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Comparing Cognitive, Relational and Stress Mechanisms Underlying GenderDifferences in Recovery from Bereavement-Related Internalizing ProblemsMichelle Little a; Irwin N. Sandler b; Sharlene A. Wolchik b; Jenn-Yun Tein b; Tim S. Ayers b

a Psychology Department, University of Texas at San Antonio, b Arizona State University,

Online Publication Date: 01 July 2009

To cite this Article Little, Michelle, Sandler, Irwin N., Wolchik, Sharlene A., Tein, Jenn-Yun and Ayers, Tim S.(2009)'ComparingCognitive, Relational and Stress Mechanisms Underlying Gender Differences in Recovery from Bereavement-Related InternalizingProblems',Journal of Clinical Child & Adolescent Psychology,38:4,486 — 500

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Comparing Cognitive, Relational and Stress MechanismsUnderlying Gender Differences in Recovery from

Bereavement-Related Internalizing Problems

Michelle Little

Psychology Department, University of Texas at San Antonio

Irwin N. Sandler, Sharlene A. Wolchik, Jenn-Yun Tein, and Tim S. Ayers

Arizona State University

Four putative mediators underlying gender differences in youths’ recovery frombereavement-related internalizing problems were examined in a sample (N¼ 109; agerange¼ 8–16 years at the initial assessment) of parentally bereaved youth: intrusivethoughts about grief, postdeath stressors, negative appraisals of postdeath stressors,and fear of abandonment. A three-wave parallel process longitudinal growth modeldesign was employed. Changes in internalizing problems and mediators were measuredas a function of months since the death. Girls showed stability in depression symptomsand a slight rise in anxiety symptoms; boys’ trajectories of symptoms of anxiety anddepression declined. Girls’ higher initial levels of postdeath stressors, threat appraisalsand fear of abandonment mediated their higher level of internalizing problems 14months later. Girls’ higher initial fear of abandonment also mediated additional growthin anxiety relative to boys.

There is considerable evidence that parental death isassociated with increased risk for developing depressionand other internalizing problems during childhood andadulthood (Kranzler, Shaffer, Wasserman, & Davies,1990). Well-designed, community-based studies usingcomparable nonbereaved comparison groups have foundthat bereaved children are more likely than nonbereavedchildren to experience elevated levels of depressive symp-toms (Worden & Silverman, 1996), even as toddlers(McLeod, 1991). Further, internalizing problems relatedto parental bereavement persist up to several years afterthe death (Reinherz et al., 1999).

Several studies have shown higher rates and morepersistent stability of internalizing problems for bereavedgirls than boys (Reinherz et al., 1999; Schmiege, Khoo,Sandler, Ayers, & Wolchik, 2006; Worden & Silverman,1996). Worden and Silverman found that girls’ higher

levels of internalizing problems emerged 2 years followingparental death. Moreover, in the current sample ofbereaved youth, Schmiege et al. (2006) found that girlsshowed a stable trajectory of internalizing problems,whereas boys showed a decline over 45 months followingthe death. This pattern of findings suggests that bereavedgirls are less likely to recover from bereavement-relatedinternalizingproblems compared toboys. This differentialpersistence in bereaved girls’ internalizing problems mayincrease their vulnerability for the development of adultinternalizing disorders. Consistent with this notion, long-itudinal research (McLeod, 1991; Reinherz et al., 1999)shows thatwomenwho experiencedparental death as chil-dren or youth (up to age 16) are more likely than men toexperience major depression in young adulthood (forexception, seeKendler, Sheth,Gardner,&Prescott, 2002).

Moving beyond risk analyses to the study of mechan-isms underlying gender differences in bereavedchildren’s internalizing problems advances knowledgein two significant ways. First, findings for bereavedchildren may have implications for response to other

Correspondence should be addressed to Michelle Little, Psycho-

logy Department, One UTSA Circle, University of Texas at San

Antonio, San Antonio, TX 78249. E-mail: Michelle.little@utsa.edu

Journal of Clinical Child & Adolescent Psychology, 38(4), 486–500, 2009

Copyright # Taylor & Francis Group, LLC

ISSN: 1537-4416 print=1537-4424 online

DOI: 10.1080/15374410902976353

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losses so that understanding processes that mediate gen-der differences in internalizing problems followingbereavement may have broader implications for ourtheoretical understanding of gender differences in thedevelopment of internalizing problems. Second, if themechanisms are potentially modifiable they may be tar-geted in theoretically guided preventive interventions toreduce the heightened risk for developing internalizingproblems in bereaved girls (Rutter & Maughan, 1997;Sandler, Wolchik, Davis, Haine, & Ayers, 2003).

The primary aim of this study is to compare andcontrast three alternative theoretical models to explaingender differences in trajectories of internalizingproblems following parental death. These include differ-ential ruminative responses to loss, differential exposureto and negative appraisals of postdeath stressors,and differential response to interpersonal loss. Thesemodel comparisons were chosen based on review ofthe research on gender differences in bereavement andour current developmental understanding of genderdifferences in risk for internalizing problems.

GENDER DIFFERENCES IN RUMINATIVERESPONSES TO STRESS

There is considerable evidence that women show a moresevere and persistent ruminative response to significantstressors and losses than men (Nolen Hoeksema &Girgus, 1994; Nolen Hoeksema & Morrow, 1991).Recent research shows that girls are more likely to exhi-bit a ruminative response to their negative affect thanboys, which is characterized by persistent, negative intru-sive thoughts focusing on their negative affect (Abela,Brozina, & Haigh, 2002; Grant et al., 2004). Focusingpassively on negative affect (‘‘I don’t want to get out ofbed’’) and negative consequences of those symptoms(‘‘I will never feel better’’) rather than on active problemsolving or distraction leads to greater stability in childand adolescent depression (Abela, Brozina, & Haigh,2002; Broderick & Korteland, 2004) and has been linkedprospectively with anxiety (Calmes & Roberts, 2007).

Research on grief also provides support for the roleof a ruminative response to grief in the persistence ofinternalizing problems for bereaved women. For exam-ple, Meuser and Marwit (1999) found that widowswho showed high levels of emotion-focused coping sur-rounding their losses, characterized by ruminativeworry, self-blame, and regret about the death, experi-enced higher levels of grief 4 years after the death thanthose who did not use emotion-focused coping. Forthe current study, we considered potential links betweengender, intrusive grief thoughts, and internalizingproblems. Similar to other research on grief (Prigerson& Jacobs, 2001) intrusive grief thoughts was measured

broadly and captured both the frequency of negative,intrusive thoughts about the death, as well as the degreethat intrusive grief thoughts interfered with daily activ-ities. We hypothesized that bereaved girls would experi-ence more intrusive grief thoughts than boys, and inturn, intrusive grief thoughts would be linked with thestability of internalizing problems in bereaved girls.

GENDER DIFFERENCES IN EXPOSURE TOSTRESSORS AND NEGATIVE APPRAISALS

OF STRESSORS

Evidence from several studies indicates that bereavedgirls may be exposed to more stressful events followingthe death, particularly family-related stressors. Two long-itudinal studies provide support for the relation betweenstress exposure and mental health problems in parentallybereaved girls. Tein, Sandler, Ayers, and Wolchik (2006)found that exposure to stressful life events predicted men-tal health problems in a sample of parentally bereavedgirls and that the effects of a preventive intervention toreduce exposure to stressful events partially accountedfor program effects to reduce girls’ mental health pro-blems 11 months after the program. In their retrospectivelongitudinal study, Bifulco, Brown, and Harris (1987)reported that the family stressors experienced bybereaved girls after parental death were part of a causalchain leading to increased feelings of hopelessness andlow self-esteem in childhood and increased vulnerabilityto depression in adulthood. However, neither of thesestudies assessed gender differences in the occurrence ofstressful events or whether gender differences in theoccurrence of stressful events accounted for gender differ-ences in the development of internalizing problems.

Borrowing from the developmental literature to buildour understanding of gender differences in response toparental loss,we elected to consider interpersonal stressorsas a mediator of gender differences in internalizing pro-blems. Although not considered explicitly in the bereave-ment literature, developmental researchers have linkedgirls’ higher exposure to interpersonal stressors withfemale liability for internalizing problems (Hankin, Mer-melstein, & Roesch, 2007; Jose & Ratcliffe, 2004;Rudolph, 2002). In addition, research of at-risk youthhighlights the potential influence of gender differences inexposure to one type of interpersonal stress—familialstressors—in explaining girls’ increased risk for internaliz-ing problems, although this hypothesis has not been testedin bereavement studies (Crawford, Cohen, Midlarsky, &Brook, 2001). For example, Sandler and colleagues(2003) suggested that girls are more likely than boys toexperience increased caregiving responsibilities after par-ental loss and that this burden may account for bereavedgirls having higher levels of mental health problems than

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boys. A similar explanation was suggested by Grant andCompas (1995) in their study of gender differences in chil-dren’s adaptation to parental chronic illness.We hypothe-sized that bereaved girls would experience more stressfulevents, particularly interpersonal events, than boys andthat increased exposure to stressors would be linked withgirls’ higher internalizing problems. Toward this end, wealso examined gender differences in exposure to specifictypes of stressors (i.e., changes in child’s environment,responsibilities, and family and peer stressors) to deter-mine whether differences in exposure to interpersonaltypes of events may be specifically linked to gender differ-ences in internalizing problems.

An alternative model within the stress and copingframework centers on how stressors are appraised(Lazarus & Folkman, 1984). Recent developmental stu-dies suggest that preadolescent and adolescent girls showgreater cognitive vulnerability in their appraisal of thecauses and consequences of stressful events than boys,particularly for stressful interpersonal events (Abela &Hankin, 2008; Hankin & Abramson, 2001). Cognitivevulnerability is defined by a tendency to make negativeinferences about the causes and consequences of an event(i.e., global and stable attributions), and negative infer-ences about the implications of the event for oneself(Abela&Hankin, 2008). Cognitive vulnerability has beenlinked prospectively with depressive symptoms in youth(e.g., Morris, Ciesla, & Garber, 2008), and negative eventappraisals have been linked with youth anxiety incross-sectional and longitudinal studies research (Sheets,Sandler, & West, 1996; Smari, Petursdottir, & Porsteins-dottir, 2001; Wolchik, Tein, Sandler, & Ayers, 2006).Studying bereaved youth, Lin, Sandler, Ayers, Wolchik,and Luecken (2004) found that negative appraisal of theconsequences of stressful events was a significant factordiscriminating youth who had clinical levels of mentalhealth problems from those who did not. In the currentstudy, we tested whether appraisals of the negativeconsequences of stressful events accounted for gender dif-ferences in trajectories of internalizing problems.

GENDER DIFFERENCES IN SECURITYOF SOCIAL ATTACHMENT

A third potential mediator of gender differences ininternalizing problems after parental death involvesthreats to self-system beliefs concerning the security ofone’s relationship with the surviving caregiver. Thishypothesis is consistent with findings from studies withnonbereaved samples that adolescent girls’ increased sen-sitivity to interpersonal threats and their susceptibility toabandonment fears are related to their higher risk fordepression and anxiety relative to boys (Hammen et al.,1995; Rudolph & Flynn, 2007). It is also consistent with

motivational theories of stress, which posit that stressfulevents threaten basic needs, such as the need for securesocial ties with a caring social network, which in turnlead to increased mental health problems (Sandler,2001; Skinner & Wellborn, 1994). Children’s level of ful-fillment of the need for a secure social tie with caringadults can be assessed as their belief that there willalways be someone there to take care of them. Higherlevels of concern about whether one would continue tobe cared for (i.e., fear of abandonment) was found to pre-dict greater mental health problems in prospective ana-lyses of children following parental divorce (Wolchik,Tein, Sandler, & Doyle, 2002) and parental death usingthe current sample (Wolchik et al., 2006). However, fearof abandonment has not been studied as a mediator ofgender differences in the development of internalizingproblems over time.

GOALS OF THE CURRENT STUDY

This study examines the prospective impact of putativemediators of gender differences in the trajectory of inter-nalizing problems in a sample of bereaved youth usingthe control group of an experimental trial of a preven-tion program, the Family Bereavement Program. Toour knowledge, this is the first study to examine mediat-ing influences on gender differences in youths’ mentalhealth problems in a bereaved sample. We examinedfour potential mediators of gender differences in thestability of internalizing problems after parental death:intrusive thoughts about grief, postdeath stressors,stressful events, negative appraisals about stressfulevents, and fear of abandonment. Our models alsoaccounted for potential age effects on mediators andinternalizing problem outcomes. We expected thatyouth who were older (i.e., more likely to be adolescentrather than middle childhood) at the time of bereave-ment would have higher levels of depressive symptomsand slower rates of recovery following the death. Inaddition, we hypothesized that younger youth wouldbe more likely to report fears of abandonment, negativeappraisals of stressful events, and higher levels ofanxiety symptoms compared to older youth.

We hypothesized that youths’ experience of intrusivegrief, bereavement-related stressors and threats to secur-ity would contribute to prospective levels and adversechange in depression and anxiety up to 2 to 3 years fol-lowing the death. We examined the influence of proposedmediators as measured at the time most proximal to thedeath (between 3 and 30 months in our sample) to cap-ture the impact of psychological processes as close tothe time of death as possible on subsequent internalizingproblems. We further chose growth rate and follow-up14-month status as outcomes because we wanted to trace

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the impact of meditational processes on recovery frominternalizing problems that were bereavement related.In a prior study using the same sample, we found thatgender differences in recovery on internalizing symptomsover multiple years (1.5–3.5 years) varied across gender(Schmiege et al., 2006). In sum, three longitudinal media-tion paths were compared and contrasted in this study.Mediation models examined (a) prospective mediationof gender differences in 14-month outcomes of interna-lizing problems, (b) prospective mediation of gender dif-ferences in the rate of change in internalizing problems,and (c) whether gender differences in the rate of changeof internalizing problems were mediated by concurrentchange in the slope of the mediator.

METHOD

Participants

The sample consisted of 109 youth from 66 families whoparticipated in the self-study condition (i.e., control con-dition) of an experimental evaluation of a preventionprogram (Sandler et al., 2003). Parental death hadoccurred an average 9.5 months prior to the Time 1interview (SD¼ 6.26). Cause of death was as follows:67% illness, 21% accident, and 12% homicide or suicide.Surviving participant caregivers in these families were asfollows; 52% were mothers, 37% were fathers, and 11%were another relative or friend. All caregivers were livingwith child=adolescent participants during the studyperiod. Mean age of the participating youth at the firstinterview was 11.3 (SD¼ 2.22) with a range of 8 to 16years; 57 (52%) were boys. More than half of the youth(70%) had begun or were in the midst of the adolescenttransition during the study period (i.e., 11.5 years orolder). Female youth participants did not significantlydiffer from boys in age, or the likelihood of experiencingthe loss of a mother. Mean number of youth participat-ing in the study per family was 1.64 (SD¼ .82). Ethnicityof the youth was as follows: 71% non-HispanicCaucasian, 10% Hispanic, 7% African American, 7%Native American, and 5% Other. Median yearly familyincome was in the range of $30,001 and $35,000.

Procedures

Participants were recruited to participate in a programfor parentally bereaved youth using a variety of methodsincluding mail solicitation to professionals working withyouth (e.g., school nurses), presentations to agenciesthat had contact with bereaved children, media presen-tations, and articles in community newsletters. Specialefforts were used to contact agencies and schools servingethnic minority families. The eligibility criteria forparticipating in the study were as follows: (a) death of

a biological parent or parent figure, defined as someonein the parenting role for at least 2 years prior to thedeath; (b) parental death occurred between 4 and 30months prior to the beginning of the program; (c) atleast one youth in the family was between 8 and 16 yearsof age; (d) at least one youth and one caregiver werewilling to be randomly assigned to the group or self-study program; (e) caregiver and participating youthcould complete the assessment battery in English;(f) neither caregiver nor any youth was currently receiv-ing other mental health or bereavement services;(g) youth was not in a special class for the mentally han-dicapped, or did not have a serious disruptive behaviordisorder, with the exception of youth with attention def-icit disorder who were taking medication to reducesymptoms of inattention or hyperactivity; and (h) familywas not planning to move out of the area in the next 6months. All youth who met the eligibility criteria wereinvited to participate. The resulting sample of deceasedparents was demographically representative of theirresiding county’s population of deceased personsbetween the ages of 28 and 58, in terms of gender, eth-nicity, and cause of death (Lin et al., 2004). Additionaldetails on recruitment methods and retention of partici-pants are presented by Sandler et al. (2003).

Data for this study were derived from three assess-ments (waves). The first wave (T1; pretest) was com-pleted prior to random assignment to experimentalcondition, and the second (T2) and third (T3) wavesoccurred 3 and 14 months after the pretest, respectively.Most participants were interviewed in their homes; asmall percentage of interviews occurred at the univer-sity. Caregivers and youth were interviewed individuallyby trained interviewers. The study protocol wasapproved by the Institutional Review Board of itsuniversity of origin and all caregivers signed informedconsents and youth signed assent forms. Families werepaid $40 for an interview concerning one youth and$30 per interview for each additional youth.

All participants included in the current analyses werein the self-study control condition of the randomizedexperimental trial of a prevention program for bereavedyouth. The self-study program consisted of providing allmembers of the family (caregivers, children, and adoles-cents) three books at 1-month intervals during the inter-vention period (between pretest and Wave 2). Bookswere accompanied by a syllabus that briefly outlinedthe topics addressed in the program and where thesetopics were covered in the books.

Measures

Mediators

Intrusive grief thoughts. Intrusive thoughts regard-ing the parent’s death were assessed with nine items

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developed for the evaluation study (Bereavement Pro-gram, 1999). Items (i.e., ‘‘How often did you find your-self thinking how unfair it is that your parent died, eventhough you didn’t want to think about it?’’) were scoredon a 5-point scale and reverse coded so that higherresponses reflected more intrusive thoughts. Confirma-tory factor analysis affirmed the validity of the factorstructure and reliability of the Intrusive Grief ThoughtsScale in the current sample, v2(24, N¼ 109)¼ 61.73,p< .001 (comparative fit index [CFI]¼ .95, root meansquare error of approximation [RMSEA]¼ .07). Allstandardized factor loadings were significant and above.50. Cronbach’s alpha was .88 at Wave 1, .91 at Wave 2,and .93 at Wave 3. Measurement invariance of this scaleacross gender was also affirmed in preliminary confirma-tory factor analyses with the full sample, thus establish-ing the cross-gender measurement validity of this scale.A multigroup model with loadings, intercepts, andresiduals constrained to be equal across genders showedan exemplary fit, v2(63, N¼ 244)¼ 75.57, p> .05(CFI¼ .98, RMSEA¼ .04).

Stressors. At every wave, youth were askedwhether they had experienced 51 negative life events inthe prior month. Events were derived from the GeneralLife Events Schedule for Children (Sandler, Ramirez, &Reynolds, 1986) and Parent Death Events List (Sandleret al., 1992). Degree of stressfulness of life events wasrated by expert judges. The 51 items were classified into11 event types by expert raters. Item categories, numberof items in each category, and sample items are providedin the appendix. Internal consistency is not appropriatefor life event measures (Sandler & Guenther, 1985).However, 2-week test–retest reliability was establishedfor the General Life Events Schedule for Children(r¼ .88) in a prior study (Sandler et al., 1992). Further,both life event measures correlate positively withdepression and conduct problems in the current sample(Sandler et al., 1992).

Negative appraisals. At every wave, two types ofnegative appraisals of two stressful events were mea-sured: threat appraisals and depressive appraisals. Nega-tive appraisals were measured using the Threat Scale, arevised measure of negative appraisals of self and othercreated for a study of divorce (Sheets et al., 1996).Youth rated how much they experienced these thoughtsfor the two most stressful events they had experienced inthe prior month. Stressfulness was based on an idio-graphic rating, determined by mean stressfulness ratingsof expert raters. Threat appraisals of each stressor weremeasured by 12 items related to evaluation of negativemeaning of the event in three domains: rejection (e.g.,‘‘You thought that someone you care about didn’t want

to see you.’’), negative self-appraisal (e.g., ‘‘You thoughtthat you were not as good as other kids’’), and negativeother appraisal (e.g. ‘‘You thought that someone youlike was angry at you.’’). All ratings were made on a4-point scale from 1 (didn’t think this) to 4 (thought thisa lot). For each stressor, an average appraisal rating foreach domain of threat appraisals was computed andsummed across stressors. Domain scores were thensummed. Measurement validity was tested in a studyof divorced children, in which the alpha reliability acrossnegative appraisal domains was good (ranging from .78to .85) and domain scores were correlated with measuresof psychological symptoms (Sheets et al., 1996). Alphain the current sample was excellent (.90 at Wave 1, .91at Wave 2, and .85 at Wave 3). A series of nested modeltests did not show a significant difference in the factorloadings, intercepts, or item residuals across gender.The final multigroup model with loadings, intercepts,and residuals constrained to be equal across gendersshowed acceptable fit to the data, v2(6, N¼ 244)¼12.11, p> .05 (CFI¼ .97, RMSEA¼ .09).

Depressive appraisals were assessed with four itemsthat tapped global (i.e., ‘‘You thought that a lot ofthings were going badly for you.’’) and stable negativeinferences (i.e., ‘‘You thought that things like this wouldalways keep happening.’’) about the event. This scalewas created for this study. For each stressor, an averagedepressive appraisal rating was obtained and thendepressive appraisals were summed across stressors. Pre-liminary confirmatory factor analysis in the full studysample affirmed the validity of factor structure of theDepressive Appraisals Scale, v2(1, N¼ 240)¼ 1.62,p> .05 (CFI¼ 1.00, RMSEA¼ .03). All standardizedfactor loadings were significant and above .40. Reliabil-ity was acceptable across all waves (alpha¼ .79 atWave 1, 78 at Wave 2, and .80 at Wave 3). Measurementequivalence of the Depressive Appraisals scale was alsoaffirmed across gender. A series of nested model testsdid not show a significant difference in the factor load-ings, intercepts, or item residuals across gender. Thefinal multigroup model with loadings, intercepts, andresiduals constrained to be equal across genders showedgood fit to the data, v2(13, N¼ 240)¼ 13.88, p> .05(CFI¼ 1.00, RMSEA¼ .04).

Fear of abandonment. The seven-item Fear ofAbandonment scale was modified for this study fromthe Fear of Abandonment subscale of the Children’sProblematic Beliefs Regarding Divorce (Kurdek & Berg,1987). The items reflect worries and fears of being leftalone in the future (e.g., ‘‘You sometimes wonder whoyou would live with if your parent=guardian leftyou’’). The original Fear of Abandonment scale showedacceptable reliability (a¼ .70) and was significantly

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correlated with measures of psychological functioning inprior research (Kurdek & Berg, 1987). Preliminary con-firmatory factor analysis in the full study sampleaffirmed the factor structure of the Fear of Abandon-ment scale, v2(11, N¼ 244)¼ 14.09, p> .05 (CFI¼ .99,RMSEA¼ .02). All standardized factor loadings weresignificant and above .40. The alpha reliability in thissample was good (.77 at Wave 1, .81 at Wave 2, .90 atWave 3). Measurement invariance of this scale acrossgender was also affirmed in preliminary confirmatoryfactor analyses. A multigroup model with loadings,intercepts, and residuals constrained to be equal acrossgenders showed an exemplary fit, v2(42, N¼ 244)¼58.61, p> .05 (CFI¼ .96, RMSEA¼ .05).

Outcomes

Internalizing problems. Because a prior study usingthis sample established that gender was related tochange in youth but not parents’ reports of internalizingproblems, only self-reports of internalizing problemswere used (Schmiege et al., 2006). Separate measuresof depressive symptoms and anxiety symptoms wereused in growth models, rather than a composite of inter-nalizing problems to ensure accurate longitudinal mea-surement of both constructs (Singer & Willett, 2003).Notably, although anxiety and depression symptomswere significantly correlated, the rate of change in theseconstructs differed, indicating somewhat different devel-opmental paths. Youth completed the 27-item Chil-dren’s Depression Inventory (CDI) using the standardtime frame of 2 weeks (e.g., ‘‘I am sad all the time,’’a¼ .87; Kovacs, 1992) and the 28-item Revised Chil-dren’s Manifest Anxiety Scale (RCMAS) using the timeframe of the past month (e.g., ‘‘You were afraid of a lotof things’’; Reynolds & Richmond, 1978). Both mea-sures have been reported to have strong psychometricproperties in past research (Kovacs, 1981, 1992;Reynolds & Paget, 1981). Prior research has also estab-lished the measurement invariance of the CDI acrossgender (Carle, Millsap, & Cole, 2008) and the RCMASacross gender (Pina, Little, Knight, & Silverman, 2009).In addition, Lambert and colleagues (2004) found long-itudinal measurement invariance on items from the CDIand RCMAS using an adolescent sample. Coefficientalpha reliability was satisfactory in this sample (a¼ .87CDI; a¼ .90 RCMAS).

Data Analyses

Latent growth curve modeling in a structural equationframework (Singer & Willett, 2003) was used to describethe change in both anxiety symptoms=depression symp-toms and the potential mediators across the three waves.All models were estimated using MPLUS software(Muthen & Muthen, 2006). Both initial level of

problems (i.e., the initial status) and rate of change inproblems (i.e., the slope factor) were modeled as randomeffects for the outcomes and mediators. For selectedmediation models, the final level of anxiety symp-toms=depression symptoms (i.e., the final status) wasestimated as well as the slope factor. Growth modelingresults produced estimates of both the mean and the var-iance of the random latent factors (i.e., initial status,final status, and slope factors).

Because the longitudinal growth curves in this studywere designed to measure trajectories of recovery frombereavement-related anxiety symptoms and depressionsymptoms, longitudinal change on the mediators andthe outcomes was measured as a function of the timethat had elapsed since the death. Specifically, individu-ally varying time scores that were used to measure theshape of change were coded in terms of (a) number ofmonths since the death, ranging from 3 to 29 months,and (b) number of months elapsed between measure-ment Waves 1 (pretest) and 2 (3 months) and betweenmeasurement Waves 2 and 3 (11 months). The Wave 1time score was coded as the number of months sincethe death, and time since death served as a referencepoint for the calculation of time scores for Waves 2and 3. To illustrate, for an individual whose parent died3 months prior to the pretest, the pretest item scorewould be 3; the Wave 2 time score would be 6, whichaccounts for time since death (3 months) and time sincelast interview (3 months); and the Wave 3 time would be17, which accounts for time since death (3 months), timeelapsed between waves 1 and 2 (3 months), and betweenwaves 2 and 3 (i.e., 11 months). When estimating thelevel of problems at the final wave (i.e., final status),time scores were centered at Time 3.

Parallel process growth models were used to examinethe simultaneous change in mediators and internalizingsymptoms (Henry & Slater, 2008). Each model includedseparate status and slope factors for measurement oftrajectories of a selected mediator and an outcome in asingle model. Sample size prohibited examining multiplemediators in a single model.

We compared three potential mediating processesunderlying gender differences in the stability of interna-lizing symptoms (see Figures 1a–1c). First, we testedprospective mediation of gender differences in the finalstatus of internalizing problems (i.e., Wave 3 level).For this model, the initial status of each mediator wasregressed on a dummy coded variable indicating youths’gender (path a), the internalizing final status factor wasregressed on the initial status factor of the correspond-ing mediator (path b). In addition, the final status ofinternalizing problems was regressed on youths’ gender(path c; see Figure 1a). Next, we examined mediationof gender differences in change of internalizingsymptoms by regressing the slope factor of internalizing

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problems on the initial status factor of each mediator(see Figure 1b, path b). Finally, we tested concurrentslope mediation by testing whether gender differencesin the slope of each mediator was associated with genderdifferences in concurrent slope change of internalizingproblems (see Figure 1c). Every model included nonzerocovariances of within process latent factors and of samefactors across processes that were not part of the media-tion path (e.g., the covariance of the initial status of eachmediator and the initial status of each internalizing pro-blems outcome in models 1b and 1c).

Results of the mediation models provided estimatesof (a) the direct effect of gender on the mediator,(b) the direct effect of the mediator on the internalizingproblems outcome, and (c) the direct effect of gender oninternalizing problems. The product of coefficientsmethod was used to obtain mediation effects by multi-plying direct effect a and b (MacKinnon, Lockwood,Hoffman, West, & Sheets, 2002). Using Sobel’s method,the significance of a mediation effect was evaluated bycalculating the ratio of the mediation effect by its stan-dard error (ab=SEab). Because the distribution of theproduct of coefficients is typically nonnormal and asym-metrically skewed, we estimated asymmetric confidencelimits of the mediation effect using upper and lower

critical values for the distribution of the product oftwo random normal variables. Using this method, if 0was not in the 95% interval of the upper and lower con-fidence limits, we concluded that the mediation effectwas statistically significant. We also measured the sizeof the mediation effect using the ratio of the absolutevalue of the mediation effect (jabj) to the absolute valueof the total effect of gender (jabj þ jcj), as recommendedby MacKinnon, Warsi, and Dwyer (1995). The tenabil-ity of mediation models was compared based on the sig-nificance of direct and indirect effects. When significancetests supported the tenability of more than one model,the relative size of the Akaike and Bayesian informationcriteria (AIC and BIC) statistics were compared. AICand BIC differences of at least �2 indicate superiormodel fit (Burnham & Anderson, 1998; Raftery, 1995).

Robust full information maximum likelihood estima-tion was used for all analyses. Use of robust estimationfacilitates the most accurate estimation of standarderrors in the presence of nonnormally distributed data(Yuan & Bentler, 1998). Full information maximumlikelihood estimation provides unbiased parameter esti-mates in the presence of missing data under missing atrandom conditions (Schafer & Graham, 2002). Toaccount for interdependency in the data resulting from

FIGURE 1 (a) Prospective mediation of gender differences in final status of internalizing problems. Non-zero covariances between within-process

latent factors and between same factors across processes were also included in this model, although not shown in the figures. (b) Prospective media-

tion of gender differences in the slope of internalized problems. Non-zero covariances between within-process latent factors were also included in this

model. (c) Concurrent mediation of gender differences in the slope of internalizing problems. Non-zero covariances between within-process latent

factors were also included in this model.

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use of sibling participants, standard errors werecorrected using the complex procedure described byMuthen and Muthen (2006).

RESULTS

Descriptive statistics and zero-order correlations ofpotential mediator and outcome variables are providedin Table 1. At the baseline interview, 10% of the sample(12% of girls, 9% of boys) were experiencing clinicallysignificant depression symptoms (CDI cutoff¼ 20;Kovacs, 1981). A minority of the sample (3%; 4% ofgirls, 2% of boys) were experiencing clinically significantanxiety symptoms (RCMAS cutoff of 2 SD above themean; Reynolds & Richmond, 1978).

Given that modeling constraints of parallel processdesigns prohibited our use of multiple mediators in asingle model, we also examined the potential for multi-collinearity among predictors to ensure that our media-tors were sufficiently distinct constructs and thereforecontribute unique variance in the growth models. Basedon regression results, multicollinearity diagnostics didnot indicate that the proposed mediators were multicol-linear. Variance Inflation Factor values were well withinacceptable limits and ranged from 1.29 to 1.75. Further,the condition indices corresponding to variables thataccounted for greater than .50 of the variance were wellwithin acceptable limits (5.63 and 10.12).

Gender Differences in Trajectories of InternalizingProblems and Putative Mediators

Preliminary unconditional growth models showed thatthe level of depression symptoms differed significantlyfrom 0 at Wave 1 (M intercept¼ 9.93, p< .001;S2¼ 43.31, p< .05) and declined marginally over thethree waves (M slope¼�.09, p< .10; S2¼ .07, p> .05).In addition, the initial level of anxiety symptoms was

greater than 0 (M intercept¼ 9.39, p< .001), variedsignificantly (S2¼ 53.21, p< .001) and did not changesignificantly over the waves (M slope¼�.02, ns). Theslope of anxiety symptoms varied marginally (S2¼ .12,p< .10).

Figures 2a and 2b depict gender differences in trajec-tories of depression and anxiety symptoms. Final genderdifference models were conditioned on nonzero ageeffects. Initial level of depression symptoms did notdiffer significantly between genders, but girls showedgreater growth in depression symptoms (b¼ .15,p< .05) relative to boys who showed a significant decline(intercept of latent slope¼�.17, p< .01). Girls alsoshowed a higher level of depression symptoms at thefinal wave (b¼ 2.48, p< .05; M¼ 10.05, p< .05) thanboys (M¼ 7.49, p< .001). However, counter to hypoth-esis, age did not affect level (b¼�.11, p> .10) and rateof change (b¼�.01, p> .05) in depression symptoms.

Similarly, girls showed a higher rise in anxiety symp-toms (b¼ .21, p< .001) relative to boys, whose anxietysymptom level declined significantly (intercept ofslope¼�.13, p< .001), and varied marginally (S2¼ .12,p< .10). Anxiety symptom level at initial status didnot differ significantly across gender, but girls’ final sta-tus of anxiety symptoms (M¼ 16.04) was significantlyhigher (b¼ 3.59, p< .01) than boys (M¼ 12.69,p< .001). Finally, younger children reported marginallylower levels of anxiety symptoms at initial status(b¼�.45, p< .10) and at final status (b¼�.46, p< .10).

Gender differences in both the initial status and slopeof each mediator were examined using growth trajectorymodels conditioned on nonzero age effects. Latentfactor means and significant regression estimates areprovided in Table 2. As shown, older youth reportedlower levels of fear of abandonment, threat appraisalsand intrusive grief thoughts at initial status.

Mediation paths of gender differences were onlyexamined for those mediator latent factors that showed

TABLE 1

Zero Order Correlations and Means of Study Variables, Time 1

1 2 3 4 5 6 7 8 9 10 11 M (SD)

1. Age 1.00 11.32 (2.22)

2. Gender .00 1.00

3. Time Since Parental Death �.07 .25�� 1.00 9.50 (6.26)

4. Intrusive Grief Thoughts �.33��� .08 �.11 1.00 3.96 (.87)

5. Total Stressors �.03 .15 �.03 .42��� 1.00 10.39 (5.69)

6. Interpersonal Stressors �.13 .24� .10 .30�� .79��� 1.00 2.73 (2.45)

7. Depressive Appraisals �.06 .20� �.02 .36��� .37��� .34��� 1.00 3.83 (1.53)

8. Threat Appraisals �.20� .14 �.02 .29�� .39��� .40��� .63��� 1.00 8.91 (3.11)

9. Fear of Abandonment �.25�� .22� �.01 .41��� .32�� .25�� .40��� .28�� 1.00 2.07 (.70)

10. Depressive Symptoms (CDI Score) �.07 .15 �.06 .44��� .47��� .54��� .55��� .40��� .38��� 1.00 9.61 (6.99)

11. Anxiety Problems (RCMAS Score) �.16 .21� .02 .57��� .54��� .43��� .40��� .38��� .42��� .57��� 1.00 9.54 (6.86)

Note. N¼ 109. Correlations of all longitudinal variables (Times 2 and 3) are available from the authors.�p< .05. ��p< .01. ���p< .001.

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a significant gender difference, as shown in Table 2.Girls reported higher initial levels of fear of abandon-ment, total stressors, and depressive appraisals.However, boys and girls did not differ on slope growthon any of these mediators. Therefore, concurrent media-tion of the slope of depression symptoms=anxiety symp-toms was not tested for these mediators. The slope ofthreat appraisals differed by gender, with girls reportinga slower decline than boys, but boys and girls did notdiffer on the initial status of threat appraisals. Therefore,only the concurrent mediation on slopes model was

examined for threat appraisals. Genders did not differon the initial status or slope of intrusive grief thoughts.Therefore, the mediation of the gender difference in thestability of depression symptoms=anxiety symptomsthrough intrusive grief thoughts was not examined.

Mediation of Gender Effects on Internalizing Problems

The next set of analyses examined the mediation of gen-der effects on depression symptoms and anxiety symp-toms using a series of parallel process models. Table 3provides summary of the final mediation models includ-ing direct and mediation effects and proportion of thetotal effect represented by mediation effects. As previ-ously noted, only model types that showed significantdirect effects of the mediator on the outcome areincluded. Age was tested as a covariate in all analyses,and trimmed from final models when nonsignificant.

Fear of Abandonment and Gender Differencesin Internalizing Problems

Girls’ higher initial status of fear of abandonmentmediated their higher final status of depression symp-toms (mediation effect¼ 2.53, p< .05) and anxietysymptoms (mediation effect¼ 2.60, p< .05) comparedto boys. In addition, initial status of fear of abandon-ment mediated girls’ higher slope of anxiety symptoms(mediation effect¼ .05, p< .05). The fits of the prospec-tive mediation of anxiety symptoms final status and theprospective mediation of anxiety symptoms slopemodels were compared using AIC and sample-sizeadjusted BIC criteria. AIC and BIC criteria suggestedthat both mediation models fit the data equally well.

Stressors and Gender Differencesin Internalizing Problems

Comparison of prospective mediation of final status andprospective mediation of slope models showed that girls’

FIGURE 2 (a) Gender differences in rate of recovery from depressive

symptoms after death of a parent. (b) Gender differences in rate of

recovery from anxiety problems after death of a parent.

TABLE 2

Initial Status, Slope and Gender and Age Differences of Mediators

Latent Factors Gender Effects Age Effects

Mediator Initial Status (M) Slope (M) Initial Status (b) Slope (b) Initial Status (b) Slope (b)

Intrusive Grief Thoughts 5.84��� �.02��� .14 �.00 �.15��� �.00

Total Stressors 9.50��� �.15��� 1.73� .03 .12 �.02

Interpersonal Stressors 1.92��� �.03� 1.21��� .03 �.01 �.01

Depressive Appraisals 3.55��� �.03�� .64�� .02 �.00 �.01

Threat Appraisals 4.36��� �.02�� �.19 .02�� �.11�� .00

Fear of Abandonment 2.76��� .01��� .31�� .00 �.07��� .00

Note. N¼ 109.�p< .05. ��p< .01. ���p< .001.

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higher initial status of total stressors was indirectlyrelated to their higher level of depressive symptoms atthe final wave (mediation effect¼ 1.69, p< .05). Consis-tent with results on change in depression symptoms,girls’ higher final status of anxiety symptoms wasmediated by their higher initial status of total stressors(mediation effect¼ 1.93, p< .05). In follow-up analyses,gender differences in endorsement of stressor types atWave 1 was examined. Results showed that of 11 stres-sor types, girls showed significantly higher levels of 4stressor types corresponding to interpersonal events.These included conflict between family members(b¼ .48, p< .05), troubles related to peer relationships(b¼ .24, p< .05), separation from parents (b¼ .07,p< .10), and loss of peer or adult support (b¼ .27,p< .05).

Next, a measure of interpersonal stressors wasderived from these four negative interpersonal lifeevents. Analysis of the mean interitem correlation ofthe selected interpersonal events items was larger(r¼ .31) than the overall interitem r of the longerstressors measure (r¼ .17), thus supporting the use ofthe selected item pool as a measure of interpersonalstressors. The composite of interpersonal stressors wascomputed and used in mediation analyses. Mediationanalyses showed that initial status of interpersonalstressors mediated gender differences in final status of

depression symptoms (mediation effect¼ 3.24, p< .05)and final status of anxiety symptoms (mediationeffect¼ 3.61, p< .05).

Negative Appraisals and Gender Differencesin Internalizing Problems

Girls’ higher initial status of depressive appraisalsmediated their higher final status of both depressionsymptoms (mediation effect¼ 1.69, p< .05) and anxietysymptoms (mediation effect¼ 3.46, p< .05) compared toboys. Initial status of depressive appraisals did not med-iate gender differences in the slope of either depressionor anxiety symptoms. Girls’ slower decline in threatappraisals than boys mediated their higher slope ofdepression symptoms (mediation effect¼ .15, p< .05)and anxiety symptoms (mediation effect¼ .11, p< .05).Given that the relation between the slope of threatappraisals and internalizing problems is not a prospec-tive but rather a simultaneous relation, we examined across-lagged path analysis of these time-to-time effectsin a follow-up model (see Table 4 and Figure 3). Theprospective effects of gender differences in threatappraisals on internalizing symptoms, as well as genderdifferences of depression and anxiety symptoms onthreat appraisals, were examined simultaneously. Inaddition, the autoregressive effects of prior symptoms

TABLE 3

Final Mediation Models of Gender Differences in Final Status and Trajectories of Internalizing Problems

Outcome Variable Mediator Variable Model Type

Direct

EffectaDirect

EffectbDirect

EffectcMediation

Effect LCL UCL

Final Status of CDI Initial Status of Total Stressors Mediation of Final Status 1.76� 0.96��� 0.76 1.69� .14491 3.44372

Final Status of RCMAS Initial Status of Total Stressors Mediation of Final Status 0.76� 2.54�� 1.36 1.93� .15973 4.54301

Final Status of

CDI Score

Initial Status of Interpersonal

Stressors

Mediation of Final Status 1.24��� 2.61�� �0.73 3.24� .71822 6.60234

Final Status of

RCMAS

Initial Status of Interpersonal

Stressors

Mediation of Final Status 1.22��� 2.96��� 0.12 3.61� 1.24746 6.73511

Final Status

of CDI

Initial Status of Depressive

Appraisals

Mediation of Final Status 0.56�� 3.02� 0.09 1.69� .22456 3.8153

Final Status

of RCMAS

Initial Status of Depressive

Appraisals

Mediation of Final Status 0.61�� 5.67� �0.19 3.46� .08231 8.41110

Slope of CDI Slope of Threat Appraisals Concurrent Mediation

of Slope

0.06� 2.79� �0.01 0.15� .01852 0.38996

Slope of RCMAS Slope of Threat Appraisals Concurrent Mediation

of Slope

0.05� 2.18��� 0.08 0.11� .00586 0.24118

Final Status

of CDI

Initial Status of Fear of

Abandonment

Mediation of Final Status 0.30�� 8.42��� 0.06 2.53� .70011 4.44745

Final Status

of RCMAS

Initial Status of Fear of

Abandonment

Mediation of Final Status 0.31�� 8.40��� 0.77 2.60� .82791 4.53021

Slope of RCMAS Initial Status of Fear of

Abandonment

Prospective Mediation

of Slope

0.29�� 0.18�� 0.12� 0.05� .10867 3.0024

Note. N¼ 109.aRelation between gender and mediator. bRelation between mediator and outcome. cRelation between gender and the outcome variable.

LCL¼ lower confidence limit; UCL¼upper confidence limit; CDI¼Children’s Depression Inventory; RCMAS¼Revised Children’s Manifest

Anxiety Scale.�p< .05. ��p< .01. ���p< .001.

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and appraisals on stability of symptoms and appraisalswere accounted for in the models. Both cross-laggedpath analyses were conditioned on age and time sincedeath at each wave. The resulting cross-lagged effectsrepresented short-term prospective links in threatappraisals and internalizing symptoms and did notmeasure latent slope change or gender effects on latentchange.

As shown in Figure 3, with all cross-lagged effectsaccounted for in the model, the mediation pathsfrom gender through Wave 1 internalizing symptomsand Wave 2 threat appraisals remained significant.Specifically, girls showed a marginally higher level of

depression symptoms at Wave 1 compared to boys,which was related to their greater propensity to viewstressors as threatening at Wave 2 (marginal mediationeffect¼ .06, p< .10). Similarly, girls’ significantly higherlevel of threat appraisals at Wave 2 was mediated bytheir significantly higher level of anxiety symptoms atWave 1 (mediation effect¼ .05, p< .05).

DISCUSSION

This is the first study to test psychological processes thatmediate gender differences in depression symptoms andanxiety symptoms subsequent to the death of one’s par-ent. Four mediating processes that encompass environ-mental, cognitive, and interpersonal mechanisms werefound to underlie gender differences in anxiety anddepression symptoms: exposure to postdeath stressors,in particular interpersonal stressors; depressive apprai-sals of postdeath stressors; threat appraisals ofpostdeath stressors; and fear of abandonment. Inter-pretation of these findings will focus on the role ofinterpersonal stressors and psychological processesrelated to girls’ interpersonal vulnerability and cognitiveappraisals of stressors in increasing their vulnerabilityto depression symptoms and anxiety symptoms(Cyranowski, Frank, Young, & Shear, 2000; Hankin &Abramson, 2001).

The pattern of mediation findings suggest that inter-personal vulnerability plays a critical role in explaininggender differences in bereavement-related trajectoriesof symptoms of both depression and anxiety. First, girlsreported higher exposure to interpersonal loss (i.e.,separation from parents and loss of peer or adult sup-port) and conflict (i.e., conflict between family membersand troubles with peers). These interpersonal stressorswere related to girls’ higher level of depression and anxi-ety symptoms 14 months later. Second, girls reported

TABLE 4

Mediation Models of Gender Differences in Internalizing Problems and Threat Appraisals: Cross-Lagged Path Model

B (SE) 95% Confidence Interval

Outcome Mediator

Direct

EffectaDirect

EffectbDirect

EffectcMediation

Effect LCL UCL

Wave 2 Depressive Symptoms Wave 1 Threat Appraisals .16 (.11) .03 (.07) .03 (.07) .01 �.0166 .0313

Wave 3 Depressive Symptoms Wave 2 Threat Appraisals �.03 (.09) .13 (.12) .21 (.09)� �.00 �.0197 .0329

Wave 2 Threat Appraisals Wave 1 Depressive Symptoms .18 (.10)i .31 (.10)�� �.03 (.09) .06i �.0024 .1368

Wave 3 Threat Appraisals Wave 2 Depressive Symptoms .03 (.07) .29 (.11)�� .15 (.09) .01 �.0027 .1016

Wave 2 Anxiety Symptoms Wave 1 Threat Appraisals .16 (.11) .13 (.10) .09 (.08) .02 �.0109 .0731

Wave 3 Anxiety Symptoms Wave 2 Threat Appraisals �.03 (.09) .16 (.10) .25 (.08)�� �.01 .0028 .1081

Wave 2 Threat Appraisals Wave 1 Anxiety Symptoms .22 (.10)� .24 (.08)�� �.03 (.09) .05�

.0054 .1204

Wave 3 Threat Appraisals Wave 2 Anxiety Symptoms .09 (.08) .26 (.11)� .13 (.10) .02 �.0148 .0767

Note. LCL¼ lower 95% confidence limit; UCL¼ upper 95% confidence limit.aRelation between gender and mediator. bRelation between mediator and outcome. cRelation between gender and the outcome variable.ip< .10. �p< .05. ��p< .01. ���p< .001.

FIGURE 3 Direct effects of cross-lagged model linking gender, threat

appraisals and internalizing symptoms, Waves 1 to 3. Note: Children’s

Depression Inventory effects=Revised Children’s Manifest Anxiety

Scale effects. All effects are standardized beta estimates. Age and time

since death on every outcome was accounted for in all models.

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greater fears of abandonment, which were related totheir higher likelihood of greater level of depressionsymptoms and anxiety symptoms 14 months later, aswell as greater growth in anxiety symptoms. These find-ings both complement and extend prior developmentalresearch linking gender differences in exposure andsensitivity to interpersonal stressors and girls’ greaterlikelihood of depression symptoms in adolescence.Although the general finding that exposure and sensitiv-ity to interpersonal stressors mediate girls’ higher levelof internalizing problems is well established (Ge,Conger, & Elder, 2001; Rudolph & Flynn, 2007), thisstudy is unique showing a prospective link betweenparentally bereaved girls’ interpersonal vulnerabilityand their increased level and stability of symptoms ofanxiety and depression.

Our findings are consistent with current develop-mental theories of gender differences in depressionsymptoms. Most notably, Cyranowski and colleagues(2000) suggested that girls’ intensified affiliativeorientation during adolescence underlies theirincreased risk for depression symptoms compared toboys. Their stress-diathesis model posits that girls’increased focus on interpersonal affiliation raisestheir risk for threats to attachment security, elevatedanxiety symptoms, and reduced coping efficacy rela-tive to boys. Taken together, these interacting riskscreate a depressogenic diathesis that, in interactionwith stressful events, produces increased rates ofdepression symptoms in adolescent girls. Based onthis theoretical model, we propose that the loss of aparent during childhood or adolescence presentsan extraordinary threat to security of attachment.Bereaved girls’ greater propensity to fears of aban-donment may reflect their higher emotional sensitivityto loss of an attachment figure, which is likely topotentiate increased sensitivity to threats of interper-sonal loss in other social attachments as well asincreased likelihood of internalizing morbidity.

Analyses also revealed that gender differences in cog-nitive vulnerability, as measured by negative appraisalsof postdeath stressors, were related to girls’ increasedlevel and stability of internalizing problems over time.Specifically, girls were more likely to show global andstable (i.e., depressive) appraisals of stressors at the firstinterview than boys, which was related to higher levelsof symptoms of both anxiety and depression 14 monthslater. This pattern of results is consistent with findings ofstudies of gender differences in depression symptoms innormative populations (Hankin & Abramson, 2001).

Although there was also evidence that the slope ofgirls’ threat appraisals was related to the slope of depres-sion and anxiety symptoms, it should be noted that theconcurrent slope mediation models cannot establish themost likely causal direction. Follow-up cross-lagged

analyses, in fact, suggested that youths’ higher level ofdepression and anxiety symptoms in the bereavementcontext led to higher levels of subsequent threat apprai-sals, though no significant time-lagged relations werefound of earlier threat appraisals on later anxiety ordepression symptoms. Further longitudinal follow-upwith this sample will permit us to better discern thecausal direction of mediation relations and to examinereciprocal effects longitudinally.

It may also be the case that there are complex inter-acting relations between the hypothesized mediators.For example, it may be that youths’ exposure to inter-personal stress and cognitive vulnerability show interac-tive or reciprocal links (Hankin & Abramson, 2001).Future research examining links between bereavedyouths’ fears of abandonment, exposure to postdeathstressors, and appraisals of interpersonal postdeathstressors would aid in identifying more specific causalpaths in gender differences in bereavement-relatedsymptoms of depression and anxiety.

It is noteworthy that the hypothesized mediator thatis most specifically related to the grief process—intrusivegrief thoughts—was not related to gender differences intrajectories of depression and anxiety symptoms. Thisresult suggests that girls’ adaptation to the postdeathcontext, rather than grief per se, is most salient inexplaining bereaved girls’ stability of internalizing symp-toms. However, it may be that other aspects of the griefexperience that were not addressed in this study play arole in gender differences in internalizing symptoms ofparentally bereaved children (Melhem et al., 2004).

The nonsignificant gender difference in intrusive griefthoughts also highlights the need to further explore themediation impact of ruminative coping on gender differ-ences in internalizing symptoms in the postdeath con-text. Whether the broader construct of rumination isan independent or overlapping construct of intrusivegrief thoughts remains to be tested. In addition, futureresearch considering the mediation influence of rumina-tion on sadness in this study’s model would clarifywhether the tendency to ruminate on negative=depressive affect and thoughts better explains genderdifferences in bereavement-related internalizing symp-toms than intrusive grief thoughts (Wupperman &Neumann, 2006).

A few limitations of the study should be noted. First,the restricted sample size of children in this sampleprecluded examining age moderation of the hypothe-sized mediation effects. We expect that future researchemploying a broader age range would further under-standing of how the putative mediators may influenceaccelerated gender differences in internalizing symptomsduring the adolescent period. Also, although the youthin the current study ranged from 8 to 16 years old, mostwere adolescents. Future research with larger samples

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that include about equal numbers of children andadolescents is needed to assess whether the obtainedmediation effects apply to both children and adoles-cents. Second, the sample size prevented examining mul-tiple mediators in a single model. Future studies withlarger samples are needed to examine the unique contri-bution of these mediators. Third, the lack of a non-bereaved comparison group or another at-risk groupprecludes conclusions that the gender differences inmediation processes as described are unique to bereave-ment. Fourth, our measures of depression and anxietysymptoms were limited to self-reports covering a rela-tively short-term perspective (2 weeks; 1 month), andonly three measurement waves were used. Futureresearch using multiple reporters and a time varyingapproach with several data points would allow a morecomprehensive perspective on symptoms and allow thetesting of curvilinear gender effects. Finally, youths’recovery curves of depression symptoms and anxietysymptoms may have been influenced by their families’participation in the self-study control group or involve-ment in other mental health interventions duringthe follow-up period that was not accounted for inthis study.

Implications for Research, Policy, and Practice

Future research will ideally consider the simultaneousinfluence of neuroendocrine, psychosocial, and contex-tual antecedents of gender differences in depressionsymptoms with bereaved samples. Current researchhighlights the influence of gonadal hormonal andneurobiological changes during adolescence on theemergence of girls’ increased affiliative behavior(Cyranowski et al., 2000) and differential increase innegative affect during adolescence (Brooks-Gunn &Warren, 1989). Examining the moderating influenceof pubertal neuroendocrine changes on gender differ-ences in bereavement-related internalizing symptomswould bring us closer to understanding the interplayof contextual, biological, and psychosocial factorsunderlying these gender differences.

Another important missing piece of the puzzle is therole of parenting in attenuating gender differences inmediation of internalizing symptoms. The protectiveinfluence of supportive parenting on coping and fearof abandonment mediators of internalizing problemswas established in our sample, but whether parentinginfluences gender differences in these mediators hasnot been tested (Wolchik et al., 2006). Although beyondthe scope of the current study, future research consider-ing parent moderation of the mediation of genderdifferences in bereavement-internalizing symptoms willinform potential protective effects on gender differencesin internalizing symptoms.

The findings of this study have implications forinterventions for bereaved girls. Programs that lead toreductions in fear of abandonment, exposure to inter-personal stressors, and threat appraisals and depressiveappraisals could decrease girls’ level of depression symp-toms and anxiety symptoms after parental death. Suchchanges could be accomplished through interventioncomponents that address these processes by workingdirectly with bereaved youth (Clarke et al., 2001) as wellas components that address these mediators by workingwith caregivers (e.g., Tein et al., 2006). Consistent withthis hypothesis, a recent evaluation of the FamilyBereavement Program showed that program-inducedreductions in bereaved girls’ internalizing problems weremediated by multiple processes including improved par-enting and reductions in exposure to stressful events(Tein et al., 2007).

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APPENDIX 1

TABLE A1

Typing of Negative Life Events

Type of Events No. of Events Sample Item

Changes in Child’s Environment 6 ‘‘Your family moved to a new home.’’

Conflict Between Family Members 7 ‘‘You heard your parent=guardian arguing with others.’’

Conflict With Parent or Other Adult 2 ‘‘You had a serious disagreement or verbal fight with your

parent=guardian.’’

Death Reminders 2 ‘‘Your parent=guardian answered your questions about your

mom=dad who died.’’

Expectations for Child’s Behavior 2 ‘‘Your relative or family friends told you to be more responsible.’’

Others Troubles 5 ‘‘Your brother or sister had serious trouble with the law, school, drugs,

etc.’’

Parental Distress 6 ‘‘Your parent=guardian told you he=she was very lonely.’’

Parent Troubles 6 ‘‘Your parent=guardian could not find a job.’’

Youth’s Loss of Adult or Peer Support 6 ‘‘Someone you care about no longer wanted to spend time with you or

talk to you.’’

Youth Separation from Parent 3 ‘‘You moved to a different house than your parent=guardian lives in.’’

Youth Troubles Related to Peer Relations 6 ‘‘Your friends criticized you for hanging out with other groups.’’

500 LITTLE ET AL.

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