mediator and the risk variable were entered into a linear regression analyses together as predictors of depression, the relationship of the risk variable to depression was found to be less than it was at the beginning (at number 1).

If the relationship between the risk variable and depression is no longer significant when the last regression analysis is conducted, mediation has been demonstrated. If the aforestated relationship is reduced, but remains significant during the final regression analysis, partial mediation has been demonstrated. In other words, it can be assumed that other mediators are also operating to explain this relationship.

Question 3: Does Self-Esteem Mediate the Relationship Between Parental Rearing Behavior and Depression in Both Males and Females?

Both parental nurturance and parental rejection were used as indices of parental rearing behavior. Thus, parental nurturance and parental rejection were examined in separate analyses for both male and female subsamples.

Female subsample: Parental nurturance. Table 6 summarizes the results of the regression analyses conducted to test self-esteem as a mediator of the relationship between parental nurturance and depression in females. As can be seen in Table 6, in accordance with step 1 of the series of analyses described above, parental nurturance was found to be a significant predictor of depression score, [R.sup.2] = .244, p < .001. In accordance with step 2, self-esteem was a significant predictor of depression, [R.sup.2] = .349, p < .001. In accordance with step 3, parental nurturance significantly predicted self-esteem, [R.sup.2] = .227, p < .001. In accordance with step 4, when parental nurturance and self-esteem were entered together as predictors of depression, it was found that the impact of parental nurturance on depression was less than it was at step 1. However, the impact of parental nurturance on depression remained significant when the effects of self-esteem were considered. Thus, self-esteem only partially mediates this relationship.

Female subsample: Parental rejection. Table 7 summarizes the results of the regression analyses conducted to test self-esteem as a mediator of the relationship between parental rejection and depression in females. As can be seen in Table 7, in accordance with step 1 of the analyses described above, parental rejection was a significant predictor of depression, [R.sup.2] = .180, p < .001. In accordance with step 2, self-esteem was a significant predictor of depression, [R.sup.2] = .349, p < .001. In accordance with step 3, parental rejection significantly predicted self-esteem, [R.sup.2] = .112, p < .001. In accordance with step 4, when parental rejection and self-esteem were entered together as predictors of depression, the impact of parental rejection on depression was lessened relative to its impact at step 1. However, the impact of parental rejection on depression remained significant when the effects of self-esteem were considered. Thus, self-esteem only partially mediates this relationship.

Male subsample: Parental nurturance. Table 8 summarizes the results of analyses conducted to test self-esteem as a mediator of the relationship between parental nurturance and depression in males. As can be seen in Table 8, in accordance with step 1 of the series of analyses described above, parental nurturance significantly predicted depression, [R.sup.2] = .129, p < .001. In keeping with step 2, self-esteem significantly predicted depression, [R.sup.2] = .256, p < .001. In accordance with step 3, parental nurturance significantly predicted self-esteem, [R.sup.2] = .132, p < .001. In accordance with step 4, when parental nurturance and self-esteem were entered together as predictors of depression, the impact of parental nurturance was less than it was at step 1. However, the impact of parental nurturance on depression remained significant when the effects of self-esteem were considered, so self-esteem only partially mediates this relationship.

Male subsample: Parental rejection. Table 9 summarizes the results of the regression analyses conducted to test self-esteem as a partial mediator of the relationship between parental rejection and depression in males. As can be seen in Table 9, in accordance with step 1 of the analyses described above, parental rejection significantly predicted depression, [R.sup.2] = .110, p < .001. In accordance with step 2, self-esteem was a significant predictor of depression, [R.sup.2] = .256, p < .001. In accordance with step 3, parental rejection significantly predicted self-esteem, [R.sup.2] = .069, p < .001. In keeping with step 4, when parental rejection and self-esteem were entered together as predictors of depression, the impact of parental rejection on depression was less, relative to its impact at step 1. However, the impact of parental rejection on depression remained significant when the effects of self-esteem were considered. Thus, self-esteem only partially mediates this relationship.

Question 4: Is the Relationship Between Pubertal Status and Depression Mediated by Self-Esteem and Body-Image in Both Males and Females?

Male and female subsamples were again examined separately in the analyses for Question 4. The same four statistical steps outlined previously were used to investigate Question 4.

Female subsample. At step 1 of the analysis series, pubertal status did not significantly predict depression in females, [R.sup.2] = .002, p < .16. Hence, all subsequent analyses were dropped, as pubertal status was not a significant risk factor for depression in these females.

Male subsample. As was the case for the female subsample, pubertal status was not a significant predictor of depression score in the male subsample, [R.sup.2] = .000, p < .91. Because parental pubertal status was not a significant risk factor for depression in this group of males, all further analyses were dropped.

Question 5: Does Parental Rearing Behavior Mediate the Relationship Between SES and Depression in Both Males and Females?

Parental nurturance and parental rejection were once again examined in separate analyses, for both male and female subsamples. The same four statistical steps outlined previously were used to investigate Question 5.

Female subsample: Parental nurturance. Table 10 summarizes the results of the regression analyses conducted to test parental nurturance as a mediator of the relationship between SES and depression. As can be seen in Table 10, in keeping with step 1, SES significantly predicted depression, [R.sup.2] = .009, p < .007. In accordance with step 2, parental nurturance significantly predicted depression, [R.sup.2] = .244, p < .001. In keeping with step 3, SES was a significant predictor of parental nurturance, [R.sup.2] = .011, p < .001. In accordance with step 4, when SES and parental nurturance were entered together as predictors of depression, the impact of SES on depression was rendered insignificant. Thus, parental nurturance can be said to mediate the relationship between SES and depression in females.

Female subsample: Parental rejection. As already mentioned, SES was shown to significantly predict depression in females at step 1, [R.sup.2] = .009, p < .007. In accordance with step 2, parental rejection was a significant predictor of depression score, [R.sup.2] =. 179, p < .001. However, in regard to step 3, SES was not a significant predictor of parental rejection, [R.sup.2] = .003, p < .081. Therefore, the risk variable did not predict the mediator, and the mediational model was not borne out by the data according to the criteria delineated by Baron and Kenny (1986).

Male subsample. At step 1, SES did not predict depression in the male subsample, [R.sup.2] = .000, p < .93. Thus, SES was not a risk factor for depression in males, and all subsequent analyses pertaining to both parental nurturance and parental rejection were dropped.

DISCUSSION

Prior to this study, it appeared that no researchers in the past decade had examined how the common predictors of depression might work together in the creation of risk for depression, and more specifically, if these effects might differ by gender. Furthermore, in this field of research, more data is apparently needed regarding potential mediators of risk variables in relation to depression, and regarding potential gender differences in risk factors (Garber & Flynn, 2001). The results of the present study have some relevance to these issues.

Question 1: What Risk Factors Are the Best Predictors of Depression?

As expected, out of the nine variables examined for their relationship to depressive symptoms, peer relationships, perceived parental rearing behavior (both parental nurturance and parental rejection), and self-esteem did make significant unique contributions to depression scores. Additionally, hyperactivity/inattention and conduct problems emerged as significant predictors, for a total of 42% variance in depression score explained.

Self-esteem accounted for the majority of explained variance in depression scores (31%), with the other predictors each accounting for no more than 5% of the remaining unique variance. The finding that self-esteem is a strong predictor of depressive symptoms is not surprising, based on the current body of research that supports self-esteem as a risk factor for depression in early adolescents (see Garber, Robinson, & Valentiner, 1997; Marcotte et al., 2002; Muris et al., 2001; Robertson & Simons, 2001). However, as stated previously, prior studies have examined only self-esteem in relation to a few other risk factors. Therefore, the current finding that self-esteem emerged from a group of nine common risk variables as the best predictor of depression by a considerable margin, would seem noteworthy.

With regard to parental nurturance and parental rejection, in light of the volume of research supporting the relationship of these variables to depression (see Garber et al., 1997; Lau & Kwok, 2000; Liu, 2003; Nolan, Flynn, & Garber, 2003), it was unexpected that they would explain such a small portion of the variance in depression score (a combined total of 5%). This finding is revisited during the discussion of Question 3 below.

With regard to peer relations, its inclusion in the final model was also expected. However, given the body of research previously demonstrating the relationship between interpersonal competence and depression in youth (see Bell-Dolan, Reaven, & Peterson, 1993; Garland & Fitzgerald, 1998; Segrin, 2000), it was again surprising to find that when examined in association with other common risk factors, this variable explained such a tiny portion of unique variance in depression score (less than 1%). This finding serves to highlight the importance of considering common risk factors as a group, so that relative importance of each factor can be determined.

With regard to the remaining two significant predictors, hyperactivity/inattention and conduct problems, their inclusion in the final model was quite unexpected, in that there appears to be almost no previous evidence demonstrating the predictive value of these variables in relationship to depression in youth. In particular, it appears that the predictive value of hyperactivity/inattention, entering at step 2 of the final model (explaining 5% of unique variance), has never before been demonstrated. Only one prior study was located in which the predictive value of conduct problems had been investigated, with conduct problems explaining 7% of the variance in the depression score (Compton, Snyder, Schrepferman, Bank, & Shortt, 2003).

When considering symptoms of one disorder (in this case, Conduct Disorder and AD/HD) as a predictor of another disorder (in this case, depressive symptoms), one must consider that although co-occurring disorders may be causally related to each other, it may also be the case that apparent symptoms of one disorder (AD/HD or Conduct Disorder) are actually reflecting elevated levels of the other disorder (depression) (Compton et al., 2003). However, given that hyperactivity/inattention and conduct problems did predict depressive symptoms in this study, and that AD/HD and Conduct Disorder typically precede the development of depressive symptoms (Angold & Costello, 1993; Avenevoli et al., 2001; Merikangas & Avenevoli, 2002), it would seem that one could tenuously suggest the potential of a causal relationship between depression and these two disorders. Longitudinal studies following children diagnosed with AD/HD or Oppositional Defiant Disorder/Conduct Disorder over time are needed to shed further light on the nature of the relationship between depression and these disorders.

The exclusion of body image, pubertal status, and SES was anticipated. The relationship between body image and depression may be a significant risk factor only for females (see Adams et al., 1993; Benjet & Hernandez-Guzman, 2002; Franko & Striegle-Moore, 2002). The relationship between pubertal status and depression has been inconsistent across studies, as has the relationship of SES to depression.

Question 2: Do the Risk Factors Have Differential Importance for Males and Females?

Female subsample. The final group of predictors for the subsample of females accounted for a total of 49% of the variance in the depression scores, more variance than was explained for the total sample. Once again, self-esteem accounted for the majority of the explained variance (35%). Thus, in the female subsample, being dissatisfied with one's self, and holding a view of self as ineffective and lacking in positive qualities, remained the strongest predictor of depressive symptoms by a considerable margin.

As was also the case for the total sample, hyperactivity/inattention entered at step 2, which was totally unanticipated for the female subsample, given that females are three times less likely than males to exhibit symptoms of AD/HD (Barkley, 1998). Equally surprising was the inclusion of conduct problems in the final model for females, as males are much more likely to demonstrate this type of behavior (McMahon & Wells, 1998). Consequently, females with comorbid externalizing behaviors, although a relatively small group, appear to be at elevated risk of also experiencing depression.

As stated previously, it is potentially the case that apparent symptoms of attention regulation problems or conduct problems may simply be a reflection of elevated levels of depression (Compton et al., 2003). However, the argument that a causal relationship may also exist remains a plausible suggestion, and one that requires more attention in future longitudinal studies.

With regard to parental nurturance and parental rejection, their inclusion continued to explain only a small portion of unique variance in the female subsample. As previously noted, many studies have documented a strong relationship between parental rearing behavior and depression, and some have found that females are more negatively impacted by problematic parental rearing behavior than are males (Ge et al., 1994; Liu, 2003). A potential explanation for the small portion of variance explained by these variables is offered under the discussion of Question 3 results.

The exclusion of body image, peer relations, and pubertal status from the final model was surprising, and contradicts the hypothesis that these two variables would be significant risk factors specific to females. Previous studies indicate that females are at particular risk for depression as a result of problematic peer relationships (Hankin & Abramson, 2001; Rudolph et al., 2000), and yet peer relations was not a significant predictor of depression for the females in this study. Body image, a risk factor considered to be largely specific to females (see Kovacs et al., 2003; McCauley Ohannessian et al., 1999; Siegel, 2002), did not enter the final model. Pubertal status has also been found in some studies to place females at particular risk (Benjet & Hernandez-Guzman, 2002; Ge et al., 2001a), although it has not been found to be a significant predictor by other researchers (Marcotte et al., 2002).

Hence, in the context of other common risk factors, these three previously influential risk factors (peer relations, body image, and pubertal status) did not demonstrate significant effects. It could be that these three risk factors are secondary in influence when compared to the five risk factors comprising the final model. However, other explanations are also possible. In regard to body image, it may be that body image becomes a more salient risk factor for depression as females progress into adolescence (the females here were only 12 and 13 years of age). This suggestion is supported by the findings of Adams et al. (1993), who reported that young adolescent females were significantly less dissatisfied with their physical appearance than were females in a later stage of adolescence.

The risk for depression associated with puberty (Hayward & Sanborn, 2002; Kessler et al., 2001; Laitinen-Krispijn et al., 1999), may exist only during a specific time period, possibly only during pubertal transition. In two studies, Ge, Conger, and Elder, (2001a, 2001b) found that pubertal status was related to depressive symptoms only when it was measured at specific points in development. It was concluded by these groups of researchers that if pubertal status was assessed too early or too late in development, its association with depressive symptoms would not be detected.

In the current sample, most were pubertal (only 81 participants out of a total of 2,014 indicated they had experienced no sign of puberty), and females were significantly further along in their pubertal development than males. Furthermore, over half of the sample (1,021 participants) indicated that pubertal development appeared complete. Therefore, at the time of sampling, the window of risk may have long passed. Future research investigating the depressive symptoms of a group of youth during the time of pubertal onset would provide more clarity regarding this remaining question.

The exclusion of SES from the final model in the female subsample was expected. Several prior studies have not found SES to have a significant association with depression in youth (Liu, 2003; Robertson & Simons, 1989; Waschbusch, Sellers, LeBlanc, & Kelley, 2003). Instead, it was expected that SES would have its strongest effects on depression through its impact on parenting practices. This model was tested, and the results are discussed under Question 5.

Male subsample. The final group of predictors accounted for a total of only 36% of variance in the depression scores of the male subsample, considerably less variance than was explained for the female subsample. This finding suggests that additional, unexplored variables are operating to create depression in males.

Once again, self-esteem accounted for the majority of the explained variance in depression scores in the male subsample by a considerable margin (26%). Parental rejection and parental nurturance continued to explain only a small portion of variance (a total of 6%), which, as previously discussed, was unexpected. See Question 3 below for further discussion of why this might be the case.

The inclusion of hyperactivity/inattention and conduct problems in the final model for males was not entirely surprising, given the predominance of these disorders in the male population (Barkley, 1998; McMahon & Wells, 1998), and the high level of comorbidity associated with depression (Alpert et al., 1999; Avenevoli et al., 2001; Kovacs, 1998). However, as already mentioned, the predictive value of these variables in relation to depression appears to have been rarely demonstrated prior to this study, and a causal relationship between these behavior problems and depression has not yet been discounted.

Kovacs et al. (2003) reported that depressed females are much more likely to exhibit a comorbid behavioral condition, relative to nondepressed females, nondepressed males, and depressed males. This finding, and the results of this study (in which externalizing problems demonstrated higher associations with depression in females compared to males) converge to suggest that externalizing problems could be more strongly linked in females than in males. Given the relative rarity of AD/HD and conduct disorder in the female population, those females with such disorders could potentially feel particularly afflicted. Subsequently, these females might develop poor self-esteem, which, according to the results of this study, places adolescents at risk for depression. Empirical examination of such a connection is needed, and is an interesting avenue for future research. Regardless, at this point it can be concluded that females with externalizing problems are a distinct group that should be screened more closely with regard to depression.

Peer relations was the only risk factor to differ by gender; this variable was included in the final model for males but not females. This finding is contrary to prior findings suggesting that peer relations would be a significant risk factor only for females. However, research has also shown that adolescents with problematic peer relationships are higher in depressive symptoms than those without such problems (see Bell-Donan et al., 1993; and Garland & Fitzgerald, 1998). In the current sample, males reported significantly more interpersonal problems than did females, F(1) = 44.87, p < .001. Hence, the finding that peer relations had a significant impact for males but not for females in this study might simply be a reflection of the significantly higher level of interpersonal problems in this particular male sample. More research examining gender differences in the impact of peer relations on depression is needed in order to provide more clarity regarding this finding.

Pubertal status, body image, and SES were not included in the final model for males. The exclusion of pubertal status and body image in the final model for males was expected, as research has formerly demonstrated that these variables place females at greater risk for depression than males (see Benjet & Hernandez-Guzman, 2002; Ge et al., 2001a; and Siegel, 2002). The exclusion of SES was also expected, for reasons already outlined.

Question 3: Does Self-Esteem Mediate the Relationship Between Parental Rearing Behavior and Depression in Both Males and Females?

Self-esteem was found to partially mediate the relationship of both parental nurturance and parental rejection to depression, in both males and females. Therefore, it would appear that parental nurturance and parental rejection are related to depression, in part, through the impact of these variables on a child's self-esteem (i.e., parental rearing behavior negatively impacts upon a child's view of self, which in turn creates risk for depression).

These results elucidate the reason for the earlier finding (in both Question 1 and Question 2), that parental nurturance and parental rejection accounted for only a small portion of variance in depression scores. In Questions 1 and 2, much of the variance accounted for by the parenting variables would have been explained by the previous entry of self-esteem into the regression equation. This point of clarification is important, as the apparent crucial importance of parental rearing behavior to the depressive symptoms of youth is somewhat "disguised" by the results of Questions 1 and 2.

The question remains though, as to what other risk factors, if any, mediate the relationship between parental rearing behavior and depression. Negative interpersonal modeling has also been implicated as the means through which parental rearing behavior predicts depression (Rudolph et al., 2000). Hence, future researchers might examine interpersonal skill in youth as an additional partial mediator of the relationship between their depression scores and parental rearing behavior.

Question 4: Is the Relationship Between Pubertal Status and Depression Mediated by Self-Esteem and Body Image in Both Males and Females?

It was hypothesized that both variables would function as mediators of this relationship, as a small group of researchers have found (Marcotte et al., 2002) or suggested (Benjet & Hernandez-Guzman, 2002; Franko & Striegel-Moore, 2002) this to be the case. This hypothesis was not confirmed, as pubertal status was not a significant predictor of depression scores in either the male or female sample.

The nonsignificance of pubertal status as a predictor of depression has been reported previously (Angold & Rutter, 1992; Sagrestano, Paikoff, Holmbeck, & Fendrich, 2003). The potential reason for this finding, that there may be a "sensitive period" in which puberty and depression are related, has already been presented above.

Question 5: Does Parental Rearing Behavior Mediate the Relationship Between SES and Depression in Both Males and Females?

The hypothesis that parental rearing behavior (parental nurturance and parental rejection) would mediate the relationship between SES and depression in both male and female subsamples, was only partially supported. Specifically, the impact of SES on depression was mediated only by parental nurturance, and only in the female subsample. Consequently, females, but not males, from low SES backgrounds are placed at significant risk for depression when they experience low levels of warmth and nurturance from parents. Earlier studies have reported that females are more vulnerable to depression as a result of negative parenting practices than males (Ge et al., 1994; Liu, 2003). As well, prior studies have demonstrated that parental rearing behavior is more problematic among families of low SES (Kim & Ge, 2000; Liu, 2003; McLoyd, 1998). Still others have found that SES significantly predicts depression (Graham & Easterbrooks, 2000; Siegel, 2002). However, it appears that no other studies conducted in the past decade have demonstrated the mediational effects of parenting behavior on the relationship between SES and depression in female adolescents. This finding brings to light a second distinct group of early adolescents, females with low SES backgrounds, who would be at risk for depression when parental nurturance is lacking. Such knowledge has direct implications for prevention efforts, which will be discussed in more detail below.

Implications of the Present Findings

This study was intended to inform prevention efforts, by identifying the most salient risk factors for depression in need of intervention. Although preliminary, and not without limitations, several findings from this study have clear implications for prevention and intervention programs.

First and foremost, low self-esteem seems to be a critical risk factor for depression in early adolescents, a finding that does not differ by gender. Thus, interventions designed to alleviate or prevent this negative cognitive pattern appear crucial to the prevention of depression. Furthermore, given that parental rearing behavior was identified as a risk factor for low self-esteem, and for depression, it would seem equally vital to provide families exhibiting significantly difficult parent-child interactions with support in effective parenting practices.

In other words, self-esteem and parenting behavior most likely play major roles in the creation of depression in both males and females. It is these variables that are recommended for special attention by those involved in the design of prevention and intervention programs. Parents with female children living in a low socioeconomic bracket appear particularly important to target for intervention, as a low level of parental nurturance in such families was shown to be a mediating factor in female depression.

An additional group of early adolescents was identified as being at particular risk for depression: females with externalizing behaviors. Although this connection requires much more research, the current results suggest that females, more so than males, may be at risk for depression when externalizing behaviors are present. Thus, such females are in need of special attention in this regard.

The findings of this study also identify a need for further exploration of additional risk factors for males. The risk factors examined here demonstrated relatively adequate predictive value for females, but relatively less for males. Although females are most frequently afflicted with this disorder, the difficulties experienced by depressed males are not in any way diminished. In order to more effectively prevent depression in males, additional influential risk factors must first be identified.

Finally, it was demonstrated that females exhibit a significantly higher level of depressive symptoms than males at ages 12 and 13. Thus, any efforts at prevention of female predominance in depression rates must be undertaken in childhood, and certainly before females reach adolescence.

Limitations and Strengths of the Study

The strengths of this study include a large sample size, the inclusion of many of the most relevant predictors of depression identified to date, and the examination of risk factors by gender. However, there are also several limitations that must be noted. For the most part, the measures used in this study were reliable and valid instruments, with the exception of the measures used to detect hyperactivity/inattention and conduct problems. These two measures have questionable reliability and validity due to the fact that no previous researchers have examined their psychometric properties. Secondly, all of the measures used in this study were employed in short versions. Although most of these measures had been found to remain valid when shortened, the exact content of each shortened version had not been consistent across studies. Therefore, it is difficult to say with certainty that the psychometric properties of the measures used in this study were not weakened by these abbreviations.

Next, it is important to note that all the data used in the study were self-reported, resulting in the potential that common-method variance influenced the results. This is an additional weakness of this design, but it is important to note that many researchers have asserted that children's or adolescents' perceptions of reality, although perhaps biased, are likely the most indicative of their subsequent cognitive, emotional, and behavioral reactions (Beam, Gil-Rivas, Greenberger, & Chen, 2002; Kim & Ge, 2000; Sagrestano et al., 2003).

Furthermore, two other risk factors, parental depression and independent negative life events, were not included in this design, as these variables were not available to the researchers. The inclusion of parental depression would likely have resulted in more explained variance in both male and female samples, and potentially in a different combination of predictors entering the final model. Not having access to the parental depression variable from the NLSCY is a major weakness of this design. The inclusion of independent negative life events might also have results in more explained variance.

Finally, the fact that the majority of this sample was pubertal eliminated the possibility of examining the risk for depression created by pubertal transition. As a result, it is difficult to discern the true effects of puberty on depression from the data available in the current sample.

Suggestions for Future Research

It would be highly useful to extend the results of this research by conducting a longitudinal study. Results of such a study could provide further evidence with respect to the developmental stability of these risk factors. The addition of parental depression and negative life events as predictors, and the inclusion of children in the process of pubertal transition in future research could also add to the knowledge presented here.

Finally, future research on risk factors for depression should be conducted with greater attention to gender differences. The results presented here indicate that although males and females have risk factors in common, those risk factors have differential salience for males and females. It seems that the link between externalizing disorders and depression in females is a research area in particular need of further examination. In addition, it would appear that other risk factors may exist for males that have not yet been considered.

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Angela R. MacPhee, University of Calgary, Alberta, Canada.

Jac J. W. Andrews, University of Calgary, Alberta, Canada.

Requests for reprints should be sent to Jac J. W. Andrews, Division of Applied Psychology, University of Calgary, 2500 University Drive, N.W., Calgary, AB, Canada, T2N 1N4.
Table 1

Descriptive Statistics

Variable M SD Mode Min. Max.

Peer Relations (a) 13.04 2.74 16 0 16
Parental Nurturance (a) 18.36 4.41 24 0 24
Parental Rejection (a) 9.19 4.64 9 0 24
Self-esteem (a) 13.02 2.65 15 0 16
Body Image (a) 10.74 3.84 12 0 16
Pubertal Status (b) 2.33 0.83 3 0 3
SES (c) 4.02 1.36 4 1 6
Conduct Problems (a) 1.26 1.88 0 0 12
Hyperactivity/Inattention (a) 4.11 3.02 2 0 16
Depression Score (a) 6.34 5.17 3 0 36

(a) Higher :Higher scores reflect higher levels of the variable.

(b) Scores from 1 to 3 indicate that the participant has begun
to experience puberty; a score of 0 indicates pubertal development
has not yet begun; a score of 3 indicates that pubertal development
is well underway.

(c) A mode of 4 indicates that an income of $55,000 was the most
frequent response.

Table 2

Intercorrelations Between Predictor Variables--Entire Sample

Variable Peer Parental Parental
 Relations Nurturance Rejection

Peer -- .22 * -.15 *
Relations

Parental -- -.32 *
Nurturance

Parental --
Rejection

Self-esteem

Body Image

Pubertal
Status

SES

Conduct
Problems

Hyperactivity/
Inattention

 Self- Body Pubertal
 esteem Image Status

Peer .43 * .43 * .09 *
Relations

Parental -.41 * .27 * .00
Nurturance

Parental -.29 * -.16 * .06
Rejection

Self-esteem -- .65 * -.04

Body Image -- .02

Pubertal --
Status

SES

Conduct
Problems

Hyperactivity/
Inattention

 Conduct Hyperactivity/
 SES Problems Inattention

Peer .01 -.22 * -.25 *
Relations

Parental .09 * -.29 * -.26 *
Nurturance

Parental .01 .32 * .37 *
Rejection

Self-esteem .06 -.23 * -.32 *

Body Image .05 -.09 * -.18 *

Pubertal .02 -.02 -.02
Status

SES -- -.11 * -.12 *

Conduct -- .46 *
Problems

Hyperactivity/ --
Inattention

* p < .001

Table 3

Results of the Stepwise Regression Analysis
Using Nine Predictors--Entire Sample

Independent Variable Entered (a) [R.sup.2] [R.sup.2] p
 Change

1. Self-esteem .312 .312 .001
2. Hyperactivity/Inattention .364 .053 .001
3. Parental Nurturance .396 .032 .001
4. Parental Rejection .412 .016 .001
5. Conduct Problems .416 .004 .001
6. Peer Relations .418 .002 .001

(a) Dependent variable: depression score.

Table 4

Results of the Stepwise Regression Analysis
Using Nine Predictors--Females Only

 [R.sup.2]
Independent Variable Entered (a) [R.sup.2] Change p

1. Self-esteem .349 .349 .001
2. Hyperactivity/Inattention .423 .074 .001
3. Parental Nurturance .461 .038 .001
4. Parental Rejection .476 .015 .001
5. Conduct Problems .486 .011 .001

(a) Dependent variable: depression score.

Table 5

Results of the Stepwise Regression Analysis
Using Nine Predictors--Males Only

 [R.sup.2]
Independent Variable Entered (a) [R.sup.2] Change p

1. Self-esteem .256 .256 .001
2. Parental Rejection .299 .043 .001
3. Parental Nurturance .324 .025 .001
4. Hyperactivity/Inattention .339 .015 .001
5. Peer Relations .352 .013 .001
6. Conduct Problems .358 .006 .001

(a) Dependent variable: depression score.

Table 6

Self-esteem as a Partial Mediator of Parental Nurturance in Females

Step of Standardized
Analysis Coefficient
Series Variable Entered [beta] t-ratio p

Step 1 Parental nurturance (a) -.49 -16.28 <.001

Step 2 Self-esteem (a) -.59 -21.17 <.001

Step 3 Parental nurturance (b) .48 16.29 <.001

Step 4 Self-esteem (a) -.46 -15.04 <.001

 Parental nurturance (a) -.27 -8.98 <.001

(a) Dependent variable: depression score.

(b) Dependent variable: self-esteem.

Table 7

Self-esteem as a Partial Mediator of Parental Rejection in Females

Step of Standardized
Analysis Coefficient
Series Variable Entered [beta] t-ratio p

Step 1 Parental rejection (a) .43 13.45 <.001

Step 2 Self-esteem (a) -.59 -21.17 <.001

Step 3 Parental rejection (b) -.33 -10.61 <.001

Step 4 Self-esteem (a) -.51 -17.70 <.001

 Parental rejection (a) .26 8.98 <.001

(a) Dependent variable: depression score.

(b) Dependent variable: self-esteem.

Table 8

Self-esteem as a Partial Mediator of Parental Nurturance in Males

Step of Standardized
Analysis Coefficient
Series Variable Entered [beta] t-ratio p

Step 1 Parental nurturance (a) -.36 -10.88 <.001

Step 2 Self-esteem (a) -.51 -16.82 <.001

Step 3 Parental nurturance (b) .36 11.91 <.001

Step 4 Self-esteem (a) -.43 -13.67 <.001

 Parental nurturance (a) -.20 -6.27 <.001

(a) Dependent variable: depression score.

(b) Dependent variable: self-esteem.

Table 9

Self-esteem as a Partial Mediator of Parental Rejection in Males

Step of Standardized
Analysis Coefficient
Series Variable Entered [beta] t-ratio p

Step 1 Parental rejection (a) .33 10.00 <.001

Step 2 Self-esteem (a) -.51 -16.82 <.001

Step 3 Parental rejection (b) -.26 -8.21 <.001

Step 4 Self-esteem (a) -.45 -14.71 <.001

 Parental rejection (a) .21 7.01 <.001

(a) Dependent variable: depression score.

(b) Dependent variable: self-esteem.

Table 10

Parental Nurturance as a Mediator of SES in Females

Step of Standardized
Analysis Coefficient
Series Variable Entered [beta] t-ratio p

Step 1 SES (a) -.09 -2.71 <.007

Step 2 Parental nurturance (a) -.49 -16.28 <.001

Step 3 SES (b) .11 3.26 <.001

Step 4 Parental nurturance (a) -.49 -16.06 <.001

 SES (a) -.04 -1.31 <.19

(a) Dependent variable: depression score.

(b) Dependent variable: parental nurturance.
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Author:MacPhee, Angela R.; Andrews, Jac J.W.
Publication:Adolescence
Date:Sep 22, 2006
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