Common Versus Unique Variance Across Measures of Worry and Rumination: Predictive Utility and Mediational Models for Anxiety and Depression

Repetitive negative thinking (RNT) has been identified as a transdiagnostic construct. However, diagnosis-specific questionnaires have traditionally been used to measure RNT across emotional disorders, and thus the degree to which they assess shared versus unique aspects of RNT is unclear. Furthermore, the degree to which shared versus unique variance across these measures contributes to the prediction of anxiety and depression symptoms is yet to be fully understood. This study had three aims. First, confirmatory factor analysis was used to test the degree to which two common, diagnosis-specific questionnaires assess common versus unique variance in RNT. One questionnaire measured worry whereas the other measured two aspects of rumination (brooding, reflection). Second, the contribution of the shared and unique variance in predicting symptoms of anxiety and depression was determined. Third, the role of shared and unique variance in mediating the relationships between the vulnerability factor of negative affectivity and symptoms of anxiety and depression was assessed. Participants (N = 450) presented for treatment at a specialist clinic with anxiety and affective disorders (54% women). A nested four-factor model (RNT, worry, reflection, brooding) provided a superior fit to two-factor (worry, rumination) and three-factor (worry, reflection, brooding) oblique models. Structural equation modeling showed that RNT, brooding, and worry uniquely predicted anxiety and depression, and reflection also predicted depression. RNT partially mediated the relationship between negative affectivity and anxiety, and brooding partially mediated this relationship for depression and anxiety. Our findings suggest that both RNT and brooding may be separable and transdiagnostic constructs.     

Borderline Personality Traits Predict Poorer Functioning During Partial Hospitalization: The Mediating Role of Depressive Symptomatology

A number of factors contribute to the difficulty providers experience in treating borderline personality disorder (BPD). One complicating factor for treatment effectiveness is the presence of comorbid affective psychopathology (e.g., depression, anxiety). Participants were 176 adults (60 % female; M _age = 32.20) in a partial hospital program. Using a mediation model, the current study examined the relationship among traits of BPD, affective symptomatology, and general functioning post-treatment. Additional analyses explored whether change in the perception of therapeutic skill implementation moderated the relationship among traits of BPD, affective symptomatology, and general functioning. Little improvement/worsening of depression during partial hospitalization, but not changes in anxiety, mediated the relationship between traits of BPD and poor general functioning. Additionally, regardless of changes in perception of cognitive- or dialectical-behavioral skill implementation, little improvement/worsening depressive symptomatology continued to mediate the negative relationship noted above. This study has important implications for treatment of BPD and suggests that targeting depressive symptoms in short-term settings may be crucial in acute stabilization.     

Social problem-solving deficits,dependency, and depressive symptoms

Depressive symptoms have been linked to deficits in social problem solving. We extended earlier work by evaluating the specificity of problem-solving deficits to depressive (vs. anxiety) symptoms and by incorporating another correlate of depression, interpersonal dependency. Specifically, we addressed (a) a prediction that problem-solving skill and dependency would correlate inversely and (b) the question of whether problem-solving skill is associated with depressive symptom severity, controlling for dependency. In an unselected sample (N=115), results varied for different aspects of social problem solving. Problem-solving skills (e.g., generating multiple alternatives, evaluating pros and cons before deciding) were unrelated to depressive symptoms, anxiety symptoms, or dependency. Problem orientation (a constructive attitude toward problems involving seeing them as manageable challenges) was inversely related to dependency and to both depressive and anxiety symptom severity. The relation between problem orientation and depressive symptoms was reduced but not eliminated by controlling statistically for dependency.     

The Relationships of Personality and Cognitive Styles with Self-Reported Symptoms of Depression and Anxiety

Many studies have reported concurrent relationships between depressive symptoms and various personality, cognitive, and personality-cognitive vulnerabilities, but the degree of overlap among these vulnerabilities is unclear. Moreover, whereas most investigations of these vulnerabilities have focused on depression, their possible relationships with anxiety have not been adequately examined. The present study included 550 high school juniors and examined the cross-sectional relationships among neuroticism, negative inferential style, dysfunctional attitudes, sociotropy, and autonomy, with a wide range of anxiety and depressive symptoms, as well as the incremental validity of these different putative vulnerabilities when examined simultaneously. Correlational analyses revealed that all five vulnerabilities were significantly related to symptoms of both anxiety and depression. Whereas neuroticism accounted for significant unique variance in all symptom outcomes, individual cognitive and personality-cognitive vulnerabilities accounted for small and only sometimes statistically significant variance across outcomes. Importantly, however, for most outcomes the majority of symptom variance was accounted for by shared aspects of the vulnerabilities rather than unique aspects. Implications of these results for understanding cognitive and personality-cognitive vulnerabilities to depression and anxiety are discussed.     

Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment

The current study examined changes in social anxiety thoughts and beliefs following cognitive-behavioral treatment (CBT). Participants (N = 77) were adults with a principal diagnosis of SAD who received 12, 2-h sessions of group CBT at a hospital-based outpatient anxiety disorders clinic. There were significant decreases from pretreatment to posttreatment in social anxiety symptoms and in symptoms of depression, nonspecific anxiety and tension, as well as significant improvements in social anxiety beliefs, as assessed via the Social Thoughts and Beliefs Scale (STABS; Turner et al., Psychol Assess 15:384–391, 2003). Change in social anxiety beliefs made a significant contribution to the prediction of social anxiety symptoms at posttreatment over and above pretreatment social anxiety symptoms and changes in depression, nonspecific anxiety and tension. A positive change in the belief that others are more socially-competent emerged as a significant unique predictor of social anxiety symptoms at posttreatment. The findings demonstrate that the STABS is sensitive to cognitive-behavioral treatment. The findings also suggest that social comparison processes in particular are a key aspect of improvement in social anxiety symptoms. This is an important direction for future research.     

Predicting Changes in Depressive Symptoms from Pregnancy to Postpartum: The Role of Brooding Rumination and Negative Inferential Styles

The current study examined the role of cognitive factors in the development and maintenance of depressive symptoms from pregnancy into the postpartum period. One hundred and one women were assessed for levels of rumination (brooding and reflection), negative inferential styles, and depressive symptoms in their third trimester of pregnancy and depressive symptom levels again at 4 and 8 weeks postpartum. We found that, although none of the three cognitive variables predicted women’s initial depressive reactions following childbirth (from pregnancy to 1 month postpartum), brooding rumination and negative inferential styles predicted longer-term depressive symptom changes (from pregnancy to 2 months postpartum). However, the predictive validity of women’s negative inferential styles was limited to women already exhibiting relatively high depressive symptom levels during pregnancy, suggesting that it was more strongly related to the maintenance of depressive symptoms into the postpartum period rather than increases in depressive symptoms following childbirth. Modifying cognitive risk factors, therefore, may be an important focus of intervention for depression during pregnancy.     

Patterns of depressive symptom response in duloxetine-treated outpatients with mild, moderate or more severe depression

AIMS: This was a post hoc analysis to determine whether baseline severity of depression influenced the efficacy of duloxetine in treating major depressive disorder (MDD) and to better characterise the symptom response profile for duloxetine in patients with mild, moderate or more severe depression. METHODS: Data were pooled from four double-blind, placebo-controlled studies in which outpatients with MDD were randomised to duloxetine (60 mg/day) or placebo for 8-9 weeks. Patients were retrospectively stratified according to baseline 17-item Hamilton Depression Rating scale (HAMD17) total scores: mild=total score相似文献   

Cognitive Errors in Youth with Anxiety Disorders: The Linkages Between Negative Cognitive Errors and Anxious Symptoms

This study examined the linkages between negative cognitive errors and anxiety in a sample of children and adolescents referred for anxiety problems (N = 251). The Children's Negative Cognitive Error Questionnaire was used to assess cognitive errors and several self-report measures of anxiety were used to examine the specific linkages between cognitive errors and different aspects of children's anxiety phenomenology. Results indicated that each of the measures of anxiety (i.e., trait anxiety, manifest anxiety, and anxiety sensitivity) were significantly related to each of the cognitive errors examined (i.e., catastrophizing, overgeneralization, personalizing, and selective abstraction). The cognitive errors of catastrophizing, overgeneralization, and personalizing were still correlated with trait anxiety, anxiety sensitivity, and manifest anxiety while controlling for children's level of depression. In addition, the correlation between selective abstraction and anxiety sensitivity was still evident while controlling for children's level of depression. Stepwise regression analyses indicated that overgeneralization was the strongest predictor of trait anxiety, catastrophizing and personalizing were the strongest predictors of anxiety sensitivity and manifest anxiety, and overgeneralization and selective abstraction were the strongest predictors of depression. Results also indicated that age moderated the relation between some types of cognitive errors and anxiety. The results are discussed with respect to the development of cognitive models of anxiety in youth, future research directions, and potential treatment implications.     

Sequential improvement of anxiety, depression and anhedonia with sertraline treatment in patients with major depression

OBJECTIVE: To establish the therapeutic effect profile of sertraline in major depression. It was hypothesized that the antidepressant effect of sertraline showed three phases: Phase 1 where improvements in anxiety are most pronounced; Phase 2 where the greatest improvements are in depressive symptoms; and Phase 3 where the symptoms of anhedonia show the most improvement. To test this hypothesis, an 8-week, open-label study was conducted. METHODS: Patients with a major depressive episode (DSM-IV) and a score > or = 24 on the 17-item HAM-D were enrolled and treated with sertraline 50-150 mg/day. The three symptomatic clusters, anxiety, depression and hedonia, were defined a priori using the Inventory of Depressive Symptomatology-Clinician rated (IDS-C). Periods of interest were: Days 0-7 for anxiety, Days 7-21 for depression and Days 21-56 for anhedonia. Raters were blinded as to the constitution of the clusters and periods. RESULTS: 140 patients were recruited. Improvement in the anxiety cluster of the IDS-C was greatest during Days 0-7, whereas over Days 7-21 most improvement was observed in the depression cluster and the greatest improvement in the hedonic cluster occurred during Days 21-56. CONCLUSION: These preliminary results are consistent with the hypothesis that the therapeutic effects of sertraline occur in a sequential manner. The symptoms of anxiety improved first, followed by depression and then anhedonia.     

Self-Criticism,Failure, and Depressive Affect: A Test of Personality–Event Congruence and Symptom Specificity

Diathesis-stress models of cognitive vulnerability to depression posit that personality factors (e.g., self-criticism) interact with congruent negative life events to produce distinct depressive symptom clusters. The present study employed a stress-induction procedure to assess whether self-criticism would interact with achievement-related failure to increase introjective depressive affect in a nonclinical sample. Hypotheses were generally supported with respect to introjective depressive affect reported immediately following the stress-induction procedure. However, self-criticism did not interact with achievement failure in predicting depressive affect reported 24 hours later.     

Worry and Rumination: Repetitive Thought as a Concomitant and Predictor of Negative Mood

Worry and depressive rumination have both been described as unproductive, repetitive thought which contributes to anxiety or depression, respectively. It was hypothesized that repetitive thought, rather than its specific forms, is a general concomitant of negative mood. Study 1 was a cross-sectional test of the hypothesis. Repetitive thought was positively correlated with anxiety and depression in students (n = 110). In patients (n = 40), repetitive thought was positively correlated with anxiety and depression, and rumination was also specifically correlated with depression. Study 2 was a prospective test of the hypothesis. In students (n = 90), there were significant cross-sectional relationships between repetitive thought and both anxiety and depression. In addition, repetitive thought at least partially predicted maintenance of anxious symptoms. Phenomena such as goal interruption, failures of emotional processing, and information processing may lead to repetitive thought which increases negative mood states, including both anxiety and depression.     

Depression coping self-efficacy as a predictor of relapse 1 and 2 years following psychiatric hospital-based treatment

This longitudinal study involved 1 - and 2-year follow-up assessments of participants who received inpatient (n = 25) or partial hospital program (PHP) (n = 24) treatment for depression. The purposes of this study were to (a) compare 2-year follow-up depressive symptom and depression coping self-efficacy scores with posttreatment scores, (b) examine depression coping self-efficacy scores as a predictor of health care visit frequencies following treatment, and (c) examine differences in 2-year depressive symptom and depression coping self-efficacy scores between original treatment groups. Participant (n = 49) health records were reviewed for frequencies and types of health care visits at 1-year posttreatment. Twenty-six (52% response rate) participants completed the Depression Coping Self-Efficacy Scale, Center for Epidemiologic Studies Depression Scale, and Two-Year Follow-Up Questionnaire at 2-years posttreatment. One-year findings indicated posttreatment depression coping self-efficacy scores were associated with frequencies of psychiatric episodes of care. Relapse rates (> 25%) were consistent with previous reports. Despite maintenance of improvements in depressive symptom and depression coping self-efficacy scores, depressive symptom scores remained above cutoff levels at 2 years posttreatment. Two-year findings did not differ based on original treatment type. Findings support further research examining the DCSES as a predictor of relapse and a target for treatment.     

老年住院患者抑郁症状的综合康复治疗

目的 :观察抗抑郁药 (SSRIs)联合心理治疗对老年住院患者抑郁症状的临床疗效。方法 :6 0例伴抑郁症状的老年住院患者 ,结合Zung量表及HAMD评分进行抑郁症状的诊断以及应用SSRIs(帕罗西汀 )和心理干预治疗。结果 :综合治疗 6周后 ,6 0例患者的抑郁和躯体症状均有改善 ,Zung量表及HAMD评分均有下降 ,与治疗前比较差异有显著性 ,抑郁症状改善的有效率 >70 %。结论 :综合康复治疗对有抑郁症状的老年住院患者的康复有重要意义 ,SS RIs对老年患者安全有效。     

口服药物自杀未遂者心理状况分析及心理干预

目的:探讨口服药物自杀未遂者的心理状态,为心理评估和心理干预提供依据。方法:采用明尼苏达多相人格调查表、Zang’s抑郁自评量表、焦虑自评量表和症状自评量表评定42例口服药物自杀存活患者心理状态,在常规治疗、健康教育与心理干预3个月后,应用Zang’s抑郁自评量表、焦虑自评量表和症状自评量表再次进行评测,并与国内常模比较。结果:口服药物自杀存活患者Zang’s抑郁自评量表、焦虑自评量表总分和症状自评量表中躯体化、人际关系、抑郁、焦虑、恐惧等因子分值高于国内常模(P<0.05或P<0.01),经过健康教育与综合性心理干预后口服药物自杀存活患者的Zang’s抑郁自评量表、焦虑自评量表总分和症状自评量表中躯体化、人际关系、抑郁、焦虑、恐惧等因子分值显著降低(P<0.05或P<0.01)。结论:口服药物自杀未遂患者存在抑郁、焦虑、躯体化症状等负性情感;健康教育与综合性心理干预能缓解和改善抑郁、焦虑等负性情感。     

重症抑郁症病人认知功能与焦虑的关系

目的 :探讨重症抑郁症病人的认知功能性失调与焦虑障碍的关系。方法 :对24例伴有严重焦虑障碍和21例不伴有严重焦虑障碍的重症抑郁症病人在入院治疗前及常规药物治疗后 ,分别同时应用功能失调状况评定量表“DAS”、HAMD抑郁量表及Beck抑郁自评量表“BDI”进行测评与对照研究。结果 :常规药物治疗后两组患者抑郁症状严重程度(HAMD总分)明显减轻或消失 ,疗效显著(P<0.01)。但是认知功能改善存在较大差异。不伴焦虑的抑郁症在药物治疗后其认知障碍的严重程度随着抑郁症状的减少也明显减轻 ,而伴有焦虑的抑郁症病人在药物治疗后 ,尽管抑郁症状已明显减少或消失 ,但其认知障碍依然存在。结论 :伴有焦虑的抑郁症病人 ,认知障碍更突出、顽固。因而在治疗过程中 ,必须将药物和认知行为治疗相结合 ,这样才能获得长期的疗效并能预防复发。     

Symptoms of distress as prospective predictors of pain-related sciatica treatment outcomes

Prior studies evaluating predictors of pain-related outcomes following treatment for sciatica have been limited by methodological problems, including retrospective study design, use of unvalidated outcome measures, and short-term follow-up periods. Despite these limitations, some reports have suggested that symptoms of psychological distress may predict individual differences in pain treatment-related outcomes (e.g., higher levels of depressive and anxious symptomatology are associated with greater pain and disability after treatment). In this study, we sought to determine whether acute symptoms of depression and anxiety were prospectively associated with treatment outcomes over a 3-year follow-up period in surgically treated and non-surgically treated patients with sciatica. Patients were recruited from the practices of community-based physicians throughout the state of Maine, and underwent in-person baseline assessments, with mailed follow-up questionnaires at 3, 6, 12, 24, and 36 months. Study outcomes included patient-reported symptoms of pain and disability. For each outcome variable, we examined whether baseline mood (i.e., mood assessed prior to the initiation of treatment), as well as mood at the immediately preceding assessment point, prospectively predicted outcomes over 3 years in multivariate repeated-measures analyses. In most analyses, symptoms of depression and anxiety, both at baseline and at the preceding time point, were significant independent predictors of worse pain and function after controlling for relevant covariates. Collectively, elevated distress appears to be a significant risk factor for reduced treatment benefit (i.e., less improvement in pain and disability) over short and medium-term follow-up periods in patients with sciatica. Future research should determine whether the prospective identification and treatment of patients with high levels of distress (a "yellow flag") is associated with improved treatment outcomes.     

老年急性冠脉综合征患者伴发焦虑抑郁状况及护理需求

目的探讨老年急性冠脉综合征（ACS）患者伴发焦虑抑郁状况的影响因素及护理需求情况。方法选取256例老年ACS患者为研究对象,采用Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）和观察表对其进行测评,了解患者的焦虑、抑郁发生情况,分析焦虑抑郁发生的影响因素及护理需求情况。结果256例老年ACS患者存在焦虑症状占47．26％,抑郁症状占18．36％,同时合并焦虑抑郁症状占12．89％,焦虑抑郁总发生率为78．51％。Logistic回归分析结果显示,伴发焦虑抑郁状况主要与疾病相关知识、行为方式、医院环境、社会支持系统等因素有密切关系（β=-1．354,-2．045,-1．012;P〈0．05）;焦虑抑郁患者的疑病观念、不适主诉增多、注意力不集中、食欲减退、情绪低落、睡眠障碍等均高于无焦虑抑郁症状患者（P〈0．05）;有焦虑抑郁症状患者的各种护理需求中,需要吸氧（118例）、需要扣背（90例）、需要按摩（99例）、需要心理健康干预（112例）较无症状者（24,15,14,18例）明显增多,差异具有统计学意义（x2=16．18,11．49,10．18,10．84;P〈0．05）。结论对于老年ACS伴发焦虑抑郁患者应加强心理护理,有针对性的进行个体健康教育,对有效减少或防止老年ACS焦虑和抑郁的发生,促进疾病的好转、改善愈后和提高患者的生活质量具有重要意义。     

Optimum number of sessions for depression and anxiety

AIM: To examine the relationship between the number of psychological treatment sessions completed by patients (1-5 sessions, 6-8 sessions, >8 sessions) and the change in self-rated depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). METHOD: Recording demographic characteristics and various clinical outcome measures for all referrals to the service and examining the relationship between changes in self-reported anxiety and depression symptoms. RESULTS: For depression, the study shows that having 6-8 sessions offers more benefit than 1-5 sessions. Having more than eight sessions does not confer any additional benefit. Indeed, there is little difference between 1-5 sessions and more than eight sessions for depression. For anxiety, symptoms appear to continue to improve with increasing numbers of treatment sessions. CONCLUSION: Beyond eight treatment sessions, there appears to be no additional improvement. This is not the case for anxiety, where continuing treatment sessions appear to reduce symptoms.     

Marital functioning, chronic pain, and psychological distress

This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.     

丁螺环酮治疗伴随抑郁症焦虑症19例疗效观察

目的探讨丁螺环酮治疗伴随抑郁症状的焦虑症的疗效及不良反应作用。方法按中国精神障碍分类与诊断标准第3版诊断,随机选取收入本院的19例伴随抑郁症状的焦虑症患者,采用丁螺环酮治疗并进行临床观察,采用汉密尔顿焦虑量表、抑郁症专业量表及不良反应量表(TESS)进行评定。结果用丁螺环酮治疗19例伴抑郁症状的焦虑症总有效率为94.7%,对伴随严重焦虑症出现的轻、中度抑郁症状也有显著疗效,总有效率89.5%。其不良反应以头昏、头痛、口干、失眠等为常见,TESS评分同期比较差异均无统计学意义。结论丁螺环酮除具有良好的抗焦虑作用以外,抗抑郁症的疗效也是肯定的。