Evaluation of the integrated cognitive model of depression and its specificity in a migrant population

This study empirically tested the specificity of the integrated cognitive model (ICM) of depression, which postulates that negative life events interact with dysfunctional attitudes to increase the frequency and severity of automatic thoughts, subsequently affecting depressive symptoms. We also examined the three competing models: the linear mediation model, the alternative etiologies model, and the symptom model. We anticipated that we might examine these models more appropriately using data from a population at an increased risk of developing depressive symptoms. As such, two-wave panel data were obtained from a group of 107 Korean migrants who had been in Australia less than 1 year. Structural equation modeling revealed that the ICM provided an adequate and much better fit than the three competing models. The ICM was also found to support the cognitive specificity theory of depression and anxiety. These findings suggest that dysfunctional attitudes can be a common cognitive moderator of depression and anxiety, whereas automatic thoughts and anxious self-statements can be specific cognitive mediators of anxiety and depression, respectively.     

Anthropological Notes on the Concept of Aggression†

Objective: Cognitive theories have proposed the idea of content specificity, which holds that emotional disorders are associated with unique sets of negative cognitions. The existent research exploring the content specificity related to posttraumatic stress disorder (PTSD) and depression is sparse, and research is especially needed in veteran samples. The purpose of this study was to examine the associations of PTSD symptom clusters and comorbid depressive symptoms with posttraumatic cognitions. Method: This study was cross-sectional in design, and the sample consisted of data from 150 male combat veterans with PTSD drawn from the baseline assessments of a large clinical trial. Analyses involved a series of separate and simultaneous linear regressions to examine the unique associations of comorbid depressive symptoms and PTSD symptom clusters with posttraumatic cognitions, as well as post hoc analyses to examine the mediational role of comorbid depressive symptoms. Results: Findings demonstrated that posttraumatic negative cognitions about the self and self-blame were most strongly associated with comorbid depressive symptoms and the depression-related PTSD numbing cluster. Comorbid depressive symptoms also partially mediated nearly all the relationships between posttraumatic cognitions and PTSD symptom clusters. Conclusions: The findings of this study suggest that posttraumatic cognitions about the self and self-blame are not specific to PTSD but rather are more strongly related to symptoms of depression and negative affect. The results also suggest a potential pathway from posttraumatic cognitions to PTSD through the partially mediating influence of comorbid depression, and highlight the need to assess and treat comorbid depression in veterans with PTSD.     

Longitudinal aspects of obsessive compulsive cognitions in a non-clinical sample: a five-year follow-up study

The cognitive behavioural models of Obsessive Compulsive Disorder (OCD) have stressed the role of cognitions, not only in aetiology but also in maintenance of the disorder. Little is known about the temporal relations between obsessive-compulsive cognitions and OCD symptoms. The aim of this study was to carry out a prospective assessment of OCD related beliefs and symptoms in a non-clinical sample. A total of 99 university students completed the Obsessive Beliefs Questionnaire (OBQ), Padua Inventory (PI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Worry Domain Questionnaire (WDQ) one, three and five years after baseline administration. Structural modelling predicting scores at later time periods and growth curve modelling were used to analyze the data. The results showed that obsessive-compulsive cognitions varied significantly over time. It was also found that the OBQ predicted symptom scales (Impaired Mental Control, Contamination and Checking) only at baseline. However symptom scores remained stable at each time point, as shown by the subscales of Impaired Mental Control, Contamination and Checking of the PI and the BAI, BDI and WDQ. Implications for future research and the cognitive model of OCD are discussed.     

Fire-related cognitions moderate the impact of risk factors on adjustment following wildfire disaster

This study builds upon current understanding of risk and protective factors for post-disaster adjustment by examining relationships between disaster-related cognitions, three empirically supported risk factors for poorer adjustment (i.e., greater disaster impact, female gender, and racial/ethnic minority status), and three common post-disaster outcomes (i.e., depression, anxiety, and somatic complaints). Participants were 200 students exposed to wildfire disaster. Simultaneous hierarchical regression analyses revealed that, during the acute stress period: (1) disaster-related cognitions in interaction with fire impact and minority status, as well as gender, were related to anxiety symptoms, (2) cognitions were related to depression symptoms, and (3) cognitions in interaction with minority status, as well as fire impact, were related to somatic symptoms. No examined variables predicted symptom change.     

Principal components of the Beck Depression Inventory and regional cerebral metabolism in unipolar and bipolar depression.

BACKGROUND: We determined clustering of depressive symptoms in a combined group of unipolar and patients with bipolar disorder using Principle Components Analysis of the Beck Depression Inventory. Then, comparing unipolars and bipolars, these symptom clusters were examined for interrelationships, and for relationships to regional cerebral metabolism for glucose measured by positron emission tomography. METHODS: [18F]-fluoro-deoxyglucose positron emission tomography scans and Beck Depression Inventory administered to 31 unipolars and 27 bipolars, all medication-free, mildly-to-severely depressed. BDI component and total scores were correlated with global cerebral metabolism for glucose, and voxel-by-voxel with cerebral metabolism for glucose corrected for multiple comparisons. RESULTS: In both unipolars and bipolars, the psychomotor-anhedonia symptom cluster correlated with lower absolute metabolism in right insula, claustrum, anteroventral caudate/putamen, and temporal cortex, and with higher normalized metabolism in anterior cingulate. In unipolars, the negative cognitions cluster correlated with lower absolute metabolism bilaterally in frontal poles, and in right dorsolateral frontal cortex and supracallosal cingulate. CONCLUSIONS: Psychomotor-anhedonia symptoms in unipolar and bipolar depression appear to have common, largely right-sided neural substrates, and these may be fundamental to the depressive syndrome in bipolars. In unipolars, but not bipolars, negative cognitions are associated with decreased frontal metabolism. Thus, different depressive symptom clusters may have different neural substrates in unipolars, but clusters and their substrates are convergent in bipolars.     

Posttraumatic Cognitions Inventory (PTCI): psychometric properties and gender differences in an Israeli sample

The Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin, & Orsillo, 1999) was found to have three factors: negative view of self, negative view of world, and self-blame. We validated the PTCI among 326 Israeli adults exposed to various types of traumas. Results provided support for the original three-factors. Negative cognitions about self scale had the highest correlations with severity of PTSD and depression symptoms, whereas self-blame had only weak correlations with these measures. Among men, negative cognitions about self were associated most strongly with PTSD severity whereas among women, negative cognitions about self were associated primarily with depression. Gender may play an important role in posttraumatic cognitions and their relationship to PTSD and depression.     

Phenomenology of depression in young girls

OBJECTIVE: To examine the prevalence of depressive symptoms, the overlap between caregiver and child report, the association between depression and anxiety, and the relationship between symptoms of depression and impairment in young girls. METHOD: Participants in the Pittsburgh Girls Study, a community sample of 2,451 girls aged 5-8 years old and their primary caregivers were interviewed in 2000-2001 using the Child Symptom Inventory and the Short Moods and Feelings Questionnaire to measure depression, the Screen for Child Anxiety and Related Emotional Disorders to measure anxiety, and the Children's Global Assessment Scale to measure impairment. RESULTS: Less than 1% of 5- to 8-year-old girls had five or more symptoms of major depression according to the caregiver report. Individual differences in symptom counts and depression scores by caregiver and child report were observed. Agreement between caregivers and girls on depression symptoms was low, with only 2% of the variance in caregiver-reported depression on the Child Symptom Inventory being accounted for by child report on the Short Moods and Feelings Questionnaire. The level of association between depression and anxiety scores suggested that these constructs are associated but relatively independent in young girls. Both caregiver report and child report of depressive symptoms were uniquely associated with impairment ratings. CONCLUSIONS: Although major depression appears to be rare among 5- to 8-year-old girls, continuous measures of depressive symptoms yield significant individual differences that are associated with impairment. Thus, preliminary evidence suggests that depressive symptoms can be validly measured in 5- to 8-year-old girls.     

Do PTSD symptoms and trauma-related cognitions about the self constitute a vicious cycle? Evidence for both cognitive vulnerability and scarring models

Cognitive models of post-traumatic stress disorder (PTSD) posit that negative cognitions regarding the self and the world underlie the disorder. In contrast, scarring models — which postulate that distress brings about an elevation in vulnerability — predict the inverse relationship. Both models were tested amongst 156 Israeli trauma victims. Participants were assessed for PTSD symptoms and trauma-related cognitions (negative thoughts regarding self and world) over 2 weeks (T1), 4 weeks (T2), and 12 weeks (T3) following the traumatic event. A cross-lagged structural equation modeling analysis yielded evidence for both cognitive vulnerability and scarring. Baseline PTSD was prospectively associated with an increase in negative cognitions regarding both the self and the world during the T1–T2 period. Negative cognitions regarding the self were prospectively associated with an increase in PTSD symptoms during both T1–T2 and T2–T3 periods. PTSD symptoms and negative cognitions regarding the self thus appear to form a vicious cognitive-symptomatic cycle which might impede recovery.     

Posttraumatic stress disorder symptoms in trauma-exposed college students: the role of trauma-related cognitions, gender, and negative affect

Considerable evidence indicates a prominent role for trauma-related cognitions in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. The present study utilized regression analysis to examine the unique relationships between various trauma-related cognitions and PTSD symptoms after controlling for gender and measures of general affective distress in a large sample of trauma-exposed college students. In terms of trauma-related cognitions, only negative cognitions about the self were related to PTSD symptom severity. Gender and anxiety symptoms were also related to PTSD symptom severity. Theoretical implications of the results are discussed.     

Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD

Parents may develop symptoms of distress and dysfunctional cognitions in response to their child’s exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child’s trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child’s trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child’s trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.     

Silence and Psychotherapy

With the growing interest in the role of cognitions in PTSD, this prospective study examined the course and bi-directional relationship between post-trauma cognitions and symptoms of PTSD. A sample of Israeli combat veterans, including former prisoners of war, was assessed in 1991, and later followed up in 2003 and 2008. PTSD symptoms were measured at three time points. Cognitions concerning the self and the world were measured twice. Applying Autoregressive Cross-Lagged (ARCL) modeling strategy, initial PTSD symptoms predicted subsequent negative cognitions but not vice versa. In addition, repeated measures design revealed that individuals with chronic PTSD symptoms had relatively negative cognitions that further amplified with time. More specifically, increasingly negative cognitions were documented among ex-prisoners of war. The main findings suggest that negative cognitions are fueled by PTSD and that in chronic PTSD there is an amplification of pathogenic outcomes over time. Discussion of the findings is in the context of current cognitive models of PTSD.     

Assessing Effort: Differentiating Performance and Symptom Validity

The current study aimed to clarify the relationship among the constructs involved in neuropsychological assessment, including cognitive performance, symptom self-report, performance validity, and symptom validity. Participants consisted of 120 consecutively evaluated individuals from a veteran’s hospital with mixed referral sources. Measures included the Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ (WAIS-IV FSIQ), California Verbal Learning Test-Second Edition (CVLT-II), Trail Making Test Part B (TMT-B), Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), WAIS-IV Reliable Digit Span (RDS), Post-traumatic Check List-Military Version (PCL-M), MMPI-2 F scale, MMPI-2 Symptom Validity Scale (FBS), MMPI-2 Response Bias Scale (RBS), and the Postconcussive Symptom Questionnaire (PCSQ). Six different models were tested using confirmatory factor analysis (CFA) to determine the factor model describing the relationships between cognitive performance, symptom self-report, performance validity, and symptom validity. The strongest and most parsimonious model was a three-factor model in which cognitive performance, performance validity, and self-reported symptoms (including both standard and symptom validity measures) were separate factors. The findings suggest failure in one validity domain does not necessarily invalidate the other domain. Thus, performance validity and symptom validity should be evaluated separately.     

Construct validity of an instrument to assess major depression in parents in epidemiologic studies.

OBJECTIVE: The Longitudinal Study of Child Development in Quebec (LSCDQ) is a community study of children that examines the risk factors, such as parental depression, linked to childhood psychopathology and maladaptive functioning. Our goal was to test the construct validity of an instrument to assess major depression in the parents. METHOD: Parents of a representative sample of 2120 infants born in the province of Quebec in 1998 were selected. The major depression instrument was administered to the parents when the infants were aged 29 months. We tested the construct validity of the instrument by examining 1) sex differences in symptoms and prevalence, 2) the rank order of the prevalence of symptoms, 3) the clustering of symptoms, and 4) the association of depression with functional impairment and treatment-seeking behaviour. RESULTS: Depression was twice as common in mothers as in fathers. Most mothers and fathers who reported ever being depressed for 2 or more weeks had also experienced at least 4 additional depression symptoms. The rank order of symptom prevalence was comparable to that found in other studies. At least 50% of parents reported having talked to a professional and that suffering from depression had interfered with their functioning. CONCLUSIONS: The expected sex differences, the rank order of symptom prevalence, the symptom clustering, and the associations with functional impairment and treatment-seeking behaviour support the construct validity of a brief questionnaire on parental major depression.     

Perceptions of the family,personality characteristics,and adolescent internalizing symptoms

OBJECTIVE: To explore the influences of adolescent self-reported and interviewer-rated perceptions of family functioning, parent perceptions of the family, and adolescent personality on internalizing symptoms. METHOD: Two hundred one adolescent twins (mean age = 16.2 +/- 2.0 years; 90% white) completed the Family Assessment Device (FAD), Eysenck Personality Inventory, Children's Depression Inventory, and Multidimensional Anxiety Scale for Children and participated in an interview about their relationships with parents. Parents completed the FAD. Twins were divided into two samples for analysis. RESULTS: Multiple regression analyses in sample A showed that adolescent perceptions of family function accounted for 35% of the variance in depressive symptoms, but did not significantly predict anxiety. Self-reported perceptions were more strongly associated with symptoms than were interviewer-rated perceptions. Parent FAD and adolescent neuroticism accounted for 24% of the variance in adolescent self-reported perceptions. Results were similar in sample B. CONCLUSIONS: Adolescent perceptions of the family are linked to their depressive symptoms and associated with neuroticism. Adolescents who are high in neuroticism may perceive their families more negatively. Clinicians need to carefully discern components of family function that lead to teen depression versus biased cognitions that lead teenagers to perceive family relationships as negative.     

Psychometric evaluation of a measure of Beck's negative cognitive triad for youth: applications for African-American and Caucasian adolescents

A measure of Beck's negative cognitive triad, the Cognitive Triad for Children (CTI-C), was evaluated for its psychometric properties and utility with a community sample of 880 African-American and Caucasian adolescents. High-school students ranging from 14 to 17 years of age completed the CTI-C, the Children's Depression Inventory (CDI) and the Children's Attributional Style Questionnaire-Revised (CASQ-R) on two occasions 4 months apart. The CTI-C was found to be internally consistent, Cronbach's alpha=.90, to have acceptable test-retest reliability, r=.70, and concurrent validity as demonstrated by a significant correlation with the CASQ-R, r=.53. A principal factor analysis with promax rotation did not yield support for Beck's tripartite model of negative cognitions about the self, world, and future but rather yielded three factors with a combination of cognitions from all three domains. African American adolescents who reported more maladaptive cognitions on the CTI-C reported fewer depressive symptoms on the CDI 4 months later compared to their Caucasian counterparts, suggesting some limitation to using the CTI-C to predict depressive symptoms in African-American youth; however, Factor 1 derived from a factor analysis with the sample was more consistent in predicting future symptoms among both African-American and Caucasian adolescents. This factor consisted largely of positively worded items, offering some support for low positive affect as a predictor of depressive symptoms in adolescents.     

The relationship between cognitive control and posttraumatic stress symptoms

Background and objectivesRecently researchers have theorized that individual differences in cognitive control (i.e., the ability to complete goal-directed behavior by actively maintaining information while inhibiting irrelevant information) may elucidate processes involved in disorders characterized by intrusive thoughts and memories. By this account, the relationship between cognitive control and emotional disorders would be specific to symptoms associated with intrusive cognitions, such as re-experiencing symptoms of posttraumatic stress disorder (PTSD).MethodsIn the present study, 77 undergraduate participants with a self-reported history of trauma exposure were administered assessments of cognitive control (working memory capacity; WMC), PTSD symptoms, trait anxiety, and depression. PTSD symptoms from each of the three symptom clusters (re-experiencing, avoidance, and hyperarousal) were predicted from trait anxiety, depression, and WMC performance scores using separate regression models.ResultsAfter controlling for trait anxiety and depression, there was a negative, statistically significant relationship between cognitive control and re-experiencing symptoms but not avoidance or hyperarousal symptoms.LimitationsThe study was completed cross-sectionally and did not include a diagnostic assessment of PTSD.ConclusionsFindings add to extant literature suggesting a relationship between cognitive control and intrusive cognitions. Moreover, the present study expands the current literature by demonstrating the specificity of this relationship within individuals with varying degrees of PTSD symptom severity.     

Psychometric properties of a Persian-language version of the Automatic Thoughts Questionnaire: ATQ-Persian

AIMS: To examine the psychometric properties of a Persian-language version of Hollon and Kendall's (1980) Automatic Thoughts Questionnaire (ATQ-Persian)--a measure of negative automatic thoughts in depression. METHODS: In a sample of 125 student volunteers from two Iranian universities we assessed the internal consistency and test-retest reliability of ATQ-Persian, and examined its concurrent validity against the Beck Depression Inventory (Beck et al., 1996). We also examined the factor structure of the test through comparing the fit of various proposed factor-analytic models to the data using confirmatory factor analysis. RESULTS: ATQ-Persian had excellent internal consistency (Cronbach's alpha = 0.96), test-retest reliability (r = 0.84) and correlation with the Beck Depression Inventory (r = 0.77). Using a receiver operating characteristics curve, a score of 53 on ATQ-Persian was associated with a sensitivity of 89% and a specificity of 78% for detecting moderate to severe depression defined through Beck Depression Inventory. None of the proposed factorial models fitted the data well. However, models with correlated factors generally provided better fit than models with orthogonal factors, suggesting that the latent factors underlying ATQ-Persian are highly correlated. CONCLUSIONS: These data support the reliability and validity of ATQ-Persian as a measure of negative automatic thoughts in depression.     

Posttraumatic Stress Disorder Following Stillbirth: Trauma Characteristics,Locus of Control,Posttraumatic Cognitions

This study examined the incidence of PTSD and psychiatric co-morbidity among women who experienced stillbirth and investigated the relationship between locus of control, trauma characteristics of stillbirth, posttraumatic cognitions, PTSD and co-morbid psychiatric symptoms following stillbirth. Fifty women recorded information on stillbirth experiences, and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Edinburgh Post-natal Depression Scale, Rotter’s Locus of Control Scale and the Posttraumatic Cognitions Inventory. 60, 28 and 12 % met the diagnostic criteria for probable full-PTSD, partial and no-PTSD respectively. Sixty-two percent and 54 % scored at or above the cutoff of the General Health Questionnaire-28 and postnatal depression respectively. Women who experienced stillbirth reported significantly more psychiatric co-morbid and post-natal depressive symptoms than the comparison group. Both groups were similar in locus of control. Women who experienced stillbirth reported negative cognitions about the self the most. After adjusting for postnatal depression, trauma characteristics were significantly correlated with Posttraumatic cognitions which, in turn, were significantly correlated with PTSD and psychiatric co-morbidity. Locus of control was not significantly correlated with psychological outcomes. Mediational analyses showed that negative cognitions about self mediated the relationship between trauma characteristics and psychiatric co-morbidity only. Women reported a high incidence of probable PTSD and co-morbid psychiatric symptoms following stillbirth. Stillbirth trauma characteristics influenced how they negatively perceived themselves. This then specifically influenced general psychological problems rather than PTSD symptoms.     

Cognitive change processes in a group cognitive behavior therapy of depression

The present study attempted to examine the causal relationships among changes in automatic thoughts, dysfunctional attitudes, and depressive symptoms in a 12-week group cognitive behavior therapy (GCBT) program for depression. In all, 35 depressed patients attending the GCBT program were monitored with the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale, and Beck Depression Inventory at the pre-treatment, 4th and 8th sessions, and post-treatment. The results were as follows: (1). GCBT reduces negative cognitions; (2). changes in automatic thoughts and dysfunctional attitudes lead to change in depressive symptoms; and (3). automatic thoughts play a mediating role between dysfunctional attitudes and depression. The findings taken as a whole support the Causal Cognition Model of depression.