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. Author manuscript; available in PMC: 2023 Feb 1.
Published in final edited form as: Cogn Emot. 2021 Nov 1;36(1):92–99. doi: 10.1080/02699931.2021.1995330

The Effects of Rumination on Internalizing Symptoms in the Context of the COVID-19 Pandemic among Mothers and their Offspring: A Brief Report

Hannah R Duttweiler 1, Michelle K Sheena 1, Katie L Burkhouse 1, Cope Feurer 1
PMCID: PMC8799488  NIHMSID: NIHMS1751688  PMID: 34720047

Abstract

As a result of the novel coronavirus (COVID-19) pandemic, anxiety and depressive symptoms have risen among children and adults. However, it remains unclear why the effects of the pandemic are so salient for certain individuals. This study examined rumination, a well-established risk factor for internalizing disorders, as a predictor of prospective increases in anxiety and depression symptoms in mothers and their offspring. Change in rumination during the pandemic was also examined as a predictor of symptom transmission at the dyadic level. Fifty-three biological mother-child dyads were recruited from two longitudinal studies that had completed their respective baselines prior to the COVID-19 pandemic. Mothers and youth (ages 9–15 years, 77.4% female) completed measures of depression and anxiety symptoms and rumination before and during the pandemic. Results revealed baseline rumination was positively associated with internalizing symptom changes for mothers, but not youth. Moreover, pre-to-peri pandemic changes in rumination were associated with prospective increases in mother and youth internalizing symptoms. Finally, results revealed a significant correlation for pre-to-peri pandemic depressive symptom change among mothers and youth; however, rumination did not mediate this association. Findings highlight changes in rumination as a potential mechanism for internalizing symptom risk during the COVID-19 pandemic across development.

Keywords: Rumination, Depression, Anxiety, COVID-19, Stress, Development

Introduction

The novel coronavirus pandemic (COVID-19) has resulted in significant increases in levels of anxiety and depressive symptoms for individuals of all ages (Holman et al., 2020). These symptom changes are perhaps not surprising, as the COVID-19 pandemic has represented a period of increased stress for youth and adults due to health concerns, social isolation, and financial instability resulting from pandemic-related shutdowns. Although stress exposure has been linked to increases in internalizing symptoms (Hammen, 2005), additional research is needed to clarify why effects of the pandemic are so salient for certain individuals. Additionally, the COVID-19 pandemic has been hypothesized to impact mental health outcomes at the familial level via increases in parental psychiatric symptoms (Prime et al., 2020), thereby highlighting the need to examine mechanisms of risk within families as well as at the individual level. Importantly, although mothers’ and offspring’s internalizing symptoms influence each other in a reciprocal manner (Kouros & Garber, 2010), this has not been examined in the context of the COVID-19 pandemic. Thus, to facilitate targeted prevention and intervention efforts, additional research is needed to identify who is at the greatest risk for increases in internalizing symptoms during the COVID-19 pandemic and examine possible individual and familial mechanisms implicated in these risk patterns.

One well-established risk factor for anxiety and depression that may play an important role in psychopathology during the COVID-19 pandemic is rumination. Rumination is the process of responding to and fixating on internal distress through repetitive negative thinking, and greater ruminative tendencies have been shown to prospectively predict increases in anxiety and depression symptoms in both adults and youth (for review, see Nolen-Hoeksema et al., 2008). Additionally, increases in rumination over time are also associated with greater risk for anxiety and depression symptoms (Young & Dietrich, 2015) and may be a mechanism through which exposure to stressful contexts confers risk for psychopathology (Michl et al., 2013).

Emerging evidence highlights the potential role of rumination in internalizing symptom risk within the context of the COVID-19 pandemic for adults. For example, rumination about COVID-19 was associated with depressive symptoms in working Dutch adults (Bakker & van Wingerden, 2020) and a cross-sectional study of college students in China found rumination mediated the relation between COVID-19 related stress and psychiatric symptoms (Ye et al., 2020). Additionally, the only study to-date examining prospective changes in symptoms pre-to-peri pandemic found greater rumination reported during the pandemic was associated with increases in depression symptoms for adults (Low et al., 2020). However, as these studies only assessed rumination at a single time point while the pandemic was ongoing, it is unclear whether pre-pandemic ruminative tendencies or pre-to-peri pandemic increases in rumination predict prospective changes in individuals’ internalizing symptoms during COVID-19 and whether this extends to symptom risk in youth. The current study sought to build upon prior findings and address these limitations in a unique sample of mother-child dyads.

Rumination may also play a role in the dyadic transmission of symptoms between mothers and children during the pandemic. Specifically, increases in mothers’ internalizing symptoms may be a stressor for offspring during the pandemic (Prime et al., 2020), particularly when social distancing and shelter-in-place mandates limited time spent outside the home. Given evidence of the mechanistic role of rumination in conferring risk for internalizing symptoms within stressful contexts (Michl et al., 2013), it is possible that exposure to parental symptoms contributes to dyadic symptom transmission via increases in offspring’s rumination. Supporting this, cognitive vulnerabilities are a hypothesized mechanism of mother-to-child depression transmission (Goodman, 2020), and children of mothers with, versus without, a history of depression exhibit greater levels of rumination (Woody et al., 2016). Therefore, in addition to an individual mechanism of risk, the current study also examined rumination as a mechanism for symptom changes during the pandemic at the dyadic level. Although research on internalizing symptom transmission largely focuses on transmission from parent to child, we also examined rumination as a mechanism of symptom transmission from children to their mothers.

The current study sought to address these questions utilizing a unique risk-enhanced sample of mother-child dyads originally recruited based on presence or absence of maternal history of major depressive disorder (MDD) who completed assessments of internalizing symptoms and rumination prior to the onset of the pandemic. Specifically, the current study examined whether pre-pandemic ruminative tendencies and pre-to-peri pandemic changes in rumination were associated with prospective increases in mother and youth anxiety and depression symptoms during the COVID-19 pandemic. Half of the mothers had a lifetime history of MDD, which provided greater variability in internalizing symptom risk for both mothers and children. We hypothesized that greater pre-pandemic and peri-pandemic rumination would be associated with greater prospective increases in symptoms of anxiety and depression at the individual level, even after accounting and covarying for other known risk factors for internalizing disorders (e.g., maternal MDD risk history [Goodman, 2020], age [Hankin, 2009], sex [Hankin, 2009], racial/ethnic identity [McLaughlin, Hilt, & Nolen-Hoeksema, 2007]). Additionally, we hypothesized that pre-to-peri pandemic increases in rumination in mothers and their children would mediate transmission of internalizing symptoms at the dyadic level.

Materials and Methods

Participants

The current sample included 53 biological mother-child dyads recruited from two ongoing longitudinal studies on the intergenerational transmission of depression that completed their respective baselines prior to the COVID-19 pandemic onset. The first study (n=16) included mothers and their daughters (ages 12–16) and examined correspondence between mother and daughter neural indices of affective functioning within the context of intergenerational depression transmission. The second study (n=37) included mothers and their children (ages 9–15) and evaluated the impact of a preventative intervention for depression on changes in children’s neurophysiological indices of affective processing. The current sample included 26 high risk (HR) mothers with a history of MDD and 27 low risk (LR) mothers with no history of psychopathology. Mothers were predominately White (52.8%), and 24.5% were Black, 13.2% Asian, and 9.5% multiracial or another race. The youth sample was predominately White (52.8%) with 20.8% Black, 13.2% Asian, and 13.2% multiracial or another race. Regarding ethnic identity, 24.5% of mothers and 26.4% of youth identified as Hispanic/Latinx. Youth average age at baseline was 12.5 years (SD=2.3) and 77.4% were female. Maternal average age at baseline was 42.2 years (SD=6.5). Exclusionary criteria were neurological disorders, lifetime history of bipolar disorder, schizophrenia or psychosis, traumatic brain injury, active suicidal ideation, or current alcohol and/or substance use disorder in the past 6 months.

Procedure

All procedures were evaluated and approved by the University of Illinois at Chicago Institutional Review Board. Participants from Chicago, IL and the surrounding areas were recruited from the community through flyers and ads. At the initial in-person visit, informed consent/assent was obtained; both mothers and youth completed self-report measures of anxiety and depression symptoms and rumination on an online survey platform. Additionally, mothers’ histories of MDD and other psychopathology were assessed using the Structured Clinical Interview for DSM-5 (SCID-5; First et al., 2015) to confirm eligibility for either the HR or LR group. Following the baseline assessment, a subset of HR mother-child dyads (n=10) completed an established twelve session family group-based cognitive-behavioral preventative intervention designed for depressed mothers and their offspring (for details, see Compas et al., 2009).

Participants were re-contacted between June and September 2020, during which time residents of Illinois were beginning an initial process of reopening under social distancing and masking regulations and invited to participate in a brief follow-up during which self-report measures of depression, anxiety, and rumination were re-administered via online surveys. Of the recontacted participants, 51.6% (16/31) of dyads from the first study and 56.9% (37/65) of dyads from the second study completed the follow-up assessment. On average, dyads completed the follow-up 18.34 months (SD=9.29) after their initial baseline assessment. Mothers and youth were compensated a total of $200 if enrolled in the first study and $170 if enrolled in the second study for their participation.

Measures

Maternal Depression Diagnosis.

The SCID-5 was used to assess mothers’ current and lifetime diagnoses of MDD and other DSM-5 psychiatric disorders. The interview was administered by trained research assistants, under the supervision of a clinical psychologist, at baseline to confirm study eligibility.

Mother Symptoms.

The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Beck Anxiety Inventory (BAI; Steer & Beck, 1997) were used to assess mother depressive and anxiety symptoms, respectively. The BDI-II (αs: .90, .80) and BAI (αs: .92, .92) demonstrated good internal consistency at both time points.

Youth Symptoms.

The Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977) was used to assess youth depressive symptoms and the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher, et al., 1999) was used to assess anxiety symptoms. Both the CES-D (αs: .80, .88) and SCARED (αs: .94, .94) demonstrated adequate internal consistency at both time points.

Mother and Youth Rumination.

The Ruminative Response Scale (RRS; Treynor, Gonzalez, & Nolen-Hoeksema, 2003) was used to assess both mother and youth rumination. The RRS demonstrated good internal consistency for both mothers and youth at both time points (αs: .95, .96; .91, .95 respectively).

Results

Preliminary Analyses

All study analyses were conducted in SPSS (Version 25). Upon an initial review, some variables exhibited significant skew (i.e., BDI-II, BAI, Maternal RRS); these variables were square root transformed prior to analyses to satisfy assumptions of normality. The dataset also contained missing data due to incomplete questionnaires (baseline measures – BAI: 5.7%, maternal RRS: 3.8%, CES-D: 1.9%, SCARED: 7.5%, youth RRS: 3.8%; COVID measures – maternal RRS: 1.9%; CES-D: 1.9%; SCARED: 1.9%; youth RRS: 1.9%). To assess whether data were missing at random, Little’s missing completely at random (MCAR) test was conducted; results were not significant, χ2(119)=127.27, p=.29, justifying the use of imputation methods (i.e., estimation maximization) for missing values. To examine pre-to-peri pandemic change in depression and anxiety symptoms and rumination for correlation and mediation analyses, unstandardized residual scores were calculated for each. As described below, pre-to-peri pandemic change in internalizing symptoms and rumination were examined in regression analyses by statistically controlling for the influence of pre-pandemic symptoms and rumination within the regression model itself, rather than utilizing pre-calculated residual change scores.

Table 1 presents descriptive statistics for all untransformed variables to facilitate comparison with other studies. Table 2 presents bivariate correlations among the residual change scores of the study variables. Changes in mothers’ depressive symptoms were positively correlated with changes in youth depressive symptoms. However, there were no significant relations between changes in mothers’ and youth anxiety symptoms.

Table 1.

Descriptive Statistics of Study Variables (n=53)

Baseline
Mean (SD)		 COVID Follow-up
Mean (SD)
CES-D 10.97 (7.09) 13.30 (8.77)
SCARED 19.10 (13.89) 18.59 (13.58)
Youth RRS 34.62 (9.29) 34.25 (11.06)
BDI-II 8.34 (8.28) 10.13 (8.51)
BAI 7.10 (7.76) 8.79 (8.91)
Mother RRS 37.12 (13.21) 35.65 (12.86)
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Note. CES-D = Center for Epidemiological Studies Depression Scale, SCARED = Screen for Child Anxiety Related Emotional Disorders, RRS = Ruminative Response Scale, BDI-II = Beck Depression Inventory, BAI = Beck Anxiety Inventory.

Table 2.

Correlations Among Study Variables (n=53)

1. 2. 3. 4. 5. 6. 7. 8.
1. Youth Sex (% female) -
2. Youth Age .35* -
3. Mother Age .08 .39** -
4. RES CES-D .20 .07 .05 -
5. RES SCARED .30* .10 −.06 .49** -
6. RES Child RRS .22 .26 .33* .75** .37** -
7. RES BDI-II −.01 −.003 .25 .36** .04 .23 -
8. RES BAI .22 .05 .25 .08 −.07 .07 .66** -
9. RES Mother RRS −.03 .28 .31* .11 −.07 .16 .46** .38**
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Note. RES = Pre-to-peri pandemic residual change score. CES-D = Center for Epidemiological Studies Depression Scale, SCARED = Screen for Child Anxiety Related Emotional Disorders, RRS = Ruminative Response Scale, BDI-II = Beck Depression Inventory, BAI = Beck Anxiety Inventory.

*

p<.05

**

p<.01.

Primary Analyses

Regression analyses were conducted to examine whether pre- and peri-pandemic rumination were associated with prospective increases (i.e., residual symptom change) in mother and youth internalizing symptoms. In these analyses, peri-pandemic symptoms (i.e., depression or anxiety) were entered as the outcome variable. Regarding predictor variables, pre-pandemic rumination was entered in the first step of the regression and peri-pandemic rumination was entered in the second step. Additionally, pre-pandemic internalizing symptoms (i.e., depression or anxiety) and group status (HR versus LR) were entered as covariates in the first step of the regression. Analyses were conducted separately for anxiety and depression symptoms for mothers and youth and a Bonferroni correction was applied to adjust for multiple comparisons (adjusted p=.0125).

Analyses focusing on pre-to-peri changes in internalizing symptoms for youth indicated that youth baseline rumination did not predict increases in either anxiety (β=−0.16, t[49]=−1.42, p=.16, reffect size=.20) or depression (β=0.09, t[49]=0.46, p=.65, reffect size=.07). However, controlling for baseline rumination, peri-pandemic rumination was associated with prospective increases in youth anxiety (β=0.34, t[48]=2.95, p=.005, reffect size=.39) and depression (β=0.76, t[48]=8.00, p<.001, reffect size=.76).

Analyses focusing on pre-to-peri changes in internalizing symptoms for mothers indicated pre-pandemic rumination prospectively predicted increases in mother symptoms of anxiety (β=0.46, t[49]=2.78, p=.008, reffect size=.37) and depression (β=0.53, t[49]=3.61, p=.001, reffect size=.46). Similar to offspring, statistically controlling for baseline rumination, peri-pandemic rumination was also positively associated with prospective increases in both anxiety (β=0.50, t[48]=3.54, p=.001, reffect size=.46) and depression symptoms (β=0.59, t[48]=4.50, p<.001, reffect size=.54) in mothers.

A series of post-hoc analyses were conducted to test the robustness of these findings. For youth, the relation between pre-to-peri residual changes in rumination and both anxiety and depression symptoms was maintained when individually statistically controlling for the influence of youth age, sex, and racial/ethnic identity (non-Hispanic White: yes versus no) (highest p=.01). For mothers, the relation between pre-to-peri residual changes in rumination and both anxiety and depression symptoms was maintained when individually controlling for mother age and racial/ethnic identity (highest p=.009). Additionally, as some mother-child dyads received a group intervention between the baseline and follow-up assessments (n=10), we also controlled for intervention status (received intervention: yes versus no) in tests of robustness for both youth and mothers. Results for both youth and mothers were maintained controlling for intervention status (highest p=.01).

Mediation Analyses

Finally, mediation analyses were conducted to examine if pre-to-peri pandemic residual changes in rumination mediated internalizing symptom transmission between mothers and children at the dyadic level. These analyses focused on relations between mother and youth depression symptoms, given that residual change in mother and youth anxiety symptoms were not significant in correlation analyses. All mediation models included group status (HR versus LR) as a covariate and were run using model 4 in the SPSS PROCESS macro (Hayes, 2013).

To examine residual change in rumination as a mechanism through which pre-to-peri pandemic increases in mothers’ depression symptoms predicted pre-to-peri increases in youth depression symptoms, residual change in mother depression symptoms was entered as the predictor variable, residual change in youth depression symptoms was entered as the outcome variable, and residual change in youth rumination was entered as the mediator. Youth changes in rumination did not mediate the impact of changes in mother’s depression symptoms on changes in youth depression symptoms (z=1.16, 95% CI=−0.20, 2.94).

Similarly, to examine residual change in rumination as a mechanism through which pre-to-peri pandemic increases in youths’ depression symptoms predicted pre-to-peri increases in mothers’ depression symptoms, residual change in youth depression symptoms was entered as the predictor variable, residual change in mothers’ depression symptoms was entered as the outcome variable, and residual change in mothers’ rumination was entered as the mediator. Results indicated that changes in mothers’ rumination did not mediate the impact of changes in youth depression symptoms on changes in mothers’ depression symptoms (z=0.01, 95% CI=−0.01, 0.03).

Discussion

The purpose of the study was to examine rumination as a possible risk factor and mechanism contributing to prospective increases in internalizing symptoms in mothers and youth during the COVID-19 pandemic. Based on previous findings, we hypothesized that greater levels of rumination prior to and during the pandemic would predict prospective increases in anxiety and depression symptoms in mothers and their children at the individual level. Additionally, we hypothesized that changes in rumination within the context of the pandemic would mediate the transmission of these symptoms at the dyadic level.

Partially consistent with hypotheses and prior findings (for review, see Nolen-Hoeksema et al., 2008), higher levels of baseline rumination predicted increases in internalizing symptoms for mothers during the pandemic. However, pre-pandemic rumination did not significantly predict changes in youth internalizing symptoms. Although unexpected, as rumination increases from childhood through adolescence (Jose & Brown, 2008), it is possible that developmental differences in the youth sample may have obscured the relation between baseline rumination and increases in symptoms amid the pandemic in youth. Moreover, sex differences may have also played a role as the youth sample was comprised of both males and females; indeed, there is evidence that rumination is a stronger predictor of depressive symptoms in females, relative to males (Lopez et al., 2009; Hamilton et al., 2015). Thus, future studies with larger sample sizes are needed to evaluate whether certain demographic variables moderate the association between rumination and changes in internalizing symptoms in the context of COVID-19.

Regarding pre-to-peri pandemic changes in rumination we found, while statistically controlling for baseline rumination, increased rumination peri-pandemic predicted increases in anxiety and depression symptoms for both mothers and youth. Importantly, these results were maintained when controlling for maternal depression, intervention, and demographic variables. These findings build upon previous findings indicating changes in rumination as a mechanism underlying increases in internalizing symptoms for both adults and youth, particularly within the context of periods of heightened stress (Michl et al., 2013; Nolen-Hoeksema et al., 2008). Furthermore, current findings extend this literature to the COVID-19 pandemic by being the first to our knowledge to demonstrate the relation between changes in rumination within the context of the pandemic and internalizing symptoms for both youth and adults.

The current study also examined changes in rumination during the pandemic as a mechanism for the transmission of symptoms between mothers and their children in the context of the COVID-19 pandemic. Although findings suggest dyadic members’ (i.e., mother and child) changes in depression symptoms were correlated, suggesting potential transmission of symptoms, the current study did not find evidence of rumination as a mediator of symptom transmission between mothers and their children. Although cognitive vulnerabilities, such as rumination, have been proposed as mechanisms of the intergenerational transmission of depression (Goodman, 2020), current findings are consistent with the existing literature, as Sachs-Ericsson et al. (2014) found that child rumination did not mediate the relation between parent and child symptoms. Therefore, although maternal history of depression may be associated with increased rumination in offspring (Woody et al., 2016), changes in youth rumination may not be a direct mechanism of risk transmission at the symptom level. Thus, further studies are needed to clarify the specific role of rumination in dyadic internalizing psychopathology risk, as well as to investigate other potential mechanisms of the transmission of internalizing symptoms.

Strengths of the current study include pre-pandemic baseline measures of internalizing symptoms and rumination and a prospective design. Additionally, results regarding changes in rumination as a potential mechanism contributing to increases in internalizing symptoms during the pandemic were replicated in both the mother and youth sample. However, in interpreting the current study, several limitations should be considered. First, this study utilized a small sample size which precluded an examination of group differences between high and low risk dyads and may have been underpowered to detect small effects. Second, the study did not evaluate COVID-related rumination specifically, but rather, assessed more general ruminative responses within the context of the pandemic. Third, there was only one follow-up assessment after the onset of pandemic shutdowns, so it is unclear whether findings also extend to long-term changes in cognitive patterns and symptoms. Finally, rumination and internalizing symptoms were assessed at the same two time points, thereby precluding the establishment of temporal precedence required to conclude whether changes in rumination preceded and contributed to increases in symptoms or vice versa. Future studies with repeated assessments of rumination and symptoms are required to confirm rumination as a mechanism of symptom change during the COVID-19 pandemic.

Despite these limitations, the current study provides insights into potential vulnerabilities and mechanisms of risk during periods of high stress, specifically in the context of the COVID-19 pandemic. Specifically, pre-to-peri pandemic changes in rumination were positively associated with prospective changes in anxiety and depression symptoms among both mothers and youth. Therefore, increases in rumination may be a mechanism underlying internalizing symptom risk during the COVID-19 pandemic, although replication is required prior to drawing conclusions. If replicated in future studies, current findings highlight rumination as a promising target for intervention (e.g., rumination-based cognitive behavioral therapy [Watkins, 2015]), particularly during stressful contexts. Additionally, although the mechanisms and direction of transmission remain unclear, results suggest that pre-to-peri pandemic changes in depression symptoms were correlated among mothers and youth, thereby highlighting the importance of considering familial influences when examining mechanisms of risk during the COVID-19 pandemic.

Acknowledgements

This work was supported by NIMH Grant K23MH113793, Brain and Behavior Foundation Award, and Klingenstein Third Generation Foundation Fellowship awarded to K.L.B. The project was also supported by the National Center for Advancing Translational Sciences, NIH, through Grant UL1TR002003. C.F. is supported by NIMH grant T32MH067631.

Footnotes

Declaration of Interest

The authors report no conflict of interest.

References

  1. Bakker AB, & van Wingerden J (2021). Rumination about COVID-19 and employee well-being: The role of playful work design. Canadian Psychology/Psychologie Canadienne, 62(1), 73–79. [Google Scholar]
  2. Beck AT, Steer RA, & Brown GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. [Google Scholar]
  3. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, & Baugher M (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1230–1236. [DOI] [PubMed] [Google Scholar]
  4. Compas BE, Forehand R, Keller G, Champion JE, Rakow A, Reeslund KL, McKee L, Fear JM, Colletti CJ, Hardcastle E, Merchant MJ, Roberts L, Potts J, Garai E, Coffelt N, Roland E, Sterba SK, & Cole DA (2009). Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents. Journal of consulting and clinical psychology, 77(6), 1007–1020. 10.1037/a0016930 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. First M, Williams J, Karg R, & Spitzer R (2015). Structured Clinical Interview for DSM-5-Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV). American Psychiatric Association. [Google Scholar]
  6. Goodman S (2020). Intergenerational transmission of depression. Annual Review of Clinical Psychology, 16, 213–238. [DOI] [PubMed] [Google Scholar]
  7. Hamilton JL, Stange JP, Abramson LY, & Alloy LB (2015). Stress and the development of cognitive vulnerabilities to depression explain sex differences in depressive symptoms during adolescence. Clinical Psychological Science, 3(5), 702–714. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hammen C (2005). Stress and depression. Annual Review of Clinical Psychology, 1(1), 293–319. [DOI] [PubMed] [Google Scholar]
  9. Hankin BL (2009). Development of sex differences in depressive and co-occurring anxious symptoms during adolescence: Descriptive trajectories and potential explanations in a multiwave prospective study. Journal of Clinical Child & Adolescent Psychology, 34(4), 460–472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hayes AF (2013). Mediation, moderation and conditional process analysis. New York: Guilford Press. [DOI] [PubMed] [Google Scholar]
  11. Holman EA, Thompson RR, Garfin DR, & Silver RC (2020). The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States. Science Advances, 6(42), eabd5390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jose PE, & Brown I (2008). When does the gender difference in rumination begin? Gender and age differences in the use of rumination by adolescents. Journal of Youth and Adolescence, 37(2), 180–192. [Google Scholar]
  13. Kouros CD, & Garber J (2010). Dynamic associations between maternal depressive symptoms and adolescents’ depressive and externalizing symptoms. Journal of Abnormal Child Psychology, 38(8), 1069–1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lopez CM, Driscoll KA, & Kistner JA (2009). Sex differences and response styles: Subtypes of rumination and associations with depressive symptoms. Journal of Clinical Child & Adolescent Psychology, 38(1), 27–35. [DOI] [PubMed] [Google Scholar]
  15. Low RST, Overall NC, Chang VT, & Henderson AME (2020). Emotion regulation and psychological and physical health during a nationwide COVID-19 lockdown. PsyArXiv. 10.31234/osf.io/pkncy [DOI] [PubMed] [Google Scholar]
  16. McLaughlin KA, Hilt LM, & Nolen-Hoeksema S (2007). Racial/ethnic differences in internalizing and externalizing symptoms in adolescents. Journal of Abnormal Child Psychology, 35(5), 801–816. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Michl LC, McLaughlin KA, Shepherd K, & Nolen-Hoeksema S (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339–352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nolen-Hoeksema S, Wisco BE, & Lyubomirsky S (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. [DOI] [PubMed] [Google Scholar]
  19. Prime H, Wade M, Browne DT (2020). Risk and resilience in family well-being during the COVID-19 pandemic. American Psychologist, 75(5), 631–643. [DOI] [PubMed] [Google Scholar]
  20. Radloff LS (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 85–401. [Google Scholar]
  21. Sachs-Ericsson N, Selby EA, Hames JL, Joiner TE, Fingerman KL, Zarit SH, Birditt KS, & Hilt LM (2014). Transmission of parental neuroticism to offspring’s depression: The mediating role of rumination. Personality and Mental Health, 8, 306–319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Steer RA, & Beck AT (1997). Beck Anxiety Inventory. In Zalaquett CP & Wood RJ (Eds.), Evaluating stress: A book of resources (p. 23–40). Scarecrow Education. [Google Scholar]
  23. Treynor W, Gonzalez R, Nolen-Hoeksema S (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy Research, 27, 247–259. [Google Scholar]
  24. Watkins E (2015). Psychological treatment of depressive rumination. Current opinion in Psychology, 4, 32–36. [Google Scholar]
  25. Woody ML, Kudinova AY, McGeary JE, Knopik VS, Palmer RHC, & Gibb BE (2016). Influence of maternal depression on children’s brooding rumination: Moderation by CRHR1 TAT haplotype. Cognition and Emotion, 30(2), 302–314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Ye B, Wu D, Im H, Liu M, Wang X, & Yang Q (2020). Stressors of COVID-19 and stress consequences: The mediating role of rumination and the moderating role of psychological support. Children and Youth Services Review, 118, 105466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Young CC, & Dietrich MS (2015). Stressful life events, worry, and rumination predict depressive and anxiety symptoms in young adolescents. Journal of Child and Adolescent Psychiatric Nursing, 28(1), 35–42. [DOI] [PubMed] [Google Scholar]

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