Resilience to depressive symptoms: The buffering effects of enhancing cognitive style and positive life events

Background and Objectives

There are two lines of research examining the role of cognition in depression. One line of research focuses on risk for depression, and shows that a negative cognitive style interacts with stressful life events to create depression. The second line of research focuses on recovery, and shows that an enhancing cognitive style interacts with positive life events to reduce depression. The goal of this study was to integrate these two areas and provide a more comprehensive test of the cognitive model of depression.

Methods

A 4-week prospective longitudinal design was used to test the interaction between cognitive style (both negative and enhancing) and life events (both negative and positive) in a sample of undergraduates (n = 128).

Results

Cognitively vulnerable individuals were buffered from the depressive effects of stress if they also possessed an enhancing cognitive style or experienced high numbers of positive life events. Individuals with low levels of negative cognitive style and life stress, but high levels of enhancing cognitive style or positive life events were the most resilient to depressive symptoms.

Limitations

Future research is needed to determine if the results of this study generalize to a more diverse sample as well as to clinically significant forms of depression.

Conclusions

The results provide some of the first evidence for the protective role of enhancing cognitive style and positive live events among vulnerable individuals. These findings underscore the importance of examining a broader environmental context when investigating risk and resiliency to depression.     

Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: A longitudinal study in adolescents

Background and Objectives

A negative self-view is a prominent factor in most cognitive vulnerability models of depression and anxiety. Recently, there has been increased attention to differentiate between the implicit (automatic) and the explicit (reflective) processing of self-related evaluations. This longitudinal study aimed to test the association between implicit and explicit self-esteem and symptoms of adolescent depression and social anxiety disorder. Two complementary models were tested: the vulnerability model and the scarring effect model.

Method

Participants were 1641 first and second year pupils of secondary schools in the Netherlands. The Rosenberg Self-Esteem Scale, self-esteem Implicit Association Test and Revised Child Anxiety and Depression Scale were completed to measure explicit self-esteem, implicit self-esteem and symptoms of social anxiety disorder (SAD) and major depressive disorder (MDD), respectively, at baseline and two-year follow-up.

Results

Explicit self-esteem at baseline was associated with symptoms of MDD and SAD at follow-up. Symptomatology at baseline was not associated with explicit self-esteem at follow-up. Implicit self-esteem was not associated with symptoms of MDD or SAD in either direction.

Limitations

We relied on self-report measures of MDD and SAD symptomatology. Also, findings are based on a non-clinical sample.

Conclusions

Our findings support the vulnerability model, and not the scarring effect model. The implications of these findings suggest support of an explicit self-esteem intervention to prevent increases in MDD and SAD symptomatology in non-clinical adolescents.     

Bully victimization and emotional problems in adolescents: Moderation by specific cognitive coping strategies?

Objective

Relationships between bully victimization and symptoms of depression/anxiety were examined. In addition, it was studied whether this relationship was moderated by specific cognitive coping strategies.

Methods

Participants were 582 secondary school students who filled out online self-report questionnaires on bully victimization, cognitive coping, and depression/anxiety. (Moderated) Multiple Regression analysis was performed.

Results

Strong relationships were found between bully victimization and symptoms of depression and anxiety. On top of that, two cognitive coping strategies moderated the relationship between bullying and depression, i.e. rumination (strengthening) and positive refocusing (reducing). Cognitive coping strategies that moderated the effect of bullying on anxiety symptoms were rumination, catastrophizing (strengthening) and positive reappraisal (reducing).

Conclusion

The results provide possible targets for intervention: when helping adolescents who have been bullied, maladaptive cognitive coping strategies could be assessed and challenged, while more adaptive strategies could be acquired.     

Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis

Objective

Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care.

Methods

Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated.

Results

Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r = ± 0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also.

Conclusions

Associations between cognitive illness representations and poor emotional health were in the expected direction — negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.     

Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders

Objective

Research suggests that resilience is associated with favorable treatment outcome in patients with depression and/or anxiety disorders. In this regard, the identification of specific characteristics related to resilience that could provide targets for resilience-enhancement interventions is needed. Since the type of cognitive coping strategies is a possible marker of resilience, we investigated adaptive and maladaptive cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders.

Methods

A total of 230 outpatients with depression and anxiety disorders were consecutively recruited and completed the Cognitive Emotion Regulation Questionnaire, the Connor–Davidson Resilience Scale, the Beck Depression Inventory, and the State Anxiety Inventory. A linear regression model was used to determine which cognitive emotion regulation strategies predicted resilience after controlling for relevant covariates. Additionally, this model of resilience was compared with those of depression and anxiety symptoms.

Results

Adaptive strategies were more strongly correlated with resilience than maladaptive strategies. In the regression model, more use of refocus on planning and positive reappraisal as well as less use of rumination predicted high resilience after controlling for age, gender, marital status, depression, and anxiety. Among these strategies, refocus on planning was the common strategy contributing to resilience and depression.

Conclusion

These results suggested that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contribute to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients.     

Adverse childhood experiences worsen cognitive distortion during adult bipolar depression

Background

Cognitive distortion is a central feature of depression, encompassing negative thinking, dysfunctional personality styles and dysfunctional attitudes. It has been hypothesized that ACEs could increase the vulnerability to depression by contributing to the development of a stable negative cognitive style. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and cognitive distortion, and whether any gender differences exist.

Aim

The aim of this study was to examine the association between ACEs and cognitive distortions and possible differences between genders in a sample of patients affected by bipolar disorder.

Method

130 patients with bipolar disorder (BD) (46 men and 84 females), completed the Risky Family Questionnaire to assess ACEs and the Cognition Questionnaire (CQ) to assess cognitive distortions.

Results

A positive association was found between ACE and the CQ total score. Investigating the 5 dimensions assessed through the CQ, only the dimension “generalization across situations” was significantly associated to ACE. An interaction between ACE and gender was found for “generalization across situations”, while no differential effect among females and males was found for CQ total score.

Conclusion

This is the first study to report a relationship between negative past experiences and depressive cognitive distortions in subjects affected by BD. Growing in a family environment affected by harsh parenting seems to a cognitive vulnerability to depression; this effect is especially strong in females.     

Mild cognitive impairment and risk of depression and anxiety: A population-based study

Introduction

Many people with mild cognitive impairment (MCI) suffer from concomitant depression or anxiety. Whether MCI increases the risk of future depression or anxiety is unknown.

Course of depression,mental health service utilization and treatment preferences in women receiving chemotherapy for breast cancer

Objective

This prospective study aimed to estimate the prevalence and course of depression during chemotherapy in women with Stage I–III breast cancer, identify potential risk factors for depression and determine which treatments for depression were being used and which were most preferred.

Method

Thirty-two women were followed over consecutive chemotherapy infusions, with 289 assessments conducted altogether (mean, 9.0 assessments/subject). Current depression, anxiety, physical symptoms and mental health service use were recorded during each assessment. A linear mixed effects model was used to identify factors associated with depression. Patients also ranked depression treatment preferences. We referred patients with more severe depression for treatment.

Results

Clinically significant depression was identified in 37.5% of patients. Depression severity tended to peak at 12–14 weeks and 32 or more weeks of chemotherapy. Depression severity was associated with anxiety severity, physical symptom burden, non-White race, receiving one's first chemotherapy regimen, Adriamycin-Cytoxan chemotherapy and chemotherapy duration. Most (65.5%) patients preferred evidence-based treatments for depression, and 66.7% of depressed patients were using such treatments.

Conclusions

Depression is common in women receiving chemotherapy for breast cancer. Most patients prefer evidence-based depression treatments. We recommend regular screening for depression during chemotherapy to ensure adequate detection and patient-centered treatment.     

The association of Internet addiction symptoms with anxiety,depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder

Background

The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.

Method

A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.

Results

The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms.

Conclusions

Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.     

Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis

Background

The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet.

Methods

This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥11).

Results

Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS≥11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety.

Conclusions

The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression.     

Meta-cognitive beliefs as a mediator for the relationship between Cloninger’s temperament and character dimensions and depressive and anxiety symptoms among healthy subjects

Background

Previous studies suggest that temperament and character may impact depression and anxiety through dysfunctional cognition. This study targets the mediating role of meta-cognitive beliefs in the relationship between Cloninger’s temperament and character dimensions and symptoms of depression and anxiety.

Method

One hundred and sixty-one healthy subjects filled out Cloninger’s Temperament Character Inventory (TCI), a Metacognitions Questionnaire (MCQ), the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (STAI). Correlation and mediation analyses according to Baron and Kenny’s method were performed.

Results

Harm avoidance (HA) and self-directedness (SD) were related to depression and anxiety. HA was related to negative beliefs about uncontrollability of thoughts and to beliefs about cognitive confidence. SD was associated with the same types of meta-cognitive beliefs and with general negative beliefs. Cooperativeness (CO) was related to positive beliefs about worry, beliefs about cognitive confidence and to general negative beliefs. Self-transcendence (ST) was related to all types of meta-cognitive beliefs. Mediation analysis revealed that the relationship between HA and depression and anxiety is partially mediated by certain types of meta-cognitive beliefs. The same results were obtained for the relationship between SD and depression and anxiety. General negative beliefs fully mediated the relationship between CO and depression and the relationship between ST and anxiety.

Conclusions

Meta-cognitive beliefs mediate the relationship between temperament and character dimension and depressive and anxiety symptoms, thus providing further evidence for the meta-cognitive theory of emotional disorders as presented by Wells and Matthews (Behav Res Ther 1996;32:867-870).     

Is cognitive behaviour therapy of benefit for melancholic depression?

Objective

This paper seeks to determine the relevance and likely salience of cognitive behaviour therapy (CBT) as a treatment for melancholic depression.

Methods

The findings of a randomised trial comparing 12-week outcome of 18 patients with melancholic depression receiving antidepressant medication and 11 receiving CBT were evaluated, and qualitative explanations for the outcomes were provided principally by the treating CBT practitioners.

Results

In the trial, CBT showed no improvement in depression severity in the first four weeks and then some level of improvement over the subsequent eight weeks. Outcome was superior for those receiving antidepressant medication at 12 weeks and was first demonstrated at four weeks. The benefits of CBT appeared to be in settling anxiety, dealing with cognitive processing of having a melancholic depression and addressing any personality vulnerabilities.

Conclusion

While a pilot study, our qualitative reports indicate that CBT may provide a useful role in managing melancholia as an adjunct to antidepressant medication. Future studies examining such a combination treatment model should seek to determine if indicative data provided here argue for a sequencing model of CBT being introduced after medication has addressed core biological underpinnings.     

The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions

Background and objectives

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are dangerous, is a cognitive vulnerability factor for certain anxiety symptoms such as panic and posttraumatic stress symptoms. Very little research, however, has examined the relationship between AS and obsessive-compulsive (OC) symptoms, which was the objective of the current research.

Methods

We administered dimensional measures of AS and OC symptoms to a large sample of undergraduate students (N = 636). We also included measures of general distress and cognitive distortions related to OCD (i.e., obsessive beliefs) as control variables.

Results

Regression analyses indicated that AS was predictive of OC symptoms even after controlling for general distress and obsessive beliefs. In addition, the three domains of AS (physical, social, and cognitive concerns) were differentially associated with the four dimensions of OC symptoms (contamination, responsibility for harm, symmetry, and unacceptable thoughts).

Limitations

Our findings are based on a non-clinical student sample and their generalization to OCD requires replication with a sample of OCD patients.

Conclusions

These results provide preliminary evidence that AS plays a role in OC symptoms. Implications for clinical practice and for future research are discussed.     

Attentional modulation by reward and punishment cues in relation to depressive symptoms

Background and objectives

Research indicates that individuals at-risk for depression are characterized by high sensitivity to loss and reduced sensitivity to reward. Moreover, it has been shown that attentional bias plays an important role in depression vulnerability. The current study aimed to examine the interplay between these risk factors for depression by examining the development of attentional bias toward reward and loss signals in dysphoric participants (individuals with elevated levels of depressive symptoms).

Methods

Shapes were conditioned to reward and loss and subsequently presented in a dot probe task in a sample of dysphoric and nondysphoric participants.

Results

Nondysphoric individuals oriented towards reward-related signals whereas dysphoric individuals failed to develop a reward-related attentional bias. This attentional effect was observed in the absence of group differences in motivational factors. No group differences were found for attentional bias for loss-related signals, despite the fact that dysphoric individuals performed worse in response to losing.

Limitations

The current sample is not clinical thus generalization to clinical depression is not warranted.

Conclusions

We argue that impaired early attentional processing of rewards are an important cognitive risk factor for anhedonic symptoms in persons with dysphoria.     

Neuropsychiatric predictors of conversion to dementia both in patients with amnestic mild cognitive impairment and those with subcortical vascular MCI

Objective

The aim of this study was to investigate whether specific neuropsychiatric domains could predict a conversion to dementia in those patients either with amnestic subtype of mild MCI (aMCI) or subcortical vascular MCI (svMCI).

Methods

At baseline, all subjects underwent neuropsychological tests, Neuropsychiatric Inventory (NPI), and MRI. We compared the baseline NPI scores between converters (CV) and non-converters (NCV) both in the aMCI and svMCI groups.

Results

The mean follow-up duration was 16.74 ± 8.02 months (range: 4.2–43.9). At the second time point, about 30% of aMCI and svMCI patients converted to dementia with 7.5% of aMCI patients exhibiting improvement to normal cognitive state. In female aMCI patients, those who later improved to normal cognition exhibited higher baseline depression scores than the CV group. However, baseline depression scores were higher in the CV group than the NCV group in svMCI patients, and this difference was significant only in males.

Conclusion

Our results suggest that depression might serve as a predictive marker of conversion to dementia in patients with svMCI, albeit only in males. On the other hand, patients who later improved to normal cognition showed higher scores of depression at baseline in female aMCI patients, suggesting that longer follow-ups are warranted in female patients with aMCI and depression.     

Hemoglobin levels in persons with depressive and/or anxiety disorders

Objective

Both low and high hemoglobin levels lead to more physical diseases, and both are linked to mortality. Low hemoglobin, often classified as anemia, has also been linked to more depressive symptoms, but whether both hemoglobin extremes are associated with depressive disorder and potentially also with anxiety disorder has not been examined before. This study examines to which extent hemoglobin levels are associated with depression and anxiety disorders in a large cohort.

Methods

The study sample consisted of 2920 persons from the Netherlands Study of Depression and Anxiety. Hemoglobin levels were determined after venipuncture. Depressive and anxiety disorders were determined according to a DSM-IV-based psychiatric interview. Clinical psychiatric characteristics included the severity of depression and anxiety, the duration of symptoms, the age of onset and the antidepressant use.

Results

Higher hemoglobin levels were found in those with current depressive and/or anxiety disorders after sociodemographic adjustment and both higher, and lower hemoglobin levels were found in persons with higher depression and anxiety severity. However, after full adjustment for sociodemographics, disease indicators and lifestyle, associations were no longer significant.

Conclusions

This cohort study showed that there is no independent association between depressive and/or anxiety disorders and hemoglobin levels or anemia status.     

Mindfulness-based cognitive therapy for people with diabetes and emotional problems: Long-term follow-up findings from the DiaMind randomized controlled trial

Objective

The DiaMind trial showed beneficial immediate effects of mindfulness-based cognitive therapy (MBCT) on emotional distress, but not on diabetes distress and HbA_1c. The aim of the present report was to examine if the effects would be sustained after six month follow-up.

Methods

In the DiaMind trial, 139 outpatients with diabetes (type-I or type-II) and a lowered level of emotional well-being were randomized into MBCT (n = 70) or a waiting list with treatment as usual (TAU: n = 69). Primary outcomes were perceived stress, anxiety and depressive symptoms, and diabetes distress. Secondary outcomes were, among others, health status, and glycemic control (HbA_1c).

Results

Compared to TAU, MBCT showed sustained reductions at follow-up in perceived stress (p < .001, d = .76), anxiety (p < .001, assessed by HADS d = .83; assessed by POMS d = .92), and HADS depressive symptoms (p = .004, d = .51), but not POMS depressive symptoms when using Bonferroni correction for multiple testing (p = .016, d = .48). No significant between-group effect was found on diabetes distress and HbA_1c.

Conclusion

This study showed sustained benefits of MBCT six months after the intervention on emotional distress in people with diabetes and a lowered level of emotional well-being.

Trial registration

Dutch Trial Register NTR2145, http://www.trialregister.nl.     

Mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems among adolescents in Taiwan

Background

This study aimed to examine the mediating effects of depression and anxiety on the relationships of bullying victimization and perpetration with pain among adolescents in Taiwan.

Method

A total of 4976 students of junior and senior high schools completed the questionnaires. Bullying victimization and perpetration, pain problems, depression, and anxiety were assessed. The mediating effects of depression and anxiety on the relationship between bullying involvement and pain problems and the moderating effects of sex on the medicating roles of depression and anxiety were examined by structural equation model.

Results

Both depression and anxiety were significant mediators of the relationship between bullying victimization and pain problems among adolescents. Depression was also a significant mediator of the relationship between bullying perpetration and pain problems among adolescents. Sex had no moderating effect on the mediating role of depression/anxiety on the association between bullying involvement and pain problems.

Conclusions

Medical and educational professionals should survey and intervene in depression and anxiety when managing pain problems among adolescents involved in bullying.     

Cortisol responses on the dexamethasone suppression test among women with Bulimia-spectrum eating disorders: associations with clinical symptoms

Introduction

Evidence associates Bulimia Nervosa (BN) with altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but the clinical implications of such alterations need to be better understood. We contrasted cortisol responses to the dexamethasone suppression test (DST) in bulimic and non-eating disordered women and examined relationships among DST cortisol responses, eating symptoms and co-morbid disturbances.

Method

Sixty women with Bulimia Spectrum (BS) Disorders (either BN or normal weight Eating Disorder NOS with regular binge eating or purging) and 54 non-eating disordered women of similar age and body mass index participated in a 0.5 mg DST, and completed interviews and questionnaires assessing eating symptoms and co-morbid psychopathology.

Results

Compared with the normal-eater group, the BS women demonstrated significantly less DST suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations.

Conclusions

Our findings show BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations.     

Understanding catastrophic worry in eating disorders: process and content characteristics

Background and objectives

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

Methods

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

Results

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

Limitations

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

Conclusion

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.