Severe and nonsevere events in first onsets versus recurrences of depression: evidence for stress sensitization

Overall, research has evidenced support for Post's (1992) model, which asserts that the 1st episode of depression is more likely to be associated with severe life events than are subsequent episodes. In spite of this, there are significant gaps in the understanding of the stress-depression association. This study aimed to address three gaps by (a) identifying the explanatory model underlying the association (stress sensitization vs. stress autonomy), (b) elucidating how the role of stress changes with successive episodes, and (c) examining the role of nonsevere events. The impact and occurrence of severe and nonsevere events in a 5-year longitudinal study of late-adolescent women were examined using Cox regression models. Overall, we found support for the stress sensitization model over the stress autonomy model. Specifically, the impact of nonsevere (but not severe) events was greater in individuals with a history of depression compared with those with no history of depression. In addition, the occurrence of severe (but not nonsevere) events was greater for 1st onsets than recurrences. These effects were modified by event independence. The results were discussed in terms of the underlying mechanisms of the stress-depression association and future directions for research were elaborated.     

Major life events and major chronic difficulties are differentially associated with history of major depressive episodes

Major life events have been found to precede onsets of a 1st lifetime episode of depression more commonly than subsequent recurrences. Despite general empirical support for this finding, few data directly address how the role of major life events may change over successive recurrences. Further, little research has examined major chronic difficulties in relation to a 1st lifetime episode versus a recurrence of depression. The present study tested the associations between major life events and major difficulties in relation to lifetime history of depressive episodes in a sample of 96 individuals diagnosed with major depression. Using investigator-based measures of life stress, the authors found that, whereas major life events were associated with fewer lifetime episodes, major chronic difficulties were related to more prior episodes. These findings are discussed in terms of underlying mechanisms that may account for the changing role of major life stress over successive recurrences of depression.     

Gender and social support: Taking the bad with the good?

In examining past research, a paradox can be found in the relationships between gender, social support, and depression. Although women report higher levels of depression than men, they also generally report more social support—a factor found to reduce depressive symptoms. In efforts to explain this seeming inconsistency, it was hypothesized that women report both more support and more depression because they are more likely than men to experience both positive and negative aspects of social relationships. Based on a community sample of predominantly Caucasian respondents, findings indicate that greater perceived support among women can be explained by more frequent contact with network members and a tendency to possess relationships characterized by greater intimacy, emotional disclosure, and empathy. However, women also report more frequent negative interactions with network members and are more adversely affected by marital conflict than are men. While negative interactions and conflict cannot account for gender differences in depression, they do help to explain how women can experience both more support and more depression. Among women, the health-enhancing effects of support on depression may be balanced by the detrimental effect of conflict.     

Life stress, the "kindling" hypothesis, and the recurrence of depression: considerations from a life stress perspective

Major depression is frequently characterized by recurrent episodes over the life course. First lifetime episodes of depression, however, are typically more strongly associated with major life stress than are successive recurrences. A key theoretical issue involves how the role of major life stress changes from an initial episode over subsequent recurrences. The primary conceptual framework for research on life stress and recurrence of depression is the "kindling" hypothesis (R. M. Post, 1992). Despite the strengths of the kindling hypothesis, a review of the research literature reveals inconsistencies and confusion about life stress and its implications for the recurrence of depression. Adopting a life stress perspective, the authors introduce 3 major themes that resolve the inconsistencies in the current literature. They integrate these themes and extrapolate the ideas with available data to develop a preliminary framework for evaluating competing explanatory models and to guide research on life stress and the recurrence of depression.     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.     

Attempted suicide in youth: Its relationship to school achievement,educational goals,and socioeconomic status

Twenty-six suicide attempters, 9 to 18 years of age, were compared with 725 nonattempters on measures of school achievement, educational goals, socioeconomic status, and depression. As has been found in studies using clinical samples, suicide attempters in our communitybased sample had significantly lower school achievement than nonattempters. The relationship between attempted suicide and low school achievement seemed to be explained by the effects of depression. Lower-SES youth tended to be more likely to attempt suicide than higher-SES youths. However, SES appeared to have little effect on the relationship between attempted suicide and school achievement. Results also suggest that children of mothers with low educational goals for them may be more at risk for attempted suicide than youths whose mothers have higher educational goals for their children.This research was supported by the National Institute of Mental Health, Grant No. MH36971.     

Maternal depression and developmental disability: research critique

Maternal depression in families having a child with a disability has been the subject of considerable research over the past 25 years. This review was designed to describe the literature on maternal depression, critique its research methodology, identify consensus findings across studies, and make recommendations for future research. A particular emphasis is on the distinction between exhibiting depressive symptoms and meeting clinical criteria for a depressive disorder, how or whether research studies made this distinction, and implications for our understanding of maternal adaptation to disability in a family member. Of the 42 articles reviewed, only eight were clinically diagnosed depression; most of them used a scale rating depressive symptoms. Across the studies, mothers of children with disabilities generally exhibited a higher than average rate of depressive symptoms and are more at risk for clinical depression, but the incidence may be lower than reported in previous literature. Child behavior problems, maternal stress, coping style, and support were consistently associated with depressive symptoms. We conclude that we know relatively little about clinical depression in mothers of children with disabilities. The distinction between clinical depression and depressive symptoms may be important in conceptualizing how a child with a disability can influence family members and the nature of support that may need to be provided. Future research should incorporate gold standard diagnostic tools and assess history, severity, and type of depression. Research is also needed to study treatments to reduce the occurrence of both depressive symptoms and clinical depression.     

Evaluating the gold standard: a review and meta-analysis of the Structured Interview of Reported Symptoms

The Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) is often touted as the gold standard of measures of feigning. This label likely arises in part out of the impressive accuracy rates reported in the extensive validation research that preceded its publication. However, since its publication, researchers not only have continued to investigate the measure's utility but have expanded the study of the SIRS to include novel populations, different study methodologies, and abbreviated versions. The current review examines 26 studies using the SIRS to identify feigning, evaluating both its effectiveness at differentiating feigners from genuine responders and the potential impact of moderating variables. Meta-analyses revealed that research published since the initial validation studies demonstrate higher sensitivity but lower specificity rates than those reported in the SIRS manual. Studies in which feigners were composed of simulators yielded higher classification rates than studies sampling actual suspected malingerers. Furthermore, genuine patient samples were significantly more likely than nonclinical samples to be misclassified as feigning. Abbreviated versions of the SIRS also demonstrated equivalent accuracy with the standard measure. The implications of these findings for clinical practice are discussed.     

Self-esteem reconsidered: unstable self-esteem outperforms level of self-esteem as vulnerability marker for depression

Previous studies have built up evidence that an unstable self-esteem is associated with vulnerability to depression and that it outperforms level of self-esteem as a predictor for symptoms of depression. However, most of these studies have used student samples exclusively to investigate the role of self-esteem instability in depression vulnerability. Our present study used samples of currently depressed inpatients, formerly depressed individuals, and never-depressed controls to investigate the relationship between self-esteem instability and depression. In addition, we examined the predictive validity of self-esteem instability in predicting future depressive symptoms. The results indicate that self-esteem instability is associated with depression and vulnerability to depression. Furthermore, self-esteem instability interacted with perceived stress variability and depressed mood variability in predicting future depressive symptomatology at six months follow-up. These results are in line with the diathesis-stress model and support the hypothesis that self-esteem instability might be more important than level of self-esteem in predicting vulnerability to depression.     

Are Closed‐Minded People More Open to the Idea of Killing Themselves?

This article summarizes the author's work on Openness to Experience (a personality trait) and suicidal behavior. It appears that people who obtain low scores on an inventory measuring Openness to Experience are less likely to report suicidal ideation but more likely to take their own lives. How can this apparent discrepancy be reconciled? Based on the premise that the expression of suicidal ideation can have adaptive consequences (e.g., by mobilizing family and treatment providers), it is hypothesized that people with major depression who are low in Openness may be at increased risk for completed suicide in part because they are less likely to feel, or report feeling, suicidal.     

A longitudinal analysis of anxiety and depressive symptoms

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.     

Nonlinear Associations Between Co-Rumination and Both Social Support and Depression Symptoms

Co-ruminating about one's problems appears to involve both beneficial self-disclosure and harmful rumination, suggesting that moderate levels may be the most adaptive. This study used nonlinear regression to determine whether moderate levels of self-reported co-rumination in relationships with a sibling, parent, friend, and romantic partner are linked to the highest levels of self-perceived social support and lowest levels of self-reported depression symptoms in 175 emerging adults (77% female; M = 19.66 years). As expected, moderate co-rumination was associated with high social support across all four relationship types, but, somewhat unexpectedly, high levels of co-rumination were also associated with high social support. As predicted, moderate levels of co-rumination with friends and siblings were associated with low levels of depression. Contrary to hypotheses, high levels of co-rumination were associated with high depression within romantic relationships. Co-rumination with a parent did not have a linear or quadratic association with depression. These findings suggest that high co-ruminating in supportive relationships and to a lesser extent low co-ruminating in unsupportive relationships are maladaptive interpersonal processes but that co-rumination's relation to depression depends on the co-ruminating partner. Psychotherapies for depression may target these maladaptive processes by supporting clients' development of balanced self-focused negative talk.     

Misconstruing methods and meaning in the General Factor of Personality

Research has suggested that a General Factor of Personality (GFP) might represent a real and meaningful higher‐order factor in the personality hierarchy. However, there are psychometric shortcomings in many of the studies used to support this argument, as well as convincing empirical evidence for alternative explanations of the GFP as methodological rather than meaningful. The current article re‐examines the research supporting a substantive GFP by considering and evaluating the evidence presented in a recent volume (Just, 2011). It is concluded that covariation among first‐order personality factors is more likely a statistical or methodological artefact than a theoretically meaningful higher‐order construct.     

Sample Attrition in Studies of Psychosocial Sequelae of Abortion: How Great a Problem?1

This study examines sample attrition problems in abortion research and the implications for conclusions reached about psychosocial sequelae of abortion. A review of 17 recent studies shows that the percent of the initial sample lost to follow-up ranges from a low of 13% to a high of 86%. Younger women and Catholic women appear to be less likely to participate in follow-up. Since both of these characteristics are associated with a greater likelihood of negative sequelae, follow-up studies may be underestimating the extent of negative reaction to abortion. Data from a recent study are presented; comparisons are made between characteristics of initial volunteers and the total population and between the volunteers who return for the follow-up interview and those who do not. Results support the suggestion that women for whom the abortion was more stressful are less likely to be represented in the final sample. Factors affecting the likelihood of participating in research are explored and strategies for improving the representativeness of samples are suggested.     

Source expertise and persuasion: the effects of perceived opposition or support on message scrutiny

Compared to nonexperts, expert sources have been considered to elicit more processing of persuasive messages because of expectations that the information is likely to be valid or accurate. However, depending on the position of an advocacy, source expertise could activate other motives that may produce a very different relation from that found in past research. When messages are counterattitudinal (disagreeable), experts should motivate greater processing than nonexpert sources because of expectations that they will likely provide robust opposition to one's existing views. In contrast, when advocacies are proattitudinal (agreeable), nonexpert rather than expert sources should elicit more scrutiny because of perceptions that they will likely provide inadequate support to recipients' current views. Two studies offer evidence consistent with these predictions. Manipulations of source expertise created different expectations regarding the strength of opposition or support, and these perceptions accounted for effects of source expertise on the amount of message scrutiny.     

Impact of depression on response to comedy: a dynamic facial coding analysis

Individuals suffering from depression show diminished facial responses to positive stimuli. Recent cognitive research suggests that depressed individuals may appraise emotional stimuli differently than do nondepressed persons. Prior studies do not indicate whether depressed individuals respond differently when they encounter positive stimuli that are difficult to avoid. The authors investigated dynamic responses of individuals varying in both history of major depressive disorder (MDD) and current depressive symptomatology (N = 116) to robust positive stimuli. The Facial Action Coding System (Ekman & Friesen, 1978) was used to measure affect-related responses to a comedy clip. Participants reporting current depressive symptomatology were more likely to evince affect-related shifts in expression following the clip than were those without current symptomatology. This effect of current symptomatology emerged even when the contrast focused only on individuals with a history of MDD. Specifically, persons with current depressive symptomatology were more likely than those without current symptomatology to control their initial smiles with negative affect-related expressions. These findings suggest that integration of emotion science and social cognition may yield important advances for understanding depression.     

抑郁症计算机化治疗的效果及其影响因素：基于RCT的元分析与元回归分析

运用元分析和元回归分析的方法考察抑郁症计算机化治疗的效果及其影响因素。来源于50篇文献,42项RCT研究的67个样本满足了元分析标准（N=7920）。结果发现：（1）整体效果量为0.53,三个月追踪效果量为0.14;6个月追踪效果量为0.16;（2）在年龄段、抑郁严重程度、支持方式和测量量表四个亚组分析中,其效果量存在显著差异。干预方式、干预取向和分析方法对效果量的影响不显著;（3）出版年份显著影响治疗效果量,脱落率和干预单元数对整体效果量的影响不显著。结果表明：抑郁症的计算机化治疗具有中等的效果量;年龄段、抑郁严重程度、支持方式、测量量表和出版年份对其整体效果量有调节作用。将来抑郁症计算机化治疗的研究应重视上述调节变量对治疗效果的影响。     

Last Words: Analysis of Suicide Notes from an RECBT Perspective: An Exploratory Study

A sample of 86 suicide notes was analyzed to identify the common cognitive and emotional themes contained in the text from a rational-emotive and cognitive behavior therapy (RECBT) perspective. Using grounded theory and statistical analysis to examine the data, this study found that the most frequent emotional categories to be present in these suicide notes are autonomous depression, sociotropic depression, guilt, shame, hurt and anger. It was also discovered that men, more than women, are likely to write about their experience of guilt in their suicide notes at the end of a relationship, while women are more likely to express feelings of hurt. This study may enable RECBT practitioners to better understand the cognitive and emotional factors of suicide behavior, and it may encourage future research into more specific suicide prevention protocols.     

Interpretation bias and depressive symptoms: The role of self-relevance

Cognitive theories of depression emphasize negatively biased interpretations as an important target of therapy. Much of the research on interpretation bias in depression has focused on selection, or deciding which of several interpretations is likely. However, depressive biases may also exist in the generation of possible interpretations, or the ability to think of positive alternatives. If biases exist for generation as well as selection, therapeutic techniques to encourage the generation of more positive interpretations would be warranted. Asking therapy clients to consider someone else in a similar situation is a commonly used therapy strategy but has not been sufficiently examined empirically. In the current studies, we examine interpretation generation and selection in dysphoric and nondysphoric individuals, and contrast interpretations made for the self to interpretations made for two types of “other.” Our studies reveal depressive biases in both interpretation generation and selection, and indicate that interpretation valence is highly sensitive to the type of other considered. All participants generated and selected significantly more positive interpretations for friends than for themselves, but generated significantly more negative interpretations for hypothetical others than for themselves. Our results suggest that encouraging dysphoric individuals to imagine others can be beneficial, but the type of “other” used is critically important, with instructions to consider a close friend most likely to be effective in decreasing negativity in interpretation.     

Social Support and Depression in Rheumatoid Arthritis: A One-Year Prospective Study1

Previous research on patients with rheumatoid arthritis (RA) has suggested that social support is beneficial for helping patients to adjust psychologically to the chronic and unpredictable episodes of pain. This study addresses whether support buffers the adverse effects of arthritis pain or whether support results in a decrease in the severity of pain regardless of pain levels in 233 RA patients. The results indicated that patients who reported higher satisfaction with their emotional support when experiencing higher levels of pain were less likely to be depressed than patients who do not perceive such support. The results were obtained after controlling the effects of demographic variables, functional disability variables, and the direct effects of pain and social support. However, moderating effects of emotional support were not found when this relationship was examined over a 6-month period. Rather, causal modeling suggested that both pain and emotional support contributed to a change in depression over two 6-month intervals. The results also suggested that depression may have an adverse effect on change in emotional support over a similar time frame.