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Comparison of the family environments of adolescents with conduct disorder and depression

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Title:
Comparison of the family environments of adolescents with conduct disorder and depression
Creator:
Bosler, Heather Deann
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Language:
English
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vii, 41 leaves : ; 28 cm

Thesis/Dissertation Information

Degree:
Master's ( Master of arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
Department of Psychology, CU Denver
Degree Disciplines:
Psychology

Subjects

Subjects / Keywords:
Conduct disorders in adolescence ( lcsh )
Depression in adolescence ( lcsh )
Teenagers -- Family relationships ( lcsh )
Conduct disorders in adolescence ( fast )
Depression in adolescence ( fast )
Teenagers -- Family relationships ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 30-34).
General Note:
Department of Psychology
Statement of Responsibility:
by Heather Deann Bosler.

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|University of Colorado Denver
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
60409796 ( OCLC )
ocm60409796
Classification:
LD1190.L645 2004m B67 ( lcc )

Full Text
COMPARISON OF THE FAMILY ENVIRONMENTS OF ADOLESCENTS WITH
CONDUCT DISORDER AND DEPRESSION
by
Heather Deaim Bosler
B.A., University of Colorado, Boulder, 2001
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
Psychology
2004
aV


This thesis for the Master of Arts
degree by
Heather Deann Bosler
has been approved
by
Soo Rhee
Jennifer Green
Date
Kevin Everhart


Bosler, Heather Deann (M.A., Psychology)
Comparison of the Family Environments of Adolescents with Conduct Disorder and
Depression
Thesis directed by Assistant Professor Soo Rhee
ABSTRACT
Few studies have compared the family environments of adolescents with
Conduct Disorder versus Depression. This study compared 2,750 adolescents with the
diagnosis of Conduct Disorder, Depression, or no psychiatric diagnosis in a
community sample. The subjects were administered an adapted version of the Family
Environment Scale (FES) and the Diagnostic Interview Schedule for Children (DISC-
IV) to asses DSM diagnoses. This study also examined whether diagnostic symptom
number and sex had any influence on the FES scores. Results showed that adolescents
with CD and MDD perceive their family environment as less cohesive and more
conflictual than adolescents without either disorder. In addition, the number of
CD/MDD symptoms was found to influence the FES scores, with increased
symptoms of both disorders being related to less cohesion and greater conflict.
Gender was found to be related to the Expressiveness scale, with girls being more
expressive than boys.
m


This abstract accurately represents the content of the candidates thesis. I recommend
its publication.
Signed.
SooRhee
IV


ACKNOWLEDGEMENT
My thanks to my advisor, Dr. Soo Rhee, for her knowledge and help this past year. I
also wish to thank the other members of my thesis committee for their support.


CONTENTS
Tables vii
CHAPTER
1. INTRODUCTION .............................................. 1
Gender Differences ...........................................2
Family Environment ...........................................5
Present Study ............................................ 8
2. METHOD 14
Participants 14
Procedure 14
Measures 15
Psychiatric Diagnosis and Symptoms..........................15
Family Environment ....................................... 16
3. RESULTS 18
Diagnosis 19
Symptoms 21
4. DISCUSSION 24
5. CONCLUSIONS ................................................30
REFERENCES 31
vi


TABLES
Table
1.1 Description of the Family Environment Scale Subscales.....................36
2.1 Means and Standard Deviations for CD and
No CD Groups and T-test Results...........................................37
2.2 Means and Standard Deviations for MDD and
No MDD Groups and T-test Results..........................................38
2.3 Means and Standard Deviations for CD only and
MDD only Groups and T-test Results........................................39
2.4 Summary of Simultaneous Regression Analysis for CD
and MDD Diagnosis and Gender..............................................40
2.5 Correlations for CD and MDD Symptoms.....................................41
2.6 Summary of Simultaneous Regression Analysis
for CD and MDD Symptoms and Gender........................................42
Vll


CHAPTER 1
INTRODUCTION
Two common psychological disorders that affect adolescents are Conduct
Disorder (CD) and Major Depressive Disorder (MDD). In the present study, we
examined the differences in the family environments of adolescents with CD or
MDD.
According to the Diagnostic and Statistical Manual of Mental Disorders (4th
ed.; DSM-IV; American Psychiatric Association, 1994), it is estimated that up to 16%
of boys and 9% of girls under age 18 are affected by CD. CD is characterized by
persistent patterns of behavior that include violations of the rights of others and/or
age-appropriate rule breaking. Adolescents with CD may exhibit aggressive behaviors
and be physically cruel to people, or display more covert behaviors like staying out
late or theft. CD in adolescence is also associated with substance use in young
adulthood (Brook, Whiteman, Finch, & Cohen, 1996) and adult antisocial behavior
(Robins, 1978; Loeber, Burke, & Lahey, 2002).
According to the DSM-IV (1994), the lifetime risk for MDD in a community
sample is up to 12% for men and 25% for women. Prevalence rates of depressive
disorders in one epidemiological study by Rushton, Forcier, and Schectman (2002)
ranged from 9.2% to 28.7% for children and adolescents. Adolescents with MDD
1


tend to be irritable or depressed and have a loss of interest or pleasure (DSM-
IV, APA, 1994). Depression is shown to be associated with suicide attempts (Brent et
al., 1992), as well as substance use (Greenbaum, Prange, Friedman, and Silver, 1991).
Other depressive symptoms also may include difficulty concentrating, leading to
poorer school performance (Carlson, 2000).
Depression and CD are commonly thought to co-occur in children.
Individuals with both disorders also seem to be more impaired than individuals with
either disorder occurring alone. In a study by Knox, King, Hanna, Logan, and
Ghaziuddin (1999), adolescents with MDD plus CD or Oppositional Defiant Disorder
(ODD) displayed higher levels of aggressive behavior than adolescents with MDD
only. Studies examining adolescents with comorbid depression and CD have also
found these adolescents to be more affected than individuals with each disorder
separately on a number of domains including substance dependence, school problems,
and decreased positive emotions (Marmorstein & Iacono, 2000).
Gender Differences
There are significant gender differences in the prevalence and presentation of
CD. It is commonly known that there are more males diagnosed with CD than
females in adolescence (16% of boys and 9% of girls). According to the DSM-IV,
there is also a difference in the way that the two genders express their symptoms.
Males are more likely to show confrontational aggression, whereas females are more
2


likely to display non-confrontational behaviors like lying, or running away from
home. However, this could be one reason why males are more frequently diagnosed;
their CD symptoms are more overt and detectible. Different theories also suggest
reasons for these differences in rates and behaviors. One idea proposed by Rutter
(1985) is that males are more prone to psychological stress, which in turn, leads to
problems in relationships and ultimately behavioral problems. Differences in
temperament between genders are also thought to relate to problematic family
relationships. Patterson, Reid, and Dishion (1992, p.35) stated that, Our impression
is that temperament is the most promising candidate as a biological risk factor.
Bezirganian & Cohen (1992) found that differences in temperament between boys
and girls start from toddlerhood on. They found that there is an increase in the
difference between genders as age increases, with boys showing a more difficult
temperament. This difference might influence the tendency for boys to have a more
dysfunctional relationship with their family. In addition to temperament, Eley,
Lichtenstein, and Stevenson (1999) found that there was a significant difference for
antisocial behavior in boys and girls, with boys scoring higher than girls on both
aggressive and nonaggressive antisocial behavior. While aggressive antisocial
behavior in this study was found to be due to genetic factors for both girls and boys,
results showed that there was a greater contribution of genetic factors to
nonaggressive behaviors for adolescent girls in their study while, the role of shared
environmental factors was found to be greater for nonaggressive behaviors in males.
3


The results from this study point to gender differences in the etiologies of
nonaggressive antisocial behavior.
There is also a significant gender difference in the prevalence of depression.
According to the DSM-IV, prevalence rates are twice as high for adolescent and adult
females as for males (12% for men and 25% for women). However, there is debate as
to whether gender differences in depressive symptomatology really exist. Some
studies have shown that gender differences in depressive symptomatology do not
occur in the general population, but only in clinic-referred adolescents (Compas,
Oppedisano, Connor, Gerhardt, Hinden, Thomas, and Hammen; 1997). Compas et al.
found that referred girls reported more depressed mood, higher scores on the
Anxious/Depressed Syndrome subscale, and higher scores for the MDD analogue of
the CBCL and YSR than males or nonreferred youth. However, Kovacs (2001) found
no gender differences in a sample of 92 adolescents on depressive characteristics like
recovery from an episode, risk of a new episode, or comorbid psychiatric disorder
(e.g. dysthymia, CD, or ADHD). Another difference between genders may lie in the
etiology of the disorder. Studies have shown that MDD in women represents a more
heritable disorder than in men. For example, Bierut et al. (1999) found that although
heritability for MDD was high in women, they were only modest in men.
4


Family Environment
Regardless of gender differences, CD and MDD and their co-occurrence
present significant problems, both to the affected adolescents and society. Therefore,
it is important to examine possible factors influencing these disorders. The family
environment is one factor shown to be related to both MDD and CD in adolescents
and children. Research has shown that mothers of children with conduct disorder or
depression display more aversive behavior toward their children than mothers of
controls (e.g., Dadds, Sanders, Morrison, & Rebgetz, 1992). Another study examining
the relationship between the family environment and adolescent adjustment found
that children with psychological symptoms, as measured by the Langer Symptom
Survey and the General Health Questionnaire, were more likely to view their families
as less cohesive, more conflictual, and less involved in the pursuit of recreational
activities (Klienman, Handal, Enos, Searight, and Ross, 1989). In addition to
informing us about possible significant environmental influences on CD and MDD,
there are possible clinical benefits of examining the relationship between family
environments and adolescents with CD and MDD. If there is a causal relationship
between family environment and psychopathology, we could test competing
hypothesis about what is causing the relationship. In turn, this research may inform
clinicians regarding the particular aspects of family functioning that can be focused
on dining family therapy with families of CD and MDD children and adolescents.
5


Several theories have emerged over time which support the link between
family environment and dysfunction in children and adolescents. One such theory
deals with a transactional relationship between family members. Patterson, Reid, and
Dishion (1992) proposed a coercion model that is related to adolescent antisocial
behavior. They state that ineffective discipline by the parents and lack of parental
monitoring are at the core of this negative process, where the child or adolescent is
allowed more coercive exchanges. This pattern of behavior, learned in the home, is
then played out in other social settings like school. The outcome of this is further
antisocial behavior by the affected individual. In a review of studies on parent-child
interactions in youth with conduct disorder, Kazdin (1987) points to several variables
associated with CD including harsh and inconsistent disciple styles, inappropriate
reinforcement of behaviors, lack of parental contact, and less warmth by the
caregiver. In another study, Vuchinich, Bank, and Patterson (1992) examined
antisocial behavior in boys at two different times over two years, and found that
antisocial behavior by the boys had a negative impact on parental discipline practices
and peer relationships and that parental discipline practices influenced the childs
antisocial behavior. Here, the reciprocal nature of the interaction is evident. However,
this pattern does not appear to influence antisocial behavior and CD alone.
Similar theories have been developed for the maintenance of depression in
adolescents. One idea based on the coercion theory developed by Patterson (1982)
was further developed by Davis, Sheeber, and Hops. These researchers propose that
6


the same mechanism influencing the continuation of antisocial behaviors also
influences the continuation of depression in adolescents. This shared environmental
influence is coercion. They have conducted research showing that depressed
adolescents live in aversive environments (e.g. less cohesive, less supportive, and
more conflictual), which can lead to depressive behaviors by the adolescents. In
addition, the adolescents depressive behaviors are found to be aversive to others in
their family environment They have also found support for the hypothesis that
parents may be reinforcing the depressive behavior in their depressed children.
Results from another study by Sheerber, Hops, Andrews, Alpert, and Davis (1998)
showed that mothers of depressed adolescents had an increase in facilitative and
problem-solving behavior following depressive behavior by the child, while fathers
showed decreased aggressive and problem-solving behavior. As with CD, the positive
and negative reinforcement of the depressive behavior is shown to be playing a role in
the maintenance of the depression in the adolescent.
Another theory involved in the development and maintenance of depression
and CD in adolescence is that of expressed emotion. There is evidence that mothers
of children and adolescents with emotional or disruptive disorders differ in their
expression of emotional attitudes (e.g. warmth, criticism). Vostanis, Nicholls, and
Harrington (1994) have shown that maternal warmth was significantly lower in
families of children with CD than those with emotional disorders like depression, and
lower in families of children with emotional disorders than families of controls.
7


Present Study
In the present study, we examined the relationship between the subscales of
the Family Environment Scale (FES; Moos, 1976), and CD, as well as the subscales
of the FES and MDD. The Family Environment Scale is an assessment tool widely
used to measure family environment. The scale was developed to examine an
individuals perception of their family environment on dimensions of interpersonal
relationships within the family, personal growth, family structure and organization
(see Table 1). The FES has been successfully used in several populations, including
chronically ill children (e.g., Kronenberger & Thompson, 1990), a community sample
of adolescents (e.g., Boyd, Gullone, Needleman, and Burt, 1997), and in a study
examining adolescents with other psychiatric diagnoses (e.g., attention deficit
hyperactivity disorder, post traumatic stress disorder, & dysthymia; i.e., Halloran,
Ross, & Carey, 2002).
The relationship between CD and the FES has been researched extensively.
Studies show that CD is related to lower levels of cohesion and higher levels of
conflict in the family environment (Haddad, Barocas, and Hollenbeck, 1991).
Kronenberger and Thompson (1990) found that families with chronically ill children
with behavior problems (as measured by the Missouri Childrens Behavior Checklist)
were less supportive (with positive loadings on the cohesion subscale of the FES) and
8


more conflictual than families of chronically ill children without behavior problems.
Several researchers, including Haddad et al. (1991), also found the Active-
Recreational subscale to be associated to CD. Slee (1996), who examined other
subscales of the FES, found that in addition to endorsing less cohesion and more
conflict, mothers of adolescents with CD reported their families were less expressive,
less fostering of independence, less engaged in active-recreational pursuits, less
organized, and more controlling.
The relationship between depression in adolescents and the FES also has been
examined. Results indicate that depression is also linked with perceptions of the
family as less cohesive and more conflictual (Aydiotan and Oztutunca, 2001; Sheeber
& Sorensen, 1998). For example, Sheeber, Hops, Alpert, Davis* and Andrews (1997)
found that less supportive and more conflictual family environments were related to
greater depressive symptomatology in a longitudinal study of adolescent females and
males. Also, in a similar study, Sheeber & Sorensen (1998) compared the FES scores
of families of depressed versus non-depressed adolescents and their mothers again
using the FES. They found that both the depressed adolescents (either with diagnosis
of MDD or Dysthimic Disorder [DD]) and their mothers reported their families as
being less supportive, more conflictual, and less cohesive than the non-depressed
adolescents and their mothers.
Few studies have compared the family environments of children with CD to
children with depression. Using the Self-Report Measure of Family Functioning
9


Child Version, Jewell and Stark (2003) found adolescents with CD had higher levels
of Laissez-faire Family Style (reflecting a permissive and inconsistent discipline
style) and lower levels of Enmeshment (reflecting inappropriately close relationships
that foster dependence) than depressed adolescents with either a diagnosis of MDD or
dysthymic disorder (DD). Dadds et al. (1992) also compared the family environments
of children with CD to that of children with depression, children with mixed
depression and CD, and controls, using an observational method (Family Observation
Schedule). Results indicated that family interactions were significantly more deviant
in the CD group. Both the parents and the children in the conduct disorder only group
displayed more aversive behaviors compared to the other groups, including the mixed
group. In a similar study by Sanders et al. (1992), family problem-solving interactions
were examined in adolescents with CD, children with depression, children with
mixed depression and CD, and controls. They found that both groups of conduct
disordered adolescents (i.e., CD and mixed) and their mothers showed lower levels of
positive solutions and higher levels of aversive content during problem solving than
the depressed group and the control group.
To our knowledge, only one study has examined whether the number of
depressive or CD symptoms that a child has relates to increased or decreased
endorsement on the subscales of the FES. Aydiotan and Oztutuncu (2001) found that
adolescents scores on the Cohesion subscale of the FES related to the number of
depressive symptoms, as measured by the Beck Depression Inventory, with the lower
10


scores on Cohesion being related to increased number of depression symptoms. In
another study using observational methods, Dadds et al. (1992) examined the level of
aversive behaviors, as well as reported levels of depression, during interactions
between family members in children with depression (MDD or DD) and CD.
Surprisingly, in families of children with depression, Dadds et al. found that aversive
behavior by parents decreased as the level of childrens depression (as measured by
the Child Depression Inventory) increased. However, there is research that supports
this type of finding. It seems that depressed affect can function as buffer against
aversive behaviors by other family members and vice versa (Hops et al., 1987). In
contrast to this, the aversive behavior by die children increased as the level of
depression increased. In children with CD, aversive behavior by both the parents and
children increased as the level of depression increased. In addition, a study by Frick et
al. (1992) found that maternal parenting (i.e., maternal persistence or consistency in
discipline, time spent together between mother and child, etc.) is related to the
number of Oppositional Defiant Disorder (ODD) and CD symptoms. Results
suggested that mothers of children with CD exhibited higher levels of deviant
maternal parenting than those of children with ODD, although this finding was not
statistically significant.
The present study explored the hypothesis that both CD and MDD are
associated with several subscales of the Family Environment Scale in a very large
sample of community adolescents. Given previous results (e.g., Aydiotan and
11


Oztutunca, 2001; Haddad et al., 1991; Sheeber and Sorenson, 1998; Slee, 1996), we
hypothesized that children with CD would report lower levels of cohesion, higher
levels of conflict, and less active-recreational pursuits in their family environments
than children without CD. Also, children with MDD would report lower levels of
cohesion and higher levels of conflict in their families than children without the
diagnosis. We also explored this issue quantitatively and examined whether the
number of MDD and CD symptoms were related to the FES subscale scores. Given
previous findings (i.e., Aydiotan and Oztutunca, 2001; Dadds et al., 1992; Frick et al.,
1992), we explored whether increased CD or MDD symptoms were associated with
the perception of decreased cohesion and increased conflict in family environments.
The present study also compared the FES scores of children with CD versus
children with MDD. Although none of the studies that compared the family
environments of CD and depressed children used the FES, results suggest that the
family environment of children with CD is more dysfunctional than that of children
with MDD (Dadds et al., 1992; Frick et al., 1992; Haddad et al., 1991; Jewell and
Stark, 2003). We hypothesized that children with CD would report higher levels of
conflict and lower levels of cohesion than children with MDD.
Finally, in order to have a more complete picture of the family environments
of children with CD and MDD, we conducted an exploratory analysis of the other
subscales of the FES with children diagnosed with CD and with MDD. Most
researchers examining the relationship between psychiatric disorders and the Family
12


Environment Scale have examined only a few of the subscales (i.e. cohesion, conflict,
control; e.g., Aydiotan and Oztutuncu, 2001; Sheeber and Sorenson, 1998). Because
of research using the FES that has shown that other scales are related to
psychopathology (i.e., Slee, 1996; Haddad et al., 1991), the present study attempted
to identify more of the family variables from the FES that are associated with the two
disorders.
Most previous studies examining the family environments of children or
adolescents with CD or depression have examined the parent reports of the family
environment (e.g., Frick et al., 1992; Haddad et al., 1991; Kroenberger & Thompson,
1990; Sheeber & Sorensen, 1998; Slee, 1996). In the present study, we examined
whether the childrens perceptions of their family environment are related to their
psychopathology. Also, previous studies examining the relationship between family
environments and psychopathology have used much smaller samples of adolescents
(e.g., Dadds et al., 1992, Haddad et al., 1991, Halloran et al., 2002, & Slee, 1996). In
contrast, the present study used a very large sample of community adolescents,
increasing the probability that the findings would be generalizable.
Given the gender differences in the prevalence of CD and MDD and the
presentation of CD and MDD, this study also examined whether there is an influence
of gender on the FES subscale scores. We examined whether there is a significant
interaction between gender and CD/MDD.
13


CHAPTER 2
METHOD
Participants
The participants were 1179 MZ twins, 1238 DZ twins, and 453 of their
siblings assessed by the Colorado Center on Antisocial Drug Dependence. The twins
and their siblings were recruited from the Colorado Twin Registry, a community-
based twin sample, and the Longitudinal Twin Study. Forty-eight percent of the
participants were male (N = 1373) and 52% were female (N = 1497). Age ranged
from 12 to 19 years. The mean age of the adolescents was 15.70 years (SD = 2.10).
Procedure
Data from a total of 2750 adolescents were examined in this study. Written
informed assent (from minor participants) or consent (from adult participants and
guardians of minors) was obtained from all participants prior to any assessment.
Face-to-face interviews were conducted either in the homes of the participants or at
the Institute for Behavioral Genetic Laboratories by trained interviewers. CD and
MDD were assessed via the self-report, National Institute of Mental Health
Diagnostic Interview Schedule for Children (NIMH DISC-IV, 1997), a structured
interview that is designed to assess DSM-IV symptoms and diagnoses. The
14


participants also were asked to complete the Family Environment Scale (Moos,
1974), a self-report questionnaire designed to assess their perception of their family
climate. The proposal for the current study was reviewed and approved by the Human
Research Committee through the University of Colorado at Boulder.
Measures
Psychiatric Diagnosis and Symptoms
The National Institute of Mental Health Diagnostic Interview Schedule for
Children Version IV (NIMH DISC-IV). is a structured diagnostic interview for use by
nonclinicians to yield DSM-IV and ICD-10 diagnoses (Shaffer, Fisher, Lucas,
Dulcan, Schwab-Stone, 2000). The DISC-IV offers stem questions to the
respondents, that most people with the symptom will endorse. In addition, there are
contingent questions that assess whether an endorsed symptom meets the criteria
specified by the DSM or the ICD. The reliability of the DISC-IV has been found to be
good both in clinical and community samples. The test-retest reliabilities for a sample
of247 parent-child pairs from a community sample ranged from good to moderate in
diagnostic reliability (Schwab-Stones et al., 1996). The validity of the DISC-IV has
not been researched to date, but findings using previous versions of the DISC indicate
that the validity of this measure is good. In a study examining the sensitivity of the
DISC-2.1 with uncommon psychiatric disorders in children who had been previously
15


diagnosed by clinicians (i.e., obsessive-compulsive disorder, substance use disorder),
findings revealed that the DISC had sensitivity for these disorders ranging from .73 to
1.0 (Fisher et al., 1993).
Family Environment
The Family Environment Scale, 2nd edition, was developed by R.H. Moos and
B.S. Moos (1986) to assess a persons perceptions of his or her family environment.
The scale is comprised of 90 T/F items that assess three dimension of the family
environment: 1) Relationships (Cohesion, Expressiveness, and Conflict), 2) Personal
Growth (Independence, Achievement Orientation, Intellectual-Cultural Orientation,
Active-Recreational Orientation, and Moral-Religious Emphasis), and 3) System
Maintenance (Organization and Control). The internal consistencies of the FES scales
range from .61 (Independence) to .78 (Moral-Religious Emphasis). Test-retest
reliabilities over a four-week period ranged from .54 (Independence) to .91 (Moral-
Religious Emphasis). The FES also has been used in research assessing a wide variety
of groups including children with conduct disorder (e.g. Halloran, 2002; Slee, 1996)
and depression (e.g. Aydiotan & Oztutuncu, 2001; Sheerber & Sorensen, 1998).
For the purposes of the present study, an adapted version of the FES,
previously developed by Plomin & Defries (1985), was used. Instead of the true/false
format, a 5-point likert-type scale (.strongly disagree to strongly agree) was
implemented. In addition, two of the subscales were not included. Previous work by
16


Garfinkle-Claussner (1979) did not support the Independence subscale of the FES
when factor analyzed, and the Moral-Religious subscale was not pertinent to the
research. Therefore, these two scales were eliminated. The remaining subscales were
shortened to be measured by the 5 highest-loading questions for each of the 8
subscales. Factor analysis of this alternate version has been described elsewhere
(Plomin, McCleam, Pedersen, Nesselroade, & Bergeman, 1988) and has shown to
reasonably confirm the original FES scales.
17


CHAPTER 3
RESULTS
A series of independent-samples t-tests were conducted to examine whether
die mean differences in the FES subscales scores are significant for the three
. comparison groups. The dependent variables were the 8 FES subscale scores and the
independent variable was group membership (CD vs. no CD, MDD vs. no MDD, and
CD only vs. MDD only). Given the number of comparisons, a more conservative a
level was used (i.e., p < .01), Although we.examined a very large community sample
of adolescents, the number of participants with CD, MDD, or mixed disorder was
small. Therefore, we also examined the possibility that Type II errors may have been
made by examining effect sizes.
Table 2 shows means, standard deviations, t-test results, and effect sizes for
the CD and no CD groups. We found that 2.9% of the adolescents (18 females, 66
males) had the diagnosis of CD. Results indicate statistically significant differences
between groups on the FES subscales of Cohesion, 7(2830) = 5.94, p < .01, Conflict,
7(2832) = -5.93, p < .01, Achievement Orientation, 7(2829) = 3.67, p < .01, and
Active-Recreational, 7(2832) = 3.93, p <.01. Results indicate that the CD group
reported less cohesion, more conflict, less achievement orientation, and less active-
18


type II errors have not been made. Similar results were found for MDD. Table 3
shows the results for the comparison between the MDD and no MDD groups.
Statistically significant results were found for the FES subscales of Cohesion, *(2830)
= 4.24, p < .01, Conflict, *(2832) = -3.68, p < .01, Achievement Orientation, *(2829) =
2.88, p < .01, and Active-Recreational, *(2832) = 3.57, p < .01. Results indicate that
the MDD group reported less cohesion, more conflict, less achievement orientation,
and less active-recreational pursuits than the no MDD group. Again, for the FES
subscales that are not significantly related to MDD, the effect sizes ranged from .01 to
.08, suggesting that type II errors have not been made. However, as Table 4 shows,
no statistically significant results were found for the mean differences between the
CD only and MDD only groups and, the effect sizes suggest that there are no
substantial differences in the family environment of these two groups.
We also found that there were only four individuals who received a diagnosis
for both CD and MDD. Therefore, we were unable to conduct analyses comparing the
comorbid group and individuals with CD only, MDD only, or neither disorder given
lack of power.
Diagnosis
Next, multiple regression analyses was conducted to examine whether CD
diagnosis, MDD diagnosis, and gender are significantly related to family environment
after controlling for the effects of the other independent variables. The dependent
19


variable was the FES subscale scores. The independent variables were CD diagnosis,
MDD diagnosis, gender, CD diagnosis*MDD diagnosis, CD diagnosis*gender, MDD
diagnosis*gender, and CD diagnosis*MDD diagnosis*gender. Table 5 shows the
summary of the regression analysis for CD diagnosis, MDD diagnosis, and gender.
For CD diagnosis, only a trend was found for Cohesion, indicating that there is a
decrease in cohesion in individuals with the diagnosis of CD compared to those
without CD, /(2824) = -2.36, p = .02. For MDD diagnosis, significant results were
found for the subscales of Cohesion, t(2824) = -4.09, p <.01, Conflict, t(2826) = 3.37,
p = <.01, and Active-Recreational pursuits, t(2826) = -2.79, p = <.01. It appears that
there is a decrease in family cohesion, an increase in family conflict, and a decrease
in active-recreational pursuits in individuals with the diagnosis of MDD compared to
those without MDD. Results also showed that Intellectual-Cultural Orientation was
lower in youths with the diagnosis of MDD than those without MDD, although results
for this subscale did not reach the significance level, t(2818) = -2.38, p = .02. In
addition, gender was found to be significant for Expressiveness, t(2B25) = -3.48, p <
.01, with girls being more expressive.
After examining whether CD diagnosis, MDD diagnosis, and gender were
significantly related to the family environment when controlling for the effects of
other variables, differences emerged from the original t-test analysis results. For CD,
only a trend was found for Cohesion, while the other FES subscales were no longer
significant. For MDD, the subscales of Cohesion, Conflict, and Active-Recreational
20


pursuits were again found to be significant, while Achievement Orientation was no
not found to be significant in the multiple regression analysis. Also, a trend for
Intellectual-Cultural Orientation was found for MDD in the regression analysis.
A gender by CD interaction effect, *(2818) = -2.20, p = .03 and a gender by
MDD interaction effect, *(2818) 2.21, p = .03 was found for the FES subscale of
Intellectual-Cultural Orientation, although the result was not significant. Given this
trend, the effect of CD and MDD on Intellectual-Cultural Orientation was examined
for males and females separately. For females, no statistically significant effect was
found for CD, but there was a trend for decreasing intellectual-cultural orientation,
with the diagnosis of MDD, *(1469) = -2.34, p =.02. For males, the opposite result
was found. Intellectual-cultural orientation decreases with the diagnosis of CD,
*(1349) = -2.93, p <.01, but no statistically significant effect was found for MDD.
Symptoms
We also hypothesized that increased CD or MDD symptoms will predict
lower cohesion and higher conflict in the family environments of these adolescents.
First, we examined the correlations between the FES subscales of Control and
Cohesion and CD and MDD symptom levels in all of the participants. We also
examined the other subscales from the FES to see if any other relationships exist.
Table 6 shows the correlation results for all of the FES subscales. Results indicate
that there is a statistically significant relationship between the symptoms level of CD
21


and all of the FES subscales, p <.01. For MDD, all of the FES subscales were
statistically significant, p <.01, except for Control.
Next, we conducted multiple regression analyses in order to examine whether
the number of CD symptoms, the number of MDD symptoms, and gender were
related to the 8 FES scales after controlling the effects of the other independent
variables. We also tested whether there is an interaction between gender and the
number of CD or MDD symptoms. The independent variables were CD symptoms,
MDD symptoms, gender, CD symptoms*MDD symptoms, CD symptoms*gender,
MDD symptoms*gender, and CD symptoms*MDD symptoms*gender. Table 7
shows the summary of the regression analysis for CD symptoms, MDD symptoms,
and gender. Results indicate that for CD symptoms, significant results were found for
the FES subscale of Cohesion, t(2824) = -3.63, p <.01, and Conflict, t(2826) = 4.04, p
<.01. Organization was also found to be influenced by the number of CD symptoms
but did not reach significance, f(2823) = -2.47, p = .01. Results indicate that increased
CD symptoms are associated with less cohesion, more conflict, and less organization
in the family environments of youth.
For MDD symptoms, results show that there is a significant association
between the symptom number and the FES subscales of Cohesion, r(2824) = -3.67, p
<.01, and Conflict, t(2S26) = 4.33, p <.01. Also a trend was found for Intellectual-
Cultural Orientation, f(2818) = -2.28, p = .02, and Active-Recreational pursuits,
t(2826) = -2.40, p = .02. Results indicate that increased MDD symptoms are
22


associated with less cohesion, more conflict, less intellectual-cultural orientation, and
less active-recreational pursuits in the family environments of youth. In addition,
gender was found to be significantly related to the Expressiveness subscale, with girls
being more expressive, t(2825) = -3.04, p = <.01.
After examining whether the number of CD symptoms, MDD symptoms, and
gender were significantly related to the family environment when controlling for the
effects of other variables, differences emerged from the correlation results. For CD,
only the subscales of Cohesion and Conflict were found to be significant, although a
trend was found for the Organization subscale. For MDD, Cohesion and Conflict
were again found to be significant. A trend was also found for the Intellectual-
Cultural Orientation and the Active-Recreational subscales.
No significant CD symptoms by gender interactions were found. However, an
MDD symptoms by gender interaction for Achievement Orientation, f(2823) = -1.97,
p = .05, and Organization, /(2823) = -2.20, p = .03, were found, although they were
not significant After examining the Achievement Orientation subscale by gender, it
was found that for females, there was no statistically significant relationship between
Achievement Orientation and MDD symptoms. For males, there was a trend towards
an increased number of MDD symptoms being associated with less achievement
orientation, /(1353) = -2.06, p = .04. When the Organization subscale was examined
for each gender, no significant relationship between Organization and MDD
symptoms was found for males or females.
23


CHAPTER 4
DISCUSSION
The purpose of the present study was to compare the family environments of
youth with CD, MDD, and no diagnosis. The present study compared these groups
using the self-repot measure of the Family Environment Scale. This study also
examined whether the number of symptoms of each disorder is related to the FES
subscale scores. In addition, the study examined whether gender had any influence on
the FES scores, and whether it interacted with CD or MDD to influence the FES
scores.
The present study explored the hypothesis that both CD and MDD are
associated with several subscales of the Family Environment Scale. Multiple
regression analyses to examine whether CD diagnosis, MDD diagnosis, and gender
were significantly related to family environment after controlling for the effects of the
other independent variables, showed some interesting results. Surprisingly, our results
found no significant relationship for the diagnosis of CD. However, a trend for the
Cohesion subscale was found for adolescents with CD, indicating that finding would
need to be replicated in future studies to deserve attention. Despite this, results from
multiple regression with MDD showed that the diagnosis of MDD in the adolescents
24


is associated with significantly decreased family cohesion, increased family conflict,
and less active-recreational pursuits in their family environment compared to those
without MDD. A trend for Intellectual-Cultural Orientation was also found, which
would again need to be replicated. In addition, Expressiveness was found to be
different for males and females, with females being more expressive.
Interestingly, a trend of a gender by CD and a gender by MDD interaction was
found for the Intellectual-Cultural Orientation subscale. Therefore, the regression of
Intellectual-Cultural Orientation on CD and MDD was conducted separately by
gender. For females, the diagnosis of CD did not have an effect on Intellectual-
Cultural Orientation, and only a trend was found, with Intellectual-Cultural
Orientation being lower in girls with the diagnosis of MDD. For males, the opposite
was true. The diagnosis of MDD did not have an effect on Intellectual-Cultural
Orientation, and there was a trend of Intellectual-Cultural Orientation being lower in
boys with the diagnosis of CD.
Our exploration of whether increased CD or MDD symptoms would be
associated with the perception of decreased cohesion and increased conflict in family
environments confirmed our hypothesis. We found that increased CD symptoms are,
in fact, significantly associated with all of the FES subscales, including Cohesion and
Conflict. Our hypothesis was also supported for MDD symptoms. The number of
MDD symptoms was found to be significantly related to all of the FES subscales
except for Control.
25


However, after multiple regression analyses to examine whether CD
symptoms, MDD symptoms, and gender were significantly related to family
environment after controlling for the effects of the other independent variables,
results showed that an increased number of CD symptoms was only significantly
related to more cohesion and more conflict in their family environments. A trend was
also found for Organization to be decreased as the number of CD symptoms
increased, although this finding would also need to be replicated. For MDD, results
showed that increased symptoms were again significantly related to less cohesion and
more conflict in the family environment. Results also showed a trend for less
intellectual-cultural orientation and less active-recreational pursuits being related to
higher MDD symptoms. Again, females were found to be more expressive than
males.
The results from our study suggest that the family environment is related to
CD in adolescents. These results are consistent with previous literature, especially
when examining the FES subscale of Cohesion and Conflict. For example, Slee
(1996), who examined other subscales of the FES, found that in addition to endorsing
less cohesion and more conflict, mothers of adolescents with CD reported their
families were less expressive, less fostering of independence, less engaged in active-
recreational pursuits, less organized, and more controlling. Our study found similar
results for adolescent reports of their family environments, with the exception of the
FES subscales of Organization and Control.
26


Our results for adolescents with MDD also indicate that the FES subscales of
Conflict and Cohesion are significantly related to the family environments of these
adolescents compared to those without the diagnosis. Previous literature also supports
that depression is linked with perceptions of the family as less cohesive and more
conflictual (Aydiotan and Oztutunca, 2001; Sheeber & Sorensen, 1998).
The results from our study also suggest that increased CD symptoms are
related to significantly less cohesion and more conflict in their family environments.
Although not using the same measures as our own study, Dadds et al. (1992) found
that in children with CD, aversive behavior by both the parents and children increased
as the level of depression increased.
Also, our study found that increased MDD symptoms were significantly
related to the FES subscales of Cohesion and Conflict. This is consistent with
previous finding by Sheeber, Hops, Alpert, Davis, and Andrews (1997), which found
that less supportive and more conflictual family environments were related to greater
depressive symptomatology in a longitudinal study of adolescent females and males.
Also, Aydiotan and Oztutuncu (2001) found that adolescents scores on the Cohesion
subscale of the FES related to the number of depressive symptoms, as measured by
the Beck Depression Inventory, with the lower scores on Cohesion being related to
increased number of depression symptoms.
Although our results show that there is a relationship between the family
environment and CD/MDD, this does not mean that family environment has a direct
27


effect on psychopathology. Although it is possible that family environment has a
causal effect on CD or MDD, no causal effect has been supported by our results.
Another possibility is that common genes influence both the family environment and
CD or MDD. A study by Plomin, McCleam, Pedersen, Nesselroade, and Bergeman
(1988) examining the genetic influence on childhood family environment, perceived
retrospectively, found evidence of genetic influences on each of the FES subscales.
Their results imply that an environmental scale like the FES can be influenced by
characteristics of the individual that are heritable. Therefore, future studies should
examine whether common genetic influences are responsible for the correlation
between family environment and CD/MDD. If family environment does have a
causal effect on CD or MDD, the results of this study suggest that family cohesion
and conflict as well as some other FES subscales may be important variables to
address in treatment, especially in family therapy.
The main limitation orf the present study is that the sample size was not
sufficient enough to examine a group of individuals with comorbid CD and MDD,
even though the two often co-occur. In future studies, a clinical sample may have to
be examined to test whether a comorbid group is different from the CD only or MDD
only groups.
28


CHAPTER 5
CONCLUSIONS
In the present study, we found that there are associations between the
subscales of the Family Environment Scale and CD/MDD. As found in previous
research, our results indicate that adolescents with CD and MDD perceive their
family environment as less cohesive and more conflictual than adolescents without
either disorder. In addition, gender was found to be related to the Expressiveness
scale, with girls being more expressive than boys.
29


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34


Table 1.1
Description of the Family Environment Scale Subscales
Subscales Example Items
1) Cohesion There is a feeling of togetherness in our family.
2) Expressiveness There are a lot of spontaneous discussions in our family.
3) Conflict Family members often criticize each other.
4) Achievement Orientation We always strive to do things just a little better the next time.
5) Intellectual-Cultural Orientation We rarely go to lectures, plays, or concerts.
6) Active-Recreational We often go to movies, sports events, camping, etc.
7) Organization We are generally neat and orderly.
8) Control There are set ways of doing things at home.
35


Table 2.1
Means and Standard Deviations for CD and No CD Groups and T-test Results
FES Scales CD Mean SD No CD Mean SD t df v r
Cohesion 3.27 .88 3.79 .77 5.94 2830 o V .11
Expressiveness 2.94 .73 3.13 .64 2.56 2831 .01 .05
Conflict 3.14 .68 2.64 .74 -5.93 2832 * r*H V .11
Achievement Orientation 3.64 .69 3.90 .63 3.67 2829 <.01* .07
Intellectual-Cultural Orientation 2.99 .66 3.18 .68 2.50 2824 .01 .05
Active-Recreational 3.35 .86 3.67 .73 3.93 2832 * o V .07
Organization 3.14 .80 3.33 .73 2.31 2829 .02 .00
Control 3.17 .69 3.25 .70 1.01 2832 .31 .02
Note. FES = Family Environment Scale; CD = Conduct Disorder, r = effect sizes.
* =p< .01.


Table 2.2
Means and Standard Deviations for MDD and No MDD Groups and T-test Results
FES Scales MDD Mean SD No MDD Mean SD t df V r
Cohesion 3.34 .92 3.78 .77 4.24 2830 <.01* .08
Expressiveness 3.02 .73 3.12 .64 1.15 2831 .01 .02
Conflict 3.01 .70 2.64 .74 -3.68 2832 <.01* .07
Achievement Orientation 3.66 .66 3.90 .63 2.88 2829 <.01* .05
Intellectual-Cultural Orientation 3.03 .85 3.18 .68 1.61 2824 .01 .02
Active-Recreational 3.32 .88 3.67 .73 3.57 2832 O V .07
Organization 3.13 .75 3.33 .74 2.03 2829 .02 .04
Control 3.22 .80 3.25 .69 .31 2832 .31 .01
Note. FES = Family Environment Scales; MDD = Major Depressive Disorder.
* =p < .01.


Table 2.3
Means and Standard Deviations for CD only and MDD only Groups and T-test Results
FES Scales CD Mean SD MDD Mean SD t df V r
Cohesion 3.37 .94 3.28 .84 .51 130 .61 .04
Expressiveness 3.02 .75 2.94 .74 .66 129 .51 .06
Conflict 2.98 .67 3.12 .66 -1.17 130 .25 .10
Achievement Orientation 3.70 .63 3.67 .67 .27 130 .79 .02
Intellectual-Cultural Orientation 3.05 .87 2.99 .67 .37 129 .71 .03
Active-Recreational 3.36 .87 3.38 .85 -.10 130 .92 .01
Organization 3.15 .76 3.15 .81 -.03 130 .97 .00
Control 3.23 .82 3.18 .70 .42 130 .68 .04
Note. FES = Family Environment Scale; CD = Conduct Disorder; MDD = Major Depressive Disorder.
* =p < .01.


Table 2.4
Summary of Simultaneous Regression Analysis for CD and MDD Diagnosis and Gender
CD MDD Gender
FES Scales t V t P t v
Cohesion -.10 -.36 .02 -.09 -4.09 * rH o V -.03 -1.52 .13
Expressiveness -.01 -.22 .83 -.03 -1.5 .15 -.07 -3.48 <.0l
Conflict .07 1.56 .12 .07 3.37 <.01* .01 .53 .60
Achievement Orientation -.03 -.68 .50 -.04 -1.64 .10 -.01 -.53 .60
Intellectual-cultural Orientation .04 1.02 .31 -.05 -2.38 .02 -.04 -1.85 .07
Active-Recreational -.01 -.30 .77 -.06 -2.79 * i o V .03 1.49 .14
Organization -.05 -1.19 .23 -.03 -1.39 .17 -.01 -.63 .53
Control -.01 -.20 .84 -.01 -.21 .83 -.02 -1.17 .24
Notes. FES = Family Environment Scale; CD = Conduct Disorder; MDD = Major Depressive Disorder. =
standardized multiple regression coefficient.
* =p < .01.


Table 2.5
Correlations for CD and MDD Symptoms
£
o
CD MDD
FES Scales r N v r N £_
Cohesion -.172** 2832 <.01 ,136** 2832 <01
Expressiveness -.089** 2833 <01 -.057** 2833 <01
Conflict .176** 2834 <01 .118** 2834 <01
Achievement Orientation -.087** 2831 <01 ,068** 2831 <01
Intellectual-cultural Orientation -.086** 2826 <01 -.056** 2826 <01
Active-Recreational -.094** 2832 <01 -.104** 2834 <01
Organization -.111** 2831 <01 -.068** 2831 <01
Control -.049** 2834 <01 -.007 2834 .72
Note. FES = Family Environment Scale; CD = Conduct Disorder; MDD = Major Depressive Disorder, r = Pearson
product moment correlation.
**Correlation is significant at the 0.01 level (2-tailed).


Table 2.6
Summary of Simultaneous Regression Analysis for CD and MDD Symptoms and Gender
FES Scales CD t D MDD t D Gender t P
Cohesion -.16 -3.63 o V -.09 -3.67 A * -.02 -1.06 .29
Expressiveness -.05 -1.02 .31 -.04 -1.43 .15 -.06 -3.04 <.01
Conflict .18 4.04 <.01* .11 4.33 <.01* .00 .04 .97
Achievement Orientation -.03 -.66 .51 -.01 -.35 .73 .00 -.02 .98
Intellectual-cultural Orientation -.06 -1.30 .20 -.06 -2.28 .02 -.04 -1.70 .09
Active-Recreational -.06 -1.29 .20 -.06 -2.40 .02 .03 1.60 .11
Organization -.11 -2.47 .01 -.03 -1.21 .23 .00 .16 .88
Control -.08 -1.75 .08 .02 .60 .55 -.02 -1.05 .30
Notes. FES = Family Environment Scale; CD = Conduct Disorder; MDD = Major Depressive Disorder. =
standardized multiple regression coefficient.
*p<.01.