Attributional style in clinically depressed and conduct disordered adolescents

We tested the reformulated learned helplessness theory of depression with adolescent inpatients (N = 63) who were diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) criteria as depressed, or conduct disordered, or both. Adolescents with major depression diagnoses differed from nondepressed adolescents with significantly lower attributional style scores for positive events. The study also evaluated the relation of self-reported depression, anxiety, and social maladjustment to attributional style. Subjects who reported more severe depression had a significantly lower composite score for internal, stable, and global attributions for positive events. The composite of internal, stable, and global attributions for negative events was not significantly related to either diagnosed or self-reported depression.     

Sleep in depressed and nondepressed participants with chronic low back pain: electroencephalographic and behaviour findings

STUDY OBJECTIVES: To study the nature of sleep disturbance in depressed and nondepressed patients with chronic low back pain (CLBP). DESIGN: A controlled, consecutive 4-night polysomnographic study. PATIENTS: Participants were screened (psychologic, psychiatric, and physical) to determine their study group, and 21 participants (CLBP: 4 depressed, 6 nondepressed and 11 controls) were studied. MEASUREMENTS AND RESULTS: On all nights, standard polysomnographic sleep measures as well as midline occipital and frontal electroencephalography and respiration were recorded on a Grass Model 7 polygraph. Pain, sleep quality, and depression were also measured. Participants with CLBP reported significant levels of pain and sleep disturbance as compared to controls, but all groups had equivalent amounts of sleep and comparable sleep architecture. The electroencephalographic power spectral analyses revealed significant differences, with controls having more sigma across sites, more low beta activity occipitally and frontally than nondepressed patients with CLBP, and more occipital sigma and less high beta activity than depressed participants. Between pain subgroups, the depressed participants showed more occipital delta, more occipital and central alpha, and more high beta activity across all sites than did the nondepressed participants. CONCLUSIONS: Lower sigma power in participants with CLBP suggests less-effective sensorimotor gating that may contribute to poor sleep quality. Pain subgroup differences underscore the need to consider the influence of depression in the evaluation of sleep in clinical populations. This study controlled for many factors other than pain that may contribute to the sleep complaints in this population. Consequently, the absence of signs of major sleep disturbance must not be interpreted as evidence of a lack of a true sleep problem in CLBP but more likely reflects control of these factors as well as the difficulty in measuring sleep quality.     

大学生抑郁情绪与归因方式和自尊的关系

目的：探讨抑郁的无望感／自尊理论在中国大学生被试中的应用。方法：对大学生进行Beck抑郁量表（BDI）、归因方式问卷（ASQ）和白尊量表（SES）的测定。结果：不同抑郁水平大学生之间归因方式有显著差异，但在正性事件和内外维度上关系不稳定。抑郁与自尊有显著相关，不同自尊水平大学生之间的抑郁有显著差异，低自尊大学生的抑郁和归因方式的关系明显，高自尊大学生不明显。结论：本研究总体上验证了抑郁的无望感／自尊理论，中国大学生抑郁者具有对负性事件宿命性、普遍性和持续性归因、无望感和低自尊的特点。     

An examination of congruency hypothesis in hopelessness theory of depression

A longitudinal study was conducted to test two hypotheses, congruency and hopelessness-mediation, in hopelessness theory of depression. Three cognitive diatheses (attributional style, and inferential styles for consequences as well as the self), symptoms of depression, and hopelessness were measured in a survey of 279 men and women. About three months later, symptoms and hopelessness were measured again, along with negative life events in the interim. Some support was obtained for congruency hypothesis. Women with depressogenic attributional style in interpersonal domain became depressed when they experienced negative events in the domain, while men with depressogenic attributional style in achievement domain similarly became depressed. However, no comparable effect was found for the other diatheses: inferential styles. Hopelessness-mediation hypothesis was partly supported in interpersonal domain.     

Attributional style and symptoms of depression in persons with multiple sclerosis

This study was designed to assess hypotheses derived from the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), specifically that negative attributional style would be associated with depressive symptoms and that negative life events would interact with negative attributional style to explain depressive symptoms in a sample of persons with multiple sclerosis (MS). The research was cross sectional in design. Data was collected via survey from 495 persons with MS. Attributional style was positively associated with depressive symptoms across the whole sample. The proposition that negative life events would interact with negative attributional style to explain depressive symptoms was also supported, although only for global attributional style. Longitudinal studies would assist in determining the causal direction proposed by the hopelessness theory of depression in this population. It is also appropriate that clinicians consider attributional style in persons with MS whom they are treating for depression.     

Negative cognitive style as a predictor of negative life events in depression-prone individuals: a test of the stress generation hypothesis

BACKGROUND: Stress generation effects in depressed individuals have been well-documented. However, less is known about what personal attributes of depression-prone individuals may contribute to the stress generation effect. This study investigated the role of negative cognitive style in predicting the occurrence of negative life events. METHODS: Undergraduates identified as either high (n=76) or low (n=81) in negative cognitive style were assessed for lifetime history of depression followed by periodic assessment over the course of six months for the occurrence of negative life events and depressive episodes. RESULTS: Individuals with negative cognitive styles generated more negative life events (dependent events and interpersonal events, but not more independent or achievement-related events) than individuals with more positive cognitive styles. These results appear to be unique to women. LIMITATIONS: Utilizing participants specifically chosen to be high or low in negative cognitive style may limit generalizability to other individuals. CONCLUSIONS: Results suggest that an underlying negative cognitive style may account for the stress generation effect often found in depressed individuals, particularly for women. Adequately addressing cognitive patterns in treatment or prevention programs may not only effectively reduce depression, but may also reduce the likelihood of experiencing negative life events that often serve as precipitants for depression.     

A comparison of economic and social reward in patients with chronic nonmalignant back pain.

OBJECTIVE: Patients with chronic nonmalignant back pain are often exposed to multiple sources of economic and social reward. At issue in the present study was whether these rewards are 1) correlated with similar or dissimilar outcome variables and 2) able to account for unique variance in regression models of illness behavior. METHODS: A 2 x 2 factorial design was used in which patients were retrospectively assigned to one of four independent groups: low economic/low social reward, low economic/high social reward, high economic/low social reward, and high economic/high social reward. Of 265 consecutive patients enrolled at a tertiary pain service, 75 met eligibility criteria and had chronic nonmalignant back pain. RESULTS: Preexisting differences in health status were not associated with differences in illness behavior or pain ratings. With social reward held constant, patients in the high economic reward group missed more days from work (p < .005), had more domestic disability (p < .05), and were more depressed (p < .05) than patients in the low economic reward group. With economic reward held constant, patients in the high social reward group missed more days from work (p < .05), had more domestic disability (p < .01), and were more depressed (p < .01) than patients in the low social reward group. Unlike patients in the high economic reward group, however, patients in the high social reward group had higher levels of pain (p < .05) and more nonspecific medical complaints (p < .01). CONCLUSIONS: Economic and social rewards were both associated with increased disability and depression, but only social rewards were associated with increased symptom reporting. Exposure to economic and social rewards may account for unique variance in illness behavior that cannot be explained by differences in medical diagnosis, symptom duration, pain intensity, depression, or somatization.     

Cognitive style and pleasant activities among female adolescent suicide attempters

Cognitive style and pleasant activities of 77 suicide-attempting female minority adolescents were compared with those of 2 groups of non-suicide-attempting female minority adolescents, 39 who were psychiatrically disturbed and 23 who were nondisturbed. Suicide attempters differed from other groups, even when depression and IQ were statistically controlled. They reported significantly fewer alternatives for solving interpersonal problems, were significantly more focused on problems, and were more likely to report a wishful thinking style of coping in stressful situations than were members of the nondisturbed comparison group. Across groups, depression was associated with significantly more dysfunctional attributions. Interpersonal problem-solving ability and attributional style best distinguished the suicide attempters. Results suggest using different cognitive-behavioral interventions with depressed and nondepressed minority female adolescent suicide attempters.     

A neuroendocrine study of serotonin function in depressed stroke patients compared to non depressed stroke patients and healthy controls.

OBJECTIVES: We employed a neuroendocrine challenge paradigm to study serotonergic abnormalities associated with poststroke depression. METHOD: Twelve depressed stroke patients (major depression N= 5, minor depression N = 7), 8 nondepressed stroke patients and 12 healthy volunteers completed a single-blind, placebo-controlled, challenge tests. Baseline cortisol (CORT) and prolactin (PRL) values, and these hormonal responses to 30 mg of oral d-FEN and placebo over a 4 hour period were measured in the three groups. RESULTS: There were intergroup differences for baseline adjusted PRL responses (change scores from baseline) to d-FEN (group effect F = 4.38, df = 2,29, p = 0.02) while these responses to placebo were comparable between groups (group effect F = 1.82, df = 2,29, p = 0.18). Peak PRL responses (post d-FEN maximal PRL change from baseline scores) in depressed stroke patients were significantly greater than in nondepressed patients (p = 0.005) but comparable to healthy normals (p = 0.47). However, these responses between major and minor depression were not significant (p = 0.34). There was a trend suggesting a negative correlation between peak PRL response and severity of depression (p = 0.056). Depressed patients were younger than the controls (p = 0.054). Also, the depressed group was more functionally impaired (p = 0.04) and more likely to have right-sided lesions (p = 0.009) compared with the nondepressed group. Differences in baseline adjusted PRL changes between depressed and nondepressed groups became non significant when the influence of laterality of lesions was covaried, whereas covariation of functional scores and age did not alter the significance. CORT responses did not show intergroup differences. LIMITATIONS: The study group was small and was heterogenous in lesion characteristics, time since stroke and type of depression. A fixed-order design was used in the challenge test paradigm. CONCLUSIONS: When laterality of stroke lesion was taken into account, depressed and nondepressed stroke patients did not differ in PRL responses to d-FEN.     

Psychological correlates of pain behavior in patients with chronic low back pain

Pain behaviors that are excessive for the degree of known physical disease are common in patients with chronic low back pain and are frequently assumed to arise from a comorbid depressive illness. Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult. We recruited 54 consecutive patients with chronic (>6 months) low back pain from a hospital clinic. Subjects completed self-rated assessments of anxiety and depression (Hospital Anxiety and Depression Scale) designed to be minimally affected by physical symptoms, along with assessments of disability (ODQ), pain (visual analogue scale), pain behavior (Waddell checklist), and physical impairment. Seventeen subjects (31%) exhibited excessive pain behavior. Overall, they were no more depressed or anxious than the remainder, although men with excessive pain behavior showed a trend toward being more depressed. Patients with excessive pain behavior were more disabled (self-rated and observer-rated), reported greater pain, and were more likely to be female and to have pain of shorter duration. Pain behavior did not correlate with anxiety or depression, but correlated with measures of disability and pain intensity. Factor analysis revealed that physical disability, pain intensity, and pain behavior loaded heavily on the first factor. Anxiety and depression loaded together on a separate factor. We conclude that pain behaviors were not related to anxiety or depression in our group, although gender differences between groups could have contributed to our negative findings. Pain behaviors may influence other physical measures. Further studies are required to investigate the relation between depression and pain behavior while controlling for gender differences.     

Dysphoria,attributional reasoning and future event probability

This study investigated the relationship between attributional thinking and future expectations, in a group of mildly depressed (dysphoric) and non‐depressed control individuals. Participants were asked to recall eight positive and eight negative cued autobiographical memories, and then generate a short attributional statement giving the reason why they thought each event had happened. They then rated the likelihood of each event happening in the future. Each attribution was coded along three attributional dimensions: Internality, Stability, and Globality and ratings were combined to yield a composite score for positive items and a composite score for negative items. Relative to controls, dysphorics gave more internal, stable and global attributions for negative events, but their attributions for positive events were more external, unstable and specific. The dysphoric group also showed greater pessimism for future events. Irrespective of mood state, when recalled past events were attributed to internal, stable and global causes, participants gave greater likelihood expectations, compared to when events were attributed to external, unstable and specific causes. It was concluded that attributions do play a part in the link between memory retrieval and future judgements. The explanations people give of their past experiences are important in influencing their perceptions of the likelihood of such experiences in the future. Copyright © 2003 John Wiley &Sons, Ltd.     

大学生抑郁无望与自尊综合理论因果模型的追踪研究

目的阐明消极归因方式、负性生活事件和无望抑郁的关系,检验无望感的中介效应和自尊的调节作用,并尝试建立抑郁无望与自尊综合理论的因果模型。方法在问卷调查的基础上,以某高校学生269名为研究对象,采用潜变量增长曲线模型对多变量多次追踪数据进行分析。结果1消极归因方式(路径系数为0.127)、负性生活事件的初始状态(路径系数为0.235)和无望感(路径系数为0.455)对无望抑郁的初始状态有显著正向作用;2消极归因方式通过无望感对无望抑郁初始状态的部分中介效应为0.104。负性生活事件的初始状态对无望抑郁初始状态的部分中介效应为0.112;3消极归因方式和自尊的交互作用对无望抑郁的初始状态有显著的负向作用(路径系数为-0.165)。结论消极归因方式和负性生活事件共同作用预测了无望抑郁的产生,无望感在此过程中发挥部分中介作用,自尊发挥调节作用。     

Learned helplessness and depression among Israeli women.

Depressed and nondepressed Ss were exposed to either inescapable noise or no noise conditions in an attempt to replicate a typical learned helplessness study (Miller & Seligman, 1975) with Israeli student nurses. The inescapable noise was presented either as a personally important task or as an unimportant task. When later tested on a series of 20 patterned anagrams, no performance differences were found between depressed and nondepressed Ss as was found in previous studies, nor did the importance manipulation affect performance. Within the depressed group only, it was found that the more the Ss believed they had control over the noise, the better was their performance in the anagrams. Similarly, only among the depressed was the rated aversiveness of the noise positively related to anagram performance. Depressed were only able to assess accurately the number of failures on the anagrams, while nondepressed did equally well in assessing both positive and negative aspects of their performance. The results are discussed in terms of Seligman's learned helplessness model of depression and Beck's cognitive model of depression.     

Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study

BackgroundBiased causal attribution is a critical factor in the cognitive model of depression. Whereas depressed patients interpret events negatively, healthy people show a self-serving bias (internal attribution of positive events and external attribution of negative events).MethodsUsing fMRI, depressed patients (n = 15) and healthy controls (n = 15) were confronted with positive and negative social events and made causal attributions (internal vs. external). Functional data were analyzed using a mixed effects model.ResultsBehaviourally, controls showed a self-serving bias, whereas patients demonstrated a balanced attributional pattern. Analysis of functional data revealed a significant group difference in a fronto-temporal network. Higher activation of this network was associated with non self-serving attributions in controls but self-serving attributions in patients. Applying a psycho-physiological interaction analysis, we observed reduced coupling between a dorsomedial PFC seed region and limbic areas during self-serving attributions in patients compared to controls.LimitationsResults of the PPI analysis are preliminary given the liberal statistical threshold.ConclusionsThe association of the behaviourally less frequent attributional pattern with activation in a fronto-temporal network suggests that non self-serving responses may produce a self-related response conflict in controls, while self-serving responses produce this conflict in patients. Moreover, attribution-modulated coupling between the dorsomedial PFC and limbic regions was weaker in patients than controls. This preliminary finding suggests that depression may be associated with disturbances in fronto-limbic coupling during attributional decisions. Our results implicate that treatment of major depression may benefit from approaches that facilitate reinterpretation of emotional events in a more positive, more self-serving way.     

The effect of noncontingent feedback on attributional style

The relationship between experiences with noncontingency and attributional style was examined in experimental and correlational models. One hundred and twenty-six college student subjects were provided noncontingent, contingent, or no feedback as to the correctness of their responses on a concept discrimination problem. They then completed an attributional style questionnaire, a scale designed to measure life experiences with noncontingency, and a depression inventory. The experimental hypothesis was that exposure to noncontingent outcomes, both in a laboratory and historically, would result in more depressive attributions than would exposure to contingent outcomes or to no outcomes. The manipulation of feedback contingencies produced the predicted effect on attributions for positive and negative events combined into a single composite difference score. A correlation between life experiences with noncontingency and attributions was found only for the positive events measure. However, such life experiences were correlated significantly with depression.     

Attributional style and defense mechanisms: a synthesis of cognitive and psychodynamic factors in depression

In a study involving 160 undergraduates, we tested the hypothesis that attributional style and defense style would have interactive effects on depressive symptoms. Consistent with this hypothesis, both negative attributional style and low defense maturity were associated with depressive symptoms, both as main effects and in interaction. Negative attributional style was associated with depressive symptoms primarily when accompanied by low defense maturity. The presence of a positive attributional style reduced the relation between low defense maturity and depressive symptoms, and the presence of high defense maturity reduced the relation between a negative attributional style and depressive symptoms. In addition, high defense immaturity was shown to be a possible mediator of the relation between negative attributional style and depressive symptoms. Clinical implications for psychotherapy integration are discussed.     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: Relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n=254 and n=263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.This research was supported in part by a grant from the Henry J. Kaiser Family Foundation.     

归因方式问卷的初步编制

目的：编制归因方式问卷(Attributional Style Questionnaire,ASQ)及探讨抑郁症患者的归因方式的特征。方法：对419名大学生、98名抑郁症患者及与之匹配的100名正常对照试测。结果：大学生各年级、性别之间无差异，ASQ各维度的相关、内部一致性及重测信度较好。与正常对照相比，患者倾向于将负性事件归因为整体的、持久的，而将正性事件归因为外在的、局部的、暂时的，治疗后患者对负性事件治疗后更多地归因为暂时的、局部的、总体指标上为外在的，对正性事件治疗后更多地归因为内在的。结论：归因方式问卷基本达到了测量学的要求，抑郁症患者治疗后归因有自我服务倾向。     

The role of life events in depression in primary medical care versus psychiatric settings

BACKGROUND: The relationship between negative life events and depression is inconsistent. The purpose of the current study is to investigate the hypothesis that depression in the community may be related more to major life events than is depression in psychiatric settings. METHODS: This hypothesis was tested using depressed primary medical care (PC; n=70) and psychiatric patients (n=62). Nondistressed (n=109) and distressed/nondepressed PC patients (n=43) served as comparison-control groups. Life events were rated using the contextual method of Brown and Harris (Brown, G.W., Harris, T.O., 1978. Social origins of depression. Tavistock, London). RESULTS: Depressed PC patients, but not depressed psychiatric patients, were significantly more likely to have recent severe events than the comparison-control groups. Self-reported distress in the absence of depression was not associated with severe life events. LIMITATIONS: History of depression was assessed using a simple count of number of previous episodes, and the assessment of depression history may require more sophisticated assessment. The measure of endogenous depression used in this study was created post-hoc and needs replication. CONCLUSIONS: Diathesis-stress models need to accommodate a lack of universality for severe stress prior to the onset of depression. Clinical strategies may need to reflect patient treatment preferences associated with differences across settings with respect to the perceived role of stress in their depression.