Some Theoretical and Practical Implications of a Longitudinal Study of College Woment†

Abstract

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)—Alienation and Insecure Attachment—partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.     

Object relations and reality testing in schizophrenia,bipolar disorders,and healthy controls: differences in profiles and clinical correlates

Objective

Deficits in object relations (OR) and reality testing (RT) functions are found in schizophrenia but have never been investigated in bipolar disorder. In the current study, we examine if there are OR and RT differences in schizophrenia and bipolar disorder compared to healthy controls and to what extent differences in clinical characteristics mediates the putative effect of diagnosis.

Methods

We used the Bell Object Relation and Reality Testing Inventory (BORRTI) to measure OR and RT in schizophrenia (n = 55), bipolar disorder (n = 51) and healthy controls (n = 158). Diagnoses and the life time presence of psychotic symptoms were evaluated based on the Structured Clinical Interview for DSM-IV. We used the Positive And Negative Symptom Scale to measure current symptoms.

Results

Analyses of variance with post hoc tests showed statistically significant differences in OR and RT between the Schizophrenia (SCZ), Bipolar Disorder (BD), and Healthy Control (HC) groups. Multiple regression analyses indicated that a lifetime history of psychotic symptoms contributed significantly to the variance in one BORRTI subscale (Social Incompetence) while Positive And Negative Symptom Scale components (either the positive component and emotional discomfort component) contributed significantly to the variance in all BORRTI subscales except one (Uncertainty of Perception).

Conclusions

OR and RT deficits are present both in SCZ and BD, but differences appears to be mediated by differences in current positive and depressive symptoms.     

The mediating role of self-criticism and dependency in the association between perceptions of maternal caring and depressive symptoms

Background: This study examined a theoretically based mediation model including participants' perceptions of early relationships with their mother, self‐criticism, dependency, and current depressive symptoms. We expect that (a) early relationships characterized by low levels of care and high levels of overprotection will be positively associated with both current depressive state and self‐criticism and dependency; (b) high levels of self‐criticism and dependency will be positively associated with depressive symptoms; and (c) self‐criticism and dependency will play a mediating role in the association between participants' perceptions of early relationships characterized by low levels of care and high levels of overprotection and their current depressive symptoms. Methods: A nonclinical community sample of 200 Portuguese adults participated in the study. Perceptions of early relationships were measured using the mother scales of the Parental Bonding Instrument (Parker et al. [1979: Br J Med Psychol 52:1–10]), levels of self‐criticism and dependency were measured using the Depressive Experiences Questionnaire (Blatt et al. [1976: J Abn Psy 6:383‐389]), and depressive symptoms were measured using the Center for the Epidemiological Studies of Depression Scale (Radloff [1977: Appl Psychol Meas 1:385–401]. Results: Structural equation modeling showed that the link between participants' perceptions of early caretaking relationships with their mothers and their current depressive symptoms is mediated by high levels of self‐criticism—a personality trait associated with vulnerability to depression—but not Dependency. However, an ancillary analysis indicated that the link between participants' perceptions of early maternal overprotective relationships and their current depressive symptoms is mediated by high levels of Neediness. Conclusions: Findings underscore the role of perceived early relationships in psychological vulnerability to depression among highly self‐critical and among highly needy individuals and highlight the negative role played by perceived mothers' early dysfunctional practices, characterized by low levels of caring and high levels of overprotection, for the self‐critical vulnerability to depression and by perceived mothers' high levels of overprotection, for the neediness vulnerability to depression. These potential causal mechanisms warrant longitudinal evaluation. Theoretical and clinical implications of the findings are discussed. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

A test of the cognitive content specificity hypothesis in depression and anxiety

The present study tested the cognitive content specificity hypothesis (CCSH) to assess whether anxiety and depression can be differentiated on the basis of cognitive disturbance. One hundred and thirty five depressed participants were administered the Beck depression inventory (BDI), the Beck anxiety inventory (BAI), the automatic thoughts questionnaire (ATQ) and the anxious self-statements questionnaire (ASSQ). It was hypothesised that depressive cognitions would be specifically related to, and predictive of, depressive (but not anxiety) symptoms in a depressed sample. Conversely, it was predicted that anxiety cognitions would be specifically related to, and predictive of, anxiety (but not depressive) symptoms in a depressed sample. Results revealed that the ATQ was the sole predictor of the BDI and similarly, the ASSQ was the sole predictor of the BAI. These findings support the CCSH in depression and provide an integrative framework for a greater understanding of the relationship between anxiety and depression.     

Life events exposure before a treated major depressive episode depends on the number of past episodes.

A cross-sectional survey investigated the relationship between the number of previous depressive episodes and life events, testing the kindling hypothesis, in a sample of 13,377 treated patients with unipolar depression. A linear decline of average life events exposure is observed for more frequent past episodes, even when age, gender and severity are taken into account.     

抑郁症患者抑郁症状与自我效能感、自我接纳、应付方式的关系

目的:探讨抑郁症患者抑郁症状与自我效能感、自我接纳及应付方式的关系。方法:对40例抑郁症患者(抑郁症组)进行贝克抑郁问卷(BDI)、一般自我效能感量表(GSES)、自我接纳问卷(SAQ)、应付方式问卷的评定,同时以40名正常人(正常对照组)作为对照进行GSES及SAQ的评定,两组进行比较及相关分析。结果:抑郁症组自我效能感、自我接纳因子、自我评价因子得分及SAQ总分均低于正常对照组(t=3.980,t=5.907,t=2.967,t=5.411;P均0.01)。相关分析显示,BDI得分与自我效能感、自我接纳总分均呈高度负相关(r=-0.602,r=-0.786;P均0.05);与应付方式中的情绪缓冲性应付总分、情绪加工因子、顺从回避因子呈正相关(r=0.433,r=0.425,r=0.372;P均0.05)。结论:抑郁症患者抑郁症状越严重,自我效能感、自我接纳程度越低,自我评价也越低。     

Personality traits and affective morbidity in patients with bipolar I disorder: The five-factor model perspective

In this study, we aimed to extend the present knowledge regarding the relationship of personality traits, as specified by the five-factor model (FFM), with the affective morbidity of bipolar I disorder. The primary aim of this study is to investigate the association of personality traits with affective morbidity, particularly with hospitalization for depressive, manic, or mixed episodes, in patients with bipolar I disorder. The Revised NEO Personality Inventory was administered to 83 subjects who showed a euthymic mood state. Multivariate Poisson regression analysis was performed to identify associations between five domains of personality and the number of hospitalizations for affective episode(s) (manic, depressive, and mixed state). As a secondary research interest, we attempted to determine personality traits which would be significantly different between subjects with Affective Switch from mania into depression Without Euthymia (ASWE) and non-ASWE. The Neuroticism score was positively associated with the number of hospitalization for depression and the total number of hospitalizations Extraversion and Openness scores showed a negative relationship with the number of hospitalizations for depression and the total number of hospitalizations. We found that ASWE patients showed significantly higher Neuroticism scores than did the non-ASWE group. However, there was no significant association between the hospitalization for manic episode and any particular personality trait based on the FFM. This study reveals that personality traits based on the FFM may contribute to an increased likelihood of depressive morbidity and switch into depression.     

Depressive symptoms after trauma: is self-esteem a mediating factor?

Traumatic events have predicted depressive symptoms. Despite this consensus, it remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. This study tested these relationships while considering depressive symptom types. One hundred thirty-two students reported the number of traumatic events experienced and self-esteem and depression levels. Results indicated 2 depressive symptom types: "cognitive-affective" and "somatic." Structural Equation Modeling tested an unmediated path from trauma to depressive symptoms and a path mediated by self-esteem. Results supported the unmediated relationship between trauma and "cognitive-affective" depressive symptoms, and did not support mediation by self-esteem. Findings are discussed in view of a dimensional rather than categorical approach to depression, and in consideration of alternative symptom clusters resulting from trauma in addition to those captured by posttraumatic stress disorder.     

Sex differences in the experience of depressed mood state over fifteen years

A study was conducted to examine sex differences in frequency, duration and severity of experience of depressed mood state in a non-clinical group and to consider how such findings contribute to the understanding of sex differences in depressive experience. A cohort of 156 subjects, assessed initially in 1978 in their last year of teacher training, was reassessed at 5-yearly intervals over 15 years. On each occasion, the subjects completed self-report ratings of experience of “normal depression” and measures of neuroticism, trait depression, self-esteem and sex role. The study found no sex differences in the number or duration of episodes. Women reported more symptoms per episode and some specific symptoms (including tearfulness, appetite and weight gain) more often. The number of symptoms was correlated with neuroticism, self-esteem and trait depression scores, and with gender but not sex role. The number of episodes was related to trait depression and self-esteem but not neuroticism. The results showed that there are links between female gender, neuroticism and number of symptoms experienced during depressed mood state episodes. These links are related more to female gender than to feminine sex role or premenstrual problems, and are reflected in the severity of affective change (and some specific symptoms) but not in the number of episodes. Accepted: 19 March 1997     

Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently.

BACKGROUND: The frequent comorbidity of major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) suggests a fundamental relationship between them. We sought to determine whether MDD and OCD have unique cerebral metabolic patterns that remain the same when they coexist as when they occur independently. METHODS: [18F]-fluorodeoxyglucose positron emission tomography (PET) brain scans were obtained on 27 subjects with OCD alone, 27 with MDD alone, 17 with concurrent OCD+MDD, and 17 normal control subjects, all in the untreated state. Regional cerebral glucose metabolism was compared between groups. RESULTS: Left hippocampal metabolism was significantly lower in subjects with MDD alone and in subjects with concurrent OCD+MDD than in control subjects or subjects with OCD alone. Hippocampal metabolism was negatively correlated with depression severity across all subjects. Thalamic metabolism was significantly elevated in OCD alone and in MDD alone. Subjects with concurrent OCD+MDD had significantly lower metabolism in thalamus, caudate, and hippocampus than subjects with OCD alone. CONCLUSIONS: Left hippocampal dysfunction was associated with major depressive episodes, regardless of primary diagnosis. Other cerebral metabolic abnormalities found in OCD and MDD occurring separately were not seen when the disorders coexisted. Depressive episodes occurring in OCD patients may be mediated by different basal ganglia-thalamic abnormalities than in primary MDD patients.     

Object relations and intersubjectivity in depression

Starting with a clinical vignette the authors discuss Freud's thesis from "Mourning and Melancholia" (1917) that depression is a defense against the experience of loss: Whilst a part of the self remains identified with the lost object another part directs all the aggression against it that originally had been directed against the object. As a result the relationship between self and object becomes replaced by a pathological relationship between parts of the self. As psychoanalytical and phenomenological-hermeneutical approaches congruently show, one reason why mourning cannot proceed and feelings of guilt cannot be worked through lies in the fact that depressive patients need a symbiotic, idealizing type of identification with their objects in order to stabilize their identity. Because of their narcissistic vulnerability changes, personal failures, and disappointment by their objects, which may provoke unconscious aggression and fear of loss, can easily threaten their psychic equilibrium. This gives rise to considerable difficulties within the transference-countertransference relationship. The authors argue that to establish a feeling of autonomy in depressive patients, a secure framework within therapy has to be offered and at the same time the negative transference must thoroughly be worked through.     

Depression and anxiety: from clinic to pharmacological treatment

Either as a symptom or as a trait of an axis I disorder, anxiety is frequently associated with depressive episodes. Its treatment depends mainly of the syndrome in which it is included. While the selective serotonin reuptake inhibitors seem to be indicated in depression with comorbid anxiety disorders and in anxious depression, in agitated depression may be preferable to indicate mood stabilizers or sedative antipsychotics. Benzodiazepines may be useful at the beginning of the treatment of these special forms of depression, but it is advisable to tapper them off once the affective and/or the anxiety disorders improve.     

Anxiety and depression in tinnitus sufferers

This paper focuses upon the relationship between tinnitus and personality. One hundred and twelve members of a tinnitus self-help group completed psychological and tinnitus questionnaires. In line with prior studies we found that tinnitus was associated with elevated anxiety trait and depression. Unlike previous work, use of a validated subjective tinnitus scale allowed us to directly test the strength of association. Although both anxiety trait and depressive tendency were significantly correlated with overall tinnitus severity, the coefficients were of low magnitude. Advancing age was related to a reduction in depressive tendency; and being male was associated with lower anxiety and depression scores. While hypothesizing a bi-directional causality between personality and the impact of tinnitus, we acknowledge that only longitudinal research can unequivocally test this.     

Self-criticism versus neuroticism in predicting depression and psychosocial impairment for 4 years in a clinical sample

The present study extended previous findings demonstrating self-criticism, assessed by the Dysfunctional Attitude Scale (DAS) (Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada, 1978), as a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment over time. Using data from a prospective, 4-year study of a clinical sample, DAS self-criticism and neuroticism were associated with self-report depressive symptoms, interviewer-rated major depression, and global domains of psychosocial functional impairment 4 years later. Hierarchical multiple regression results indicated that self-criticism uniquely predicted depressive symptoms, major depression, and global psychosocial impairment 4 years later over and above the Time 1 assessments of these outcomes and neuroticism. In contrast, neuroticism was a unique predictor of self-report depressive symptoms only 4 years later. Path analyses were used to test a preliminary 3-wave mediational model and demonstrated that negative perceptions of social support at 3 years mediated the relation between self-criticism and depression/global psychosocial impairment for 4 years.     

Brief report: “I can’t talk about it:” Sexuality and self-silencing as interactive predictors of depressive symptoms in adolescent dating couples

This longitudinal study examined sexual intercourse within adolescent romantic relationships as a couple-level moderator of the association between adolescent individual characteristics and depressive symptoms. Two hundred nine middle- and older-adolescent dating couples (aged 14-17 and 17-21, respectively) reported on their own self-silencing, depressive symptoms, and sexual behaviors. At Time 1, frequency of sexual intercourse significantly moderated the relationship between self-silencing and depressive symptoms, such that adolescents higher in self-silencing engaging in more frequent sex were at risk for clinically significant levels of depression. Adolescents who were low in self-silencing were not at increased risk for depression, regardless of frequency of sex. Self-silencing also significantly predicted increases in depressive symptoms from Time 1 to Time 2. Implications include the possibility that frequent sex in highly self-silencing adolescents exacerbates psychological depletion believed to link self-silencing to depressive symptoms, and that this depletion compounds over time.     

Psychosocial adjustment of epilepsy patients in Cyprus

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.     

Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression

OBJECTIVE: The association between stressful life events and the onset of major depression decreases as the number of previous depressive episodes increases. How do genetic risk factors for major depression impact on this "kindling" phenomenon? In particular, do those at high genetic risk exhibit an increase in the speed of kindling, or are they "prekindled"? METHOD: Using discrete-time survival analysis, the authors examined the interaction between genetic risk, number of previous depressive episodes, and life event exposure in the prediction of episodes of major depression in female-female twin pairs from a population-based registry. The twins were interviewed four times over a 9-year period, producing 92,521 person-months of exposure. RESULTS: The decline in the association between stressful life events and risk for major depression as the number of previous depressive episodes increased was strongest in those at low genetic risk and was weak to absent in those at high genetic risk. In the absence of previous depressive episodes, those at high genetic risk frequently experienced depressive episodes without major environmental stressors. CONCLUSIONS: Genetic risk factors for depression produce a "prekindling" effect rather than increase the speed of kindling. The "kindled" state, wherein depressive episodes occur with little provocation, may be reached by two pathways: many previous depressive episodes, perhaps driven by multiple adversities, and high genetic risk.     

The relationships between neuroticism and depressive symptoms

Summary A structural equation model designed to estimate the reciprocal associations which may exist between mental state and personality trait variables is presented. This model is applied to measures of neurocticism and depression obtained for a sample of over 1000 women studied over a two year period. The fitted model suggests that while measures of neuroticism are contaminated by the effects of short term mental state on the reporting of personality, there is still a fairly substantial relationship between trait neuroticism (corrected for the effects of mental state contamination) and reports of depressive symptoms.     

Subclinical suspiciousness as a risk factor for depressive episodes

OBJECTIVE: Previous studies suggest suspiciousness is associated with an increased risk of major depressive episodes in psychotic patients. We tested the hypothesis that this relationship would extend to nonpsychotic groups. METHOD: Data came from the Epidemiological Catchment Area (ECA) study, a longitudinal population-based study conducted at five sites in the United States. Baseline clinical and demographic features were used to predict the onset of episodes of depression at 1-year follow-up in subjects without psychotic symptoms. RESULTS: Subclinical suspiciousness was associated with an increased risk of new episodes of depression after accounting for demographic variables. However, three of six subclinical delusion-like experiences were also associated with an increased risk of depressive episodes. None of the subclinical hallucination-like experiences predicted subsequent risk. CONCLUSION: Subclinical suspiciousness appears to increase the risk of depression in the general population. Some other delusion-like experiences may do the same.     

The effect of pre-existing vulnerability factors on a laboratory analogue trauma experience

This study examined how pre-existing emotional and personality vulnerability factors affect responses to an analogue trauma experience. Sixty-eight undergraduate participants viewed a distressing film and completed measures of trait anxiety, intelligence, depression, trait dissociation, as well as changes in state anxiety, then recorded intrusions over the following week. Results revealed that trait anxiety, depression, trait dissociation, change in anxiety, and post-state anxiety were associated with intrusion frequency. Post-state anxiety mediated the relationship between trait anxiety, depression and trait dissociation, and intrusions. Implications for PTSD theories and laboratory trauma analogue research examining specific elements of cognitive models of PTSD are discussed.