ABELA ET AL.EXCESSIVE REASSURANCE SEEKING

EXCESSIVE REASSURANCE SEEKING,SELF–ESTEEM, AND DEPRESSIVE SYMPTOMSIN CHILDREN OF AFFECTIVELY ILL PARENTS:AN EXPERIENCE SAMPLING ANALYSIS

JOHN R. Z. ABELA, ELESHIA MORRISON, AND CLAIRE STARRS

The current study examined whether excessive reassurance seeking serves as a vul-nerability factor to depressive symptoms in a sample of children of affectively illparents using a multiwave longitudinal design and experience sampling methodol-ogy. In addition, we examined whether self–esteem moderates the association be-tween excessive reassurance seeking and increases in depressive symptomsfollowing increases in negative events. At Time 1, 56 children (ages 7–14) com-pleted measures assessing excessive reassurance seeking, low self–esteem, and de-pressive symptoms. Subsequently, children were given a handheld personalcomputer (HP Jornada 690), which signaled them to complete measures assessingdepressive symptoms and negative events at six randomly selected times over an8–week follow–up interval. In line with hypotheses, higher levels of reassuranceseeking were associated with greater increases in depressive symptoms followingincreases in negative events. Contrary to hypotheses, however, the strength of thisassociation was not moderated by self–esteem.

Coyne’s (1976) interpersonal theory of depression posits that depressedindividuals perpetuate a cycle of negative interpersonal exchanges thattriggers increases in their depressive symptoms. More specifically,Coyne proposes that initially nondepressed but mildly dysphoric indi-viduals seek reassurance from significant others in order to assuage

Journal of Social and Clinical Psychology, Vol. 26, No. 7, 2007, pp. 849–869

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The research reported in this article was supported by a Young Investigator Awardfrom the National Alliance for Research on Schizophrenia and Depression (NARSAD) anda New Opportunities Award from the Canada Foundation from Innovation (CFI)awarded to John R. Z. Abela.

Correspondence may be addressed to John R. Z. Abela, Department of Psychology,McGill University, Stewart Biological Sciences Building, 1205 Dr. Penfield Avenue, Mon-treal (Quebec) Canada H3A 1B1. E–mail: abela@ego.psych.mcgill.ca.

their doubts about their own self–worth and lovability. Others initiallyrespond with genuine concern and support. The individual, however,perceives this support as inadequate and consequently escalates his orher symptoms in an effort to secure more reassurance and acceptance.Although others continue to provide support, they begin to experiencefeelings of irritation and guilt, leading to a separation between the con-tent and affective quality of their reassuring statements. This discrep-ancy increases the individual’s fear of rejection, which in turn leads to afurther escalation of symptoms in order to restore the feeling of security.This downward spiral continues until either others withdraw from theindividual or the individual seeks treatment.

Joiner and colleagues (e.g., Joiner, Metalsky, Katz, & Beach, 1999a)posit that individual differences exist in the tendency to seek reassur-ance from others. Excessive reassurance seeking is defined as “a rela-tively stable tendency to excessively and persistently seek assurancesfrom others that one is loveable and worthy, regardless of whether suchassurances have already been provided” (Joiner et al., 1999a, p. 270). Ex-cessive reassurance seeking behaviors are hypothesized to be motivatedby highly accessible, maladaptive, cognitive–interpersonal scripts (e.g.,“If I feel bad, then I ask my parents if they love me”) that become activatedwhen individuals experience concerns about their self–worth and/orfuture (Van Orden, Wingate, Gordon, & Joiner, 2005). According toJoiner and colleagues, excessive reassurance seeking constitutes the cen-tral feature of Coyne’s (1976) theory as it serves as the vehicle throughwhich the “distress and desperation of depression is transmitted fromone person to another,” triggering negative outcomes for all.

Joiner and colleagues (e.g., Joiner, Katz, & Lew, 1999) posit that exces-sive reassurance seeking is particularly likely to lead to increases in de-pressive symptoms following negative events. Such reasoning is in linewith Coyne’s (1976) formulation as Coyne hypothesized that reassur-ance seeking behaviors are initially triggered by mild depressed moodexperienced in response to a negative event (e.g., loss of a relationship orother changes in social structure). Expanding upon Coyne’s model,Joiner and colleagues propose that negative events trigger concernsabout one’s worth and/or future. In an attempt to assuage such con-cerns, individuals seek reassurance from others regarding their ownlovability and others’ degree of dependability. Thus, according to Joineret al.’s extension of Coyne’s (1976) theory, excessive reassurance seekingserves as a vulnerability factor (e.g., diathesis) that interacts withnegative events (e.g., stress) to predict increases in depressivesymptoms.

Research with adult populations has generated support for many ofthe hypotheses derived from Coyne’s (1976) model. First, reassurance

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seeking has been demonstrated to be a valid, replicable, and cohesiveconstruct, distinct from other interpersonal variables such as general de-pendency, doubt in others’ sincerity, and dependence on close others(Davila, 2001; Joiner & Metalsky, 2001). Second, individuals who exhibithigh levels of reassurance seeking have been shown to exhibit higherlevels of depressive symptoms than individuals who exhibit low levelsof reassurance seeking (e.g., Joiner, 1994; Joiner, Alfano, & Metalsky,1992, 1993; Joiner & Metalsky, 1995; Joiner & Schmidt, 1998; Katz &Beach, 1997; Katz, Beach, & Joiner, 1998; Pothoff, Holahan, & Joiner,1995). Third, excessive reassurance seeking has been shown to interactwith negative events to predict increases in depressive symptoms (e.g.,Joiner & Metalsky, 2001; Katz et al., 1998; for an exception, see Shahar,Joiner, Zuroff, & Blatt, 2004). Fourth, researchers have demonstrated alink between excessive reassurance seeking and interpersonal rejection(Joiner et al., 1992, 1993; Joiner & Metalsky, 1995; Katz & Beach, 1997).Last, reassurance seeking has been found to play a role in the socialtransmission of depression, with individuals who exhibit high levels ofreassurance seeking more likely than their low reassurance seekingcounterparts to develop depression when interacting with a depressedpartner or roommate (Joiner, 1994; Katz, Beach, & Joiner, 1999). Thus,this body of research indicates an etiological role of reassurance seekingboth in the development of depression and in the generation of negativeinterpersonal outcomes (Joiner et al., 1999a).

Far less research has examined the relationship between excessive re-assurance seeking and depressive symptoms in children. Preliminaryresearch has shown that excessive reassurance seeking is associatedwith depressive symptoms and disorders among both youth psychiatricinpatients (Joiner, 1999; Joiner, Metalsky, Gencoz, & Gencoz, 2001) andchildren of affectively ill parents (Abela et al., 2005; Abela, Zuroff, Ho,Adams, & Hankin, 2006). Excessive reassurance seeking has also beenfound to predict increases in depressive symptoms following both theoccurrence of negative events (Abela et al., 2006; Prinstein, Borelli,Cheah, Simon, & Aikins, 2005) and the onset of parental depressivesymptoms (Abela et al., 2006). Last, excessive reassurance seeking hasbeen found to interact with depressive symptoms to predict interper-sonal rejection in youth psychiatric inpatients (Joiner, 1999). Thus, pre-liminary research supports the applicability of Joiner et al.’s extension ofCoyne’s (1976) theory to children. At the same time, due to the smallnumber of studies conducted with youth, additional research is needed.

The first goal of the current study was to provide an examination of thevulnerability–stress hypothesis of Joiner and colleagues’ (Joiner et al.,1999a) extension of Coyne’s (1976) theory in a sample of children and ad-olescents. In order to provide a rigorous test of this hypothesis, we uti-

EXCESSIVE REASSURANCE SEEKING 851

lized experience sampling methodology (ESM). More specifically, par-ticipants carried handheld personal computers (Jordana 690), whichsignaled them to complete questionnaires assessing the occurrence ofnegative events and depressive symptoms at randomly selected timesover a 6-week follow–up interval. An advantage of ESM is that it allowsfor the assessment of study variables in a naturalistic manner, minimiz-ing the impact of timing and context on assessments. Further, as partici-pants are cued by signaling devices to complete self–report measures inreal time, the recall bias associated with diary methods and recall biasesassociated with depressogenic distortions are minimized. ESM has beenshown to be a valid and practical means of assessing mood and cogni-tion (Csikszentmihalyi & Larson, 1987; deVries, Dijkman–Caes, &Delespaul, 1990) and has been used in a range of community and clinicalsamples (e.g., Brown & Moskowitz, 1998; Cote & Moskowitz, 1998;deVries & Delespaul, 1989; deVries, Delespaul, & Dijkman, 1987; Zuroff,Moskowitz, & Cote, 1999).

The second goal of the current study was to examine whether the rela-tionship between excessive reassurance seeking and increases in de-pressive symptoms following increases in negative events is moderatedby self–esteem. The structure of Coyne’s theory naturally allows for thepossibility that the relationship between excessive reassurance seekingand depressive symptoms is affected by moderator variables in additionto the occurrence of negative events. Researchers have investigated sev-eral interpersonal and cognitive features of depressed persons as mod-erators of this relationship including self–disclosure (Gurtman, 1987),self–blame (Gotlib & Beatty, 1985; Hokanson, Loewenstein, Hedeen, &Howes, 1986) and aid–seeking behaviors (Stephens, Hokanson, &Welker, 1987). We hypothesized that an individual’s level of self–esteemis likely to serve as an additional moderator of this relationship. Morespecifically, individuals with low self–esteem are less likely than theirhigh self–esteem counterparts to be reassured by the support and con-cern that they receive from significant others because it is inconsistentwith their negative self–view (Swann, Rentfrow, & Guinn, 2003). Suchindividuals are therefore more likely to enter into the vicious cycle de-scribed by Coyne (1976) by seeking additional reassurance from othersand consequently, over time, are more likely to have their demands forreassurance met with rejection. Only one study to date has examinedself–esteem as a moderator of the relationship between reassuranceseeking and depressive symptoms. Providing partial support for thishypothesis, using a university student sample, Joiner et al. (1992) re-ported that the combination of depressive symptoms, excessive reassur-ance seeking, and low self–esteem placed individuals at the greatest riskfor interpersonal rejection. This finding, however, held only for males

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and not for females. Further, the authors did not examine whether theinteraction of excessive reassurance seeking and low self–esteempredicted higher levels of depressive symptoms. Self–esteem as amoderator variable has not yet been examined in a child population.

In order to provide a powerful test of our hypotheses, the study uti-lized a sample of children of parents with a history of major depressiveepisodes. Employing such a sample was advantageous because childrenof parents with a history of major depressive episodes are four to sixtimes more likely than other children to develop depressive symptoms(Goodman & Gotlib, 2002). Thus, the use of such a sample likely maxi-mized the number of children and adolescents who experienced in-creases in depressive symptoms during the course of the study. The pro-cedure involved an initial laboratory assessment in which childrencompleted measures assessing reassurance seeking and depressivesymptoms. The procedure also involved a series of six follow–up assess-ments occurring at randomly selected times over the 8–week follow–upinterval, in which children were signaled by a handheld personal com-puter to complete measures assessing depressive symptoms and the oc-currence of negative events. The use of a multiwave longitudinal designallowed us to take an idiographic approach toward examining Joinerand colleagues’ (1999a) vulnerability hypothesis. Previous research ex-amining this hypothesis (i.e., Katz et al., 1998; Joiner & Metalsky, 2001;Shahar et al., 2004) has typically relied on two time–point designs inwhich (1) reassurance seeking and depressive symptoms were assessedduring an initial assessment and (2) depressive symptoms and stressorswere assessed during a follow–up assessment. Such a design necessi-tates the use of a nomothetic approach toward operationalizing high lev-els of stress. In other words, children are considered to be experiencing ahigh level of stress when their level of stress is higher than the sample’saverage level of stress. In contrast, the use of a multiwave longitudinaldesign, in which depressive symptoms and stressors are assessed re-peatedly throughout the follow–up interval, allows for an idiographic ap-proach toward operationalizing high levels of stress. In other words,children are considered to be experiencing a high level of stress whentheir level of stress is higher than their own average level of stress. Thisdistinction is central to testing Joiner and colleagues’ hypothesis that theinteraction between excessive reassurance seeking and low self–esteemwill moderate the association between children’s hassles and depressivesymptoms because Joiner and colleagues’ hypothesis posits that in-creases in levels of stress rather than absolute levels of stress will beassociated with increases in depressive symptoms in vulnerable youth(for more detailed discussion, see Abela & Hankin, in press).

In line with an idiographic perspective, we examined whether the

EXCESSIVE REASSURANCE SEEKING 853

slope of the relationship between negative events and depressive symp-toms within children varied across children as a function of excessive re-assurance seeking and self–esteem. More specifically, we hypothesizedthat high levels of reassurance seeking would be associated with greaterincreases in depressive symptoms following increases in negativeevents in youth possessing low, but not high, levels of self–esteem.Given that negative events and depressive symptoms were assessedcontemporaneously in our analyses, in order to provide a stringent ex-amination of our central hypothesis, we also examined the reversemodel, a stress–exposure model (Pothoff et al., 1995; Shahar et al., 2004),in which it was hypothesized that high levels of reassurance seekingwould be associated with greater increases in negative events followingincreases in depressive symptoms in youth possessing low, but not high,levels of self–esteem.

METHOD

PARTICIPANTS

Participants in the current study were recruited from a sample partici-pating in a larger project examining vulnerability to depression in chil-dren of parents with a history of major depressive episodes (e.g., Abela,Skitch, Adams, & Hankin, 2006; Abela, Skitch, Auerbach, & Adams,2005). Participants were recruited through ads placed in local Englishnewspapers and posters placed in the Montreal area. Both posters andnewspaper ads targeted parents with a history of major depressive dis-order and children between the ages of 6 and 14. Respondents werescreened during phone interviews using the Structured Clinical Inter-view for the DSM–IV (SCID–I; First, Gibbon, Spitzer, & Williams, 1995).Parents who met criteria for current or past major depressive disorderwere invited to participate in the study. The initial sample consisted of102 parents (88 women) with 140 children (71 girls). Thus, 38 siblingpairs were included in the initial sample.

All children were given the opportunity to participate in this secondESM portion of the study, and 56 consented to do so (45% female). Forthese 56 children, ages ranged from 7 to 14, with a mean age of 10.6 years.No siblings participated in the ESM portion of the study. The samplewas 78.8% Caucasian, 1.9% Native American, 1.9% Asian, and 17.3% ofother descent. Participants’ mother tongue included English (72.2%),French (5.6%), and others (22.2%). Parents’ marital statuses were 56.9%married, 25.5% divorced, 9.8% separated, 2.0% single, and 5.9% other.The uppermost level of education completed by the parents was somehigh school for 3.9%, a high school diploma for 3.9%, some community

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college for 7.8%, a community college diploma for 11.8%, some univer-sity for 23.5%, a university diploma for 25.5%, and a graduate school di-ploma for 23.5%. The median family income ranged from $30,000 to$45,000. Children who chose to participate in the ESM portion of thestudy did not differ significantly from children who chose not to partici-pate in age (t(103) = 1.31, ns), gender (t(101) = .48, ns), parental education(t(97) = –.53, ns), family income (t(94) = –1.03, ns), level of child depres-sive symptoms at baseline (t(102) = 1.40, ns), or level of child reassuranceseeking (t(102) = 0.09, ns) .

PROCEDURE

Participants were recruited during the second and final in–lab assess-ment of the larger project described above. During this assessment, chil-dren and parents signed consent to participate in the ESM portion of thestudy, and children were then verbally administered the followingquestionnaires: (1) the Children’s Depression Inventory (CDI; Kovacs,1981); (2) Reassurance Seeking Scale for Children (RSSC; Joiner et al.,2001); and (3) Self–Esteem Questionnaire (SEQ; Rosenberg, 1965). Sub-sequently, children were provided with HP Jornada 720 handheld com-puters for the ESM portion of the study. These computers wereprogrammed to signal children to complete self–report measures assess-ing the occurrence of negative events and the presence of depressivesymptoms every 5 to 9 days (~ once a week) at randomly selected timesoutside of class periods. When the alarm sounded, the child opened upthe computer and the question sets appeared automatically on thescreen. One question was presented at a time, and all questions wereread aloud by the computer while responses appeared on the screen.The child touched the response that best described him or her at thattime. The following questionnaires were completed at each of thesetimes: (1) CDI and (2) Hassles Scale for Children (Kanner, Feldman,Weinberger, & Ford, 1987).

MEASURES

The Structured Clinical Interview for the DSM–IV (SCID–I; First et al.,1995). The SCID–I is a semistructured clinical interview designed to in-dicate current and lifetime DSM–IV diagnoses. To allow for the diagno-sis of all DSM–IV mood disorders, the current study applied the affec-tive disorders and psychotic screen modules. Diagnostic interviewerswere required to complete an intensive training program in order to ad-minister the SCID–I interview and for assigning DSM–IV diagnoses. Thetraining program involved 40 hours of instruction, listening to

EXCESSIVE REASSURANCE SEEKING 855

audiotaped interviews, conducting practice interviews, and passingregular exams, where 85% or above had to be achieved. In order to qual-ify for conducting interviews, interviewers were required to listen tothree audiotaped interviews and demonstrate 100% agreement with theprincipal investigator on the presence or absence of a diagnosis of a de-pressive disorder. There also had to be a minimum of 85% agreement onseverity ratings of individual depressive symptoms. The principal in-vestigator held weekly supervision sessions for the interviewers wherethe interviewers’ notes were reviewed to confirm the presence or ab-sence of a diagnosis. In order to address any questions regarding theaccuracy of symptom ratings or diagnoses, interviewer audiotapes werealso reviewed.

Children’s Depression Inventory (CDI; Kovacs, 1981). The CDI is a27–item self–report questionnaire that measures the cognitive, affective,and behavioral symptoms of depression as displayed in children. Foreach item, children were asked to report whether it described how theywere thinking and feeling over the past week. Questionnaire items arescored from 0–2, where a higher score indicates greater symptom sever-ity. Total scores on the CDI questionnaire range from 0 to 52 points. Asdemonstrated in previous studies, the CDI possesses a high level of in-ternal consistency and distinguishes children with major depressive dis-orders from their nondepressed counterparts (Saylor, Finch, Spirito, &Bennett, 1984).

The Reassurance–Seeking Scale for Children (RSSC; Joiner & Metalsky,1995). The RSSC is a modified version of the Reassurance–Seeking Scale(RSS; Joiner & Metalsky, 1995) that was reworded to be comprehensibleto children. The revised scale consists of four items (e.g., Sometimes whenI ask people if they like me, they tell me to stop asking). Children are asked torate each statement on a 3–point scale (e.g., not very much, kind of a lot, andvery much). Total scores range from 0 to 8, where higher scores corre-spond to higher levels of reassurance seeking. The reliability and valid-ity of the original RSS for adults have been well documented in variousstudies (e.g., Joiner, 1994; Joiner et al., 1992). Studies using the RSSC insamples of children between the ages of 6 and 17 also report high de-grees of reliability and validity (Abela, Hankin, et al., 2005; Abela,Zuroff, et al., 2006; Joiner, 1999; Joiner et al., 2001).

Self–Esteem Questionnaire (SEQ, Rosenberg, 1965). The SEQ asks chil-dren to rate 10 statements about self–perceptions on a 1–5 scale. Chil-dren are asked to indicate whether they strongly agree, agree, disagree,or strongly disagree with each item (e.g., “I feel that I have a number ofgood qualities"). Items are scored from 0 to 3 with higher scores indicat-ing lower levels of self–esteem. Scores for each item are added, yieldinga composite score ranging from 0 to 30.

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Hassles Scale for Children (HASC; Kanner et al., 1987). The HASC is alist of 39 negative events that children may experience (e.g., parents sepa-rate or divorce, a close friend moves away). Children are asked to rate howoften each event happened to them during the past week using a scale of0 (never) to 4 (all the time). A total score is obtained by summing responseson all items and can range from 0 to 156, whereby higher scores indicatethe occurrence of a greater number of hassles.

RESULTS

DESCRIPTIVE STATISTICS

Means, standard deviations, and intercorrelations between all Time 1measures are presented in Table 1. Several findings warrant additionalattention. First, higher levels of depressive symptoms were associatedwith higher levels of reassurance seeking and lower levels of self–es-teem. Second, higher levels of reassurance seeking were associated withlower levels of self–esteem. Last, older children reported lower levels ofreassurance seeking behaviors than younger children.

Means and standard deviations for CDI and HASC scores across thesix follow–up assessments are presented in Table 2. As each child com-pleted the CDI at multiple follow–up assessments, each child has his orher own mean level of depressive symptoms (i.e., his or her her averageCDI score during the follow–up interval) as well as his/her own degreeof variation in depressive symptoms during the follow–up interval (i.e.,his or her SD on the CDI across administrations). Within–subject meanson the CDI ranged from 0.00 to 21.83 (μ = 7.64; SD = 5.87) while

EXCESSIVE REASSURANCE SEEKING 857

TABLE 1. Means, Standard Deviations, and Intercorrelations between Time 1 Measures

1 2 3 4 5

1. CDI —

2. RSSC .36** —

3. CSEQ .51*** .34* —

4. AGE .05 –.37** –.01 —

5. GENDER .07 .02 –.18 –.09

Mean 5.74 0.76 8.61 10.62 0.45

SD 4.27 1.37 4.26 2.01 0.50

Note. CDI = Children’s Depression Inventory. RSSC = Reassurance Seeking Scale for Children. CSEQ =Children’s Self–Esteem Questionnaire. AGE = Children’s age. GENDER = Children’s gender (0 = Boy; 1 =Girl). ***p < .001. **p < .01. *p < .05.

within–subject standard deviations ranged from 0.55 to 16.92 (μ = 3.00;SD = 2.76). With respect to the children’s levels of hassles, within–sub-ject means on the HASC ranged from 3.00 to 90.00 (μ = 32.91; SD = 18.62)while within–subject standard deviations ranged from 1.41 to 51.08 (μ =9.76; SD = 8.78).

TEST OF THE VULNERABILITY–STRESS HYPOTHESIS

To test our hypothesis that children who possess both high levels of ex-cessive reassurance seeking and low levels of self–esteem would reportgreater increases in depressive symptoms following increases in stressthan children who possess only one or neither of these vulnerability fac-tors, multilevel modeling was employed. Analyses were carried out us-ing the SAS (version 8.1) MIXED procedure as well as the maximumlikelihood estimation. Our dependent variable was within–subject fluc-tuations in CDI scores during the follow–up interval (FU_CDI). BecauseFU_CDI is a within–subject variable, CDI scores were centered at eachparticipant’s mean such that FU_CDI reflects fluctuations in a child’slevels of depressive symptoms as compared to his or her mean level ofdepressive symptoms. Our primary predictors of changes in depressivesymptoms (FU_CDI) were excessive reassurance seeking (RSSC),self–esteem (SEQ), and fluctuations in hassle (HASC) scores during thefollow–up interval (FU_HASSLES). As RSSC and CSEQ are be-tween–subject predictors, RSSC scores and CSEQ scores were standard-ized prior to analyses. Because FU_HASSLES is a within–subjectpredictor, HASC scores were centered at each participant’s mean priorto analyses so that FU_HASSLES may reflect fluctuations in a child’slevel of hassles as compared to his or her mean level of hassles.

Preliminary analyses were conducted examining whether children’sage or gender served as a moderator of any relationships. No significant

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TABLE 2. Means and Standard Deviations of Child Depressive Symptoms and Hasslesover Six Follow–up Assessments

1 2 3 4 5 6

CDI

Mean 7.16 6.33 7.65 6.70 8.84 8.92

SD 5.96 4.69 6.76 5.58 9.08 9.41

HASC

Mean 33.89 33.04 34.39 31.36 34.71 31.00

SD 16.57 18.83 23.81 23.89 28.76 24.46

Note. CDI = Children’s Depression Inventory. HASC = Hassles Scale for Children.

interactions involving either children’s age or gender were found. Con-sequently, for the sake of simplicity, results are presented only for mod-els including RSSC, SEQ, FU_HASSLES, and all two– and three–wayinteractions.

When fitting hierarchical linear models, one must specify appropriatemean and covariance structures. It is important to note that mean andcovariance structures are not independent of one another. Rather, an ap-propriate covariance structure is essential in order to obtain valid infer-ences for the parameters in the mean structure. Overparametrization ofthe covariance structure can lead to inefficient estimation and poor as-sessment of standard errors (Altham, 1984). On the other hand, toomuch restriction of the covariance structure can lead to invalid infer-ences when the assumed structure does not hold (Altham, 1984). Diggle,Liang, and Zeger (1994) recommend that one use a “saturated” modelfor the mean structure while searching for an appropriate covariancestructure.

In the current study, we were interested in examining the effects ofRSSC, CSEQ, and FU_HASSLES on children’s CDI scores during the6–week follow–up interval. Consequently, we chose a mean structurethat included RSSC, CSEQ, and FU_HASSLES, and all two– andthree–way interactions. Three additional effects were also included inthis initial mean structure. First, in order to control for individual differ-ences in baseline levels of depressive symptoms, children’s Time 1 CDIscores were included in the model. Second, because different childrenare likely to have different levels of depressive symptoms when experi-encing their own average level of hassles, a random intercept was in-cluded in the model. Last, given that fluctuations in negative events is awithin–subject predictor whose effect is expected to vary from partici-pant to participant, a random effect for slope was included in the model.

Compound symmetry, autoregressive, and banded Toeplitz are ex-amples of commonly used covariance structures in studies where multi-ple responses are obtained from the same individual over time, with aconsequent correlation with within–subject residuals. In order to selectone of these covariance structures for analysis of the data, models werefitted utilizing each structure and the “best” fit was chosen based on theAkaike information criterion (AIC and AICC) and the Schwarz Bayesiancriterion (BIC). The best fit was found to be an autoregressive structure.

After choosing the appropriate covariance structure, we next exam-ined the random–effects component of our model. Nonsignificant ran-dom–effect parameters were deleted from the model prior to examiningthe fixed–effects component. With respect to random effects, the ran-dom intercept (p < .01) was significant and thus was retained in themodel. Further, the AR(1) parameter was significant (r = 0.28, p < .05)

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and thus was retained in our model. The random slope, however, wasnot significant and thus was deleted from the model prior to examiningthe fixed effects.

The final results relating to the fixed–effects component of the modelare presented in Table 3. In line with Joiner and colleagues’ vulnerabil-ity–stress hypothesis, a significant two–way, cross-level interactionemerged between RSSC and FU_HASSLES. In order to examine theform of this interaction, we used the model summarized in Table 1 to cal-culate predicted CDI scores for children possessing either low or highlevels of excessive reassurance seeking (± 1.5 between–subject SD) andwho are experiencing either low or high levels of stress in comparison totheir own average level of stress (± 1.5 mean within–subject SD). The re-sults of these calculations are presented in Figure 1. Because bothFU_CDI and FU_HASSLES are within–subject variables centered ateach participant’s mean, slopes are interpreted as the increase in achild’s CDI score that would be expected in the case where he or shescored one point higher on the HASC.

Analyses were conducted for each RSSC condition, examiningwhether the slope of the relationship between negative life events anddepressive symptoms significantly differed from 0. Analyses demon-strated that children who possessed high levels of excessive reassuranceseeking reported higher levels of depressive symptoms when experienc-ing high levels of negative events than when experiencing low levels ofnegative events (slope = 0.22; t(202) = 3.61, p < .001). Level of depressivesymptoms, however, did not vary as a function of level of negativeevents for children possessing low levels of excessive reassurance seek-

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TABLE 3. Hierarchical Linear Modeling Analyses:Predicting Fluctuations in Depressive Symptoms during the Follow–up Interval

Predictor b SE F dfTime 1 CDI 3.45 0.74 21.54*** 45

RSSC –0.22 0.80 0.07 45

SEQ 1.09 0.72 2.26 45

FU_HASSLES 0.08 0.02 10.12** 202

RSSC × FU_HASSLES 0.11 0.05 6.44* 202

SEQ × FU_HASSLES –0.05 0.03 1.69 202

RSSC × SEQ 0.32 0.57 0.32 45

RSSC × SEQ × FU_HASSLES –0.05 0.03 3.11 202

Note. CDI = Children’s Depression Inventory. RSSC = Reassurance Seeking Scale for Children. SEQ =Self–Esteem Questionnaire. FU_HASSLES. = Within–subject fluctuations in Hassles Scale for Children(HASC) scores during the follow–up interval. ***p < .001. **p < .01. *p < .05.

High Reassurance Seeking

Low Reassurance Seeking

16 –

14 –

12 –

10 –

8 –

6 –

4 –

2 –

0 –

Pre

dic

ted

CD

IS

co

re

Low Intercept High

Level of Negative Events

ing (slope = –0.08, t(202) = 1.19, ns). A planned comparison of the slopeof the relationship between depressive symptoms and negative eventsfor children possessing high and low levels of RSSC indicated that thesetwo slopes differed significantly from one another (t(202) = 2.47, p < .05).

We next examined whether the strength of the association between theRSSC × FU_HASSLES interaction and FU_CDI was moderated byself–esteem. Contrary to our integrative model, however, the SEQ ×RSSC × FU_HASSLES interaction was not significant.

TEST OF ALTERNATIVE MODEL

Given that negative events and depressive symptoms were assessedcontemporaneously in the above described analyses, we also examinedan alternative model in which it was hypothesized that high levels of re-assurance seeking would be associated with greater increases in nega-tive events following increases in depressive symptoms in youthpossessing low, but not high, levels of self–esteem. Analyses were simi-lar to those described above with the exception of (1) our dependentvariable being fluctuations in HASC scores during the follow–up inter-

EXCESSIVE REASSURANCE SEEKING 861

FIGURE 1. Predicted level of depressive symptoms in children as a function ofreassurance seeking and hassles.

val rather than fluctuations in CDI scores (2) and our within–subject pre-dictor variable being fluctuations in CDI scores during the follow–upinterval rather than fluctuations in HASC during the follow–up interval.The results of our final model are reported in Table 4. Of primary impor-tance, none of the two–way or three–way cross–level interaction termswere significant predictors of fluctuations in hassles scores during thefollow–up interval.1

DISCUSSION

The results of the current study provide partial support for our hypothe-ses. More specifically, in line with Joiner and colleagues’ (1999a) exten-sion of Coyne’s (1976) interpersonal theory of depression, higher levelsof reassurance seeking were associated with higher levels of current de-pressive symptoms. Further, in line with the vulnerability–stress com-ponent of Joiner and colleagues’ model, higher levels of reassuranceseeking were associated with greater increases in depressive symptomsfollowing increases in negative events. It is important to note that suchfindings are consistent with those obtained in past cross–sectional(Abela, Hankin, et al., 2005; Joiner, 1999; Joiner et al., 2001) and longitu-dinal (Abela, Zuroff et al., 2006; Prinstein et al., 2005) research withyouth, thus adding to a growing body of literature suggesting that ex-cessive reassurance serves as a vulnerability factor to depressive symp-toms in both children and early adolescents. In addition, the currentresults expand upon those obtained in past prospective research (Joiner& Metalsky, 2001; Katz et al., 1998; Prinstein et al., 2005) by demonstrat-ing that excessive reassurance seeking interacts with within–subject

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1. Given that past research examining the stress–exposure model (e.g., Potthoff et al.,1995) has examined the effect of reassurance seeking on hassles within a main–effectframework, we also examined the hierarchical linear model reported in Table 4 in astepwise fashion. In doing so, we first examined the main effects of RSSC and SEQ onFU_HASSLES. Next, we examined the cross-level interactions between RSSC/SEQ andFU_CDI. Finally, we examined the three–way interaction between RSSC, SEQ, andFU_CDI. In our first model, after controlling for initial levels of depressive symptoms, nei-ther reassurance seeking (b = 1.40, SE = 2.91, F(1, 49) = 0.23, ns) nor self–esteem (b = 3.44, SE= 2.94, F(1, 49) = 1.37, ns) were associated with children’s level of hassles during the 8-weekfollow–up interval. In our second model, although fluctuations in children’s levels of de-pressive symptoms were significantly associated with fluctuations in their levels of hassles(b = 0.60, SE = 0.21, F(1, 203) = 7.68, p < .01), the strength of this association was not moder-ated by either reassurance seeking (b = 0.33, SE = 0.30, F(1, 203) = 1.24, ns) or self–esteem (b =–0.02, SE = 0.32, F(1, 203) = 0.00, ns). In our final model, neither RSSC × SEQ (b = 2.31, SE =2.34, F(1, 45) = 0.98, ns) nor its interaction with FU_CDI (b = –0.37, SE = 0.21, F(1, 203) = 3.05,ns) were significant predictors of children’s levels of hassles during the follow–up interval.

fluctuations in stress, as opposed to the between–subject effect of stress,to predict within–subject fluctuations in depressive symptoms. Giventhat Joiner and colleagues’ model posits that increases in stress, ratherthan absolute levels of stress, trigger reassurance seeking behavior invulnerable individuals, future research should continue to examine thishypothesis from an idiographic, as opposed to a nomothetic, perspec-tive. Doing so is likely to lead to more consistent and powerful supportfor the vulnerability hypothesis of Joiner and colleagues’ extension ofCoyne’s theory.2

Contrary to our hypotheses, the association between excessive reas-surance seeking and greater increases in depressive symptoms follow-ing increases in negative events was not moderated by self–esteem. Onepossible explanation for the lack of support for our integrative model isthat we examined trait self–esteem as a moderator rather than self–es-teem lability. More specifically, research investigating self–esteem hastypically used a trait conceptualization in which an individual’s “level”is measured at a single time point and day–to–day fluctuations are dis-

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TABLE 4. Hierarchical Linear Modeling Analyses:Predicting Fluctuations in Negative Events During the Follow–up Interval

Predictor b SE F dfTime 1 CDI 4.04 3.06 0.89 45

RSSC –0.17 3.27 0.00 45

SEQ 2.79 2.96 0.89 45

FU_CDI 0.68 0.22 9.64** 202

RSSC × CDI 0.60 0.33 3.25 202

SEQ × CDI 2.31 2.34 0.04 202

RSSC × SEQ 2.31 2.34 0.98 45

RSSC ×SEQ × CDI –0.37 0.21 3.05 202

Note. CDI = Children’s Depression Inventory. RSSC = Reassurance Seeking Scale for Children. SEQ =Self–Esteem Questionnaire. FU_CDI = Within–subject fluctuations in CDI scores during the follow–up in-terval. ***p < .001. **p < .01. *p < .05.

2. In order to examine whether similar results to those reported in the current articlewould be obtained using a nomothetic approach to analysis, we examined a hierarchicallinear model that included Time 1 CDI, RSSC, SEQ, the between–subject effect of stress(MN_HASSLES), and all two– and three–way interactions involving RSSC, SEQ, andMN_HASSLES. Although youth experiencing a level of stress that was high in comparisonto the sample’s average level of stress reported higher levels of depressive symptoms (b =0.15, SE = 0.02, F(1,41) = 40.04, p < .001), the strength of this association was not moderatedby RSSC (b = 0.05, SE = 0.03, F(1, 41) = 0.72, ns), SEQ (b = 0.02, SE = 0.04, F(1, 41) = 0.32, ns), orthe RSSC × SEQ interaction (b = –0.01, SE = 0.03, F(1, 41) = 0.04, ns).

missed as measurement error (e.g., Abela & Taylor, 2003; Abela, Webb,Wagner, Ho, & Adams, 2006). In line with this reasoning, we measuredchildren’s level of self–esteem only during the initial assessment. Recentresearch however, suggests that self–esteem lability may play a strongerrole in vulnerability to depression than does trait level of self–esteem(Butler, Hokanson & Flynn, 1994; Roberts & Kassel, 1997). The termlability signifies fluctuation, whereby an individual’s level of self–es-teem is continuously influenced by daily threats and boosts. Irrespectiveof whether or not they possess low or high trait levels of self–esteem,youth with high levels of self–esteem lability may be especially reactiveto negative events as disturbances in their social worlds trigger distur-bances in their self–perception. When coupled with excessive reassur-ance seeking, self–esteem lability may be particularly problematic be-cause negative events are likely to lead to reassurance seeking behaviorsthat are apt to be met with rejection (Joiner, 1999; Joiner et al., 1992, 1993;Joiner & Metalsky, 1995; Katz & Beach, 1997) further amplifying instabil-ity in sense of self and consequently depressive symptoms. In light ofour findings, we would suggest that future research should examinewhether the association between reassurance seeking and fluctuationsin depressive symptoms following fluctuations in negative events ismoderated by self–esteem lability.

The current study advances research examining Coyne’s (1976) inter-personal theory of depression as extended by Joiner and colleagues inseveral ways. First, the current study is one of the first prospective stud-ies to examine whether excessive reassurance seeking serves as a vulner-ability factor to depressive symptoms in a youth sample (for additionalprospective studies, see Abela, Zuroff, et al., 2006; Prinstein et al., 2005).Second, the current study is one of the first to examine whether the asso-ciation between excessive reassurance seeking and depressive symp-toms is moderated by the occurrence of negative events (for additionalstudies, see Abela, Zuroff, et al., 2006; Joiner & Metalsky, 2001; Katz etal., 1998; Prinstein et al., 2005). Last, the current study is one of the first totest the vulnerability–stress hypothesis of Joiner and colleagues’ exten-sion of Coyne’s interpersonal theory of depression using a multiwavelongitudinal design and an idiographic approach to analysis (see Abela,Zuroff, et al., 2006) as well as the first to do so using experience samplingmethodology.

At the same time, several limitations of the current study should benoted. First, self–report measures were used to assess depressive symp-toms. Although both the CDI and the BDI possess high degrees of reli-ability and validity, one cannot draw conclusions about clinically diag-nosed depression based on self–report questionnaires. Second,self–report measures were used to assess stress. Although measures of

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life events that require participants only to indicate whether or not anevent occurred are probably less likely to be influenced by informantbias than those that ask subjects to rate the subjective impact of eachevent, more sophisticated methods of analysis such as interviewing pro-cedures that assess contextual threat may provide better assessments ofstress (Brown & Harris, 1978). Third, although the current study exam-ined, and failed to provide support for, a stress exposure model (i.e.,children with high levels of reassurance seeking are exposed to a greaternumber of negative events), the design of the current study did not allowus to examine a stress generation model (i.e., children with high levels ofreassurance seeking contribute to higher levels of dependent interper-sonal, but not dependent noninterpersonal and independent negative,events; Hammen, 1991). A true examination of such a model requires aninterview-based assessment of stressors in which a team of coders blindto each youth’s vulnerability status rates stressors as dependent or inde-pendent of youths’ behaviors and characteristics (Hammen, 2006). Thus,future research is needed to exame the degree to which youth with ex-cessive reassurance seeking tendencies contribute to the negative eventsthat occur in their lives—particularly those in the interpersonal domain.Fourth, the current study examined only the relationship between exces-sive reassurance seeking and depressive symptoms. Thus, we were un-able to identify whether excessive reassurance seeking served as a vul-nerability factor specifically to depressive symptoms. Future researchshould assess a broader range of psychological symptoms in order to ex-amine the specificity of excessive reassurance seeking to depressivesymptoms in early adolescents. Fifth, the current study did not controlfor additional variables that could potentially account for the relation-ship between reassurance seeking and depressive symptoms. Conse-quently, we cannot rule out the possibility that a third variable could ac-count for the pattern of findings obtained. At the same time, it isimportant to note that research with adult populations has obtainedsupport for the relationship between reassurance seeking and depres-sive symptoms even after controlling for self–esteem (e.g., Joiner et al.,1992), interpersonal difficulties (e.g., Potthoff et al., 1995), attachment in-security (Davila, 2001), and neuroticism (Joiner, Metalsky, Katz, &Beach, 1999b). Last, the current study utilized a sample of self–identi-fied, high–risk parents (predominantly mothers) and their children. Al-though such a design leads to a powerful test of the vulnerabilityhypothesis, results cannot be generalized to other populations (e.g.,samples not recruited specifically on the basis of parental depression).Future research is needed to examine whether similar results areobtained using a community sample of children and their parents.

In sum, the results of the current study indicate that excessive reassur-

EXCESSIVE REASSURANCE SEEKING 865

ance seeking is associated with greater increases in depressive symp-toms following increases in negative events in children and early adoles-cents. At the same time, contrary to our integrative model, self–esteemwas not shown to moderate this relationship. As future research exam-ining the role of interpersonal factors in the etiology of depression accu-mulates, a greater understanding of the mechanisms that underlie theonset of depression in children will likely emerge. Such an enhanced un-derstanding is likely to improve our ability to identify children at risk fordepression, to prevent such children from experiencing future depres-sive episodes, and to provide successful treatment programs forchildren already experiencing depressive disorders.

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