Depressed mood: The role of negative thoughts,self-consciousness,and sex role stereotypes

Research typically finds that depression is twice as common among women as among men. This may relate to differences in socialization that result in different emotions, cognitions, and coping reactions. Sex-role stereotypes, employment and marital status, and differential social pressures may also be significant in making women more vulnerable to the development of depression. Women may have less decision-making power, face more adverse life events, and have limited access to resources, which may lead to feelings of helplessness and low self-esteem. Low self-esteem and negative cognitions about the self in turn may be proximal factors predictive of negative mood. Additionally, women may be more prone to ruminative self-focus rather than active coping, a significant risk factor for depression. This study examined individual predictors of depressed mood for each sex, including coping, self-esteem, negative thoughts, self-consciousness (rumination), as well as social factors such as the endorsement of sex-role stereotypes and decision-making power in the family. Results indicated that social factors were not related to depressed mood in either sex, but were related to coping styles and self-esteem. Depressed mood was associated with individual characteristics, such as avoidant coping styles, social anxiety for women, and ruminative self-focus for men. Regression analysis showed that coping through denial and negative thoughts explained depressed mood, and the latter was particularly true for men. These results point to the significance of examining both individual and social factors when attempting to understand depression in men and women.     

Depressive Symptomatology among HIV-Positive Women in the Era of HAART: A Stress and Coping Model

Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.     

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Objective: An enhanced stress and coping model was used to explain depression among HIV‐positive women in healthcare and community settings where highly active anti‐retroviral treatment (HAART) was commonplace. Method: HIV‐infected women in four cities (N=978) were assessed, cross‐sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self‐reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self‐efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self‐efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self‐efficacy, bolstering social supports, and decreasing stress in the lives of HIV‐positive women may help to reduce the negative effects of HIV disease on mood.     

The Affective Consequences of Minority Stress Among Bisexual,Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals’ levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.     

Determinants of depressive mood states in everyday life: An experience sampling study

This study tests relative contributions and time-course of proposed risk/protective factors (e.g., stress, coping, and lack of social interactions) for influencing depressed mood states in daily life. Seventy-three participants completed baseline measurement of major depressive disorder symptomatology, followed by smartphone app-based monitoring of momentary experiences of depressed mood and risk/protective factors for 7 days. All predictors had deteriorating impacts on mood as lag increased, and the optimal lag appears to be less than 120 min. Linear decay in effect sizes was found for physical activity, social interaction, and tiredness, whereas exponential decline in effect sizes was found for stress and coping ability. Stress, coping, and depressed mood at the prior time-point were the best predictors of subsequent mood. These effects did not differ as a function of trait depressive symptom severity. Findings highlight the influence of spacing of assessments in identification and magnitude of predictors of mood states, and provide insights into key drivers of change in mood and their time-course.     

Appraised changeability of a stressor as a modifier of the relationship between coping and depression: a test of the hypothesis of fit

The goodness of fit among the appraised changeability of a stressor, coping, and depression in people with psychiatric, physical health, work, and family problems was examined (N = 746). It was expected that problem-focused coping (as opposed to emotion-focused coping) would be used more and be more adaptive in situations appraised as changeable as compared with situations appraised as not changeable. Although few relationships existed between appraisal and coping, tests of fit between coping and depressed mood (maladaption) were much stronger. In people with nonpsychiatric conditions, problem-focused coping and depressed mood were negatively related when a stressor was appraised as changeable but were unrelated when a stressor was appraised as not changeable. Emotion-focused coping was positively related to depression when a stressor was appraised as changeable. No general relations were observed in the people with psychiatric conditions.     

Depression history and coping with chronic pain: a daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.     

Sex Roles, Interpersonal Control, and Depression: Who Can Get Their Way?

This study is one of a series of investigations examining the contribution of sex roles to the development of depression within a learned helplessness framework. Utilizing 143 pairs of undergraduate female participants, the present study explored subjects′ abilities to gain and maintain control in an interpersonal context. Interpersonal control was operationalized as successful persuasion in a two-person discussion task, wherein one participant had hidden instructions to be maximally persuasive in discussing a questionnaire about social behavior. The results indicated that less successful persuasion was associated with increases in depressed mood. Furthermore, women with high masculinity and low femininity were able to gain interpersonal control regardless of the sex role of their partner. The results also suggested that high femininity is associated both with giving up control in interpersonal tasks and with increases in depressed mood when one is faced with the task of exerting interpersonal control. The findings were interpreted in terms of the importance of sex role characteristics in learned helplessness and depression.     

The effects of maternal mood on mother-infant interaction

The effects of depressed mood on mother-infant interaction were studied in 30 mother-infant dyads using the Velten mood induction procedure. It was predicted that maternal depressed mood would induce dysphoria in the infants, disrupt the infants' natural responsiveness to their mothers, and interfere with the mothers' ability to manage the interaction. In addition, it was predicted that such deficits would be the result of depressed maternal mood and not simply due to any change in maternal mood. The results indicated that the infants were sensitive to depressed mood and were less contingently responsive to their mothers than were controls. Also, mothers in the depression induction condition were less successful in eliciting positive responses from their infants than were controls. These results have implications for the development of a helplessness vulnerability in infants and for the two-way direction of effect present in depressed mother-infant dyads.This research was partially funded by NIMH grant MH39283 and a Spelman-Rockefeller Seed Grant awarded to Michael O'Hara. We gratefully acknowledge the assistance of Joan Blackwood, Nancy Clift, Lynda Field, Darla Hauf, Randy Ross, Jane Ugland, and Jim Vincent in the data collection. We also thank Richard R. Hurtig, John F. Knutson, Donald K. Routh, Robert A. Forsyth, and Carolyn E. Cutrona for their helpful comments on an earlier version of this article.     

PTSD and Emotional Distress Symptoms Measured After a Motor Vehicle Accident: Relationships with Pain Coping Profiles

This study explored differences among pain patients classified as Dysfunctional, Interpersonally Distressed, and Adaptive Copers on the Multidimensional Pain Inventory with respect to PTSD symptomatology, anxiety, and depression. Eighty-five patients with pain complaints who had experienced a serious motor vehicle accident were classified into these three pain coping categories and assessed using clinician and self-report measures. Results indicated that patients classified as Adaptive Copers (n = 24) showed less PTSD symptomatology, anxiety, and depressed mood, relative to individuals classified as Dysfunctional (n = 36) and as Interpersonally Distressed (n = 25), who did not differ on these dimensions. Emotional responses during the accident (fear, helplessness, danger, perceived control, and certainty that one would die) did not differentiate the groups. Pain profiles contributed to the prediction of self-reported PTSD symptoms, controlling for state anxiety. These data suggest that pain patients with both Dysfunctional and Interpersonally Distressed coping profiles are at elevated risk for a range of posttrauma problems following a serious motor vehicle accident.     

Lay Theories Concerning Causes and Treatment of Depression

This study compared perceptions of the causes of, therapies for, and means of coping with, depression between two groups of currently nondepressed adults: one with a history of major depression and one with no history of depression. Currently nondepressed participants were selected so that effects of past experience of depression could be distinguished from those of current mood. Recovered depressed participants (RD) (n = 25) and Never depressed participants (ND) (n = 25) recruited via newspaper advertisements completed self-report measures of (a) the perceived utility of either professional or self-help coping strategies for managing their own experiences of depression; (b) likely effectiveness of several major therapies for depression; and (c) perceived accuracy of several etiological theories of depression. RD participants rated depression as being less amenable to everyday self-help methods of coping and more in need of professional intervention. However, RD and ND subgroups did not differ significantly in their perceptions of the plausibility of etiological theories of depression in general, nor in their ratings of the likely helpfulness of major therapies.     

Coping and Positive Affect in Adolescents of Mothers With and Without a History of Depression

The adolescent children of depressed mothers are at increased risk for depression, but little is known about protective factors for these children. Maintenance of positive affect in a stressful context may be an important marker of resilience. Mothers with (n = 34) and without (n = 38) a history of depression and their adolescent children completed questionnaires regarding adolescents’ coping and depressive symptoms and engaged in a 15 min videotaped interaction about family stress. Adolescents’ observed behaviors were coded using the Iowa Family Interaction Rating Scales. No significant differences emerged in observed behavior between adolescents of mothers with and without a history of depression. Higher levels of primary and secondary control coping and lower levels of disengagement coping were related to higher levels of observed positive mood and fewer depressive symptoms in adolescents. Observed positive mood was related to fewer depressive symptoms in adolescents, even after accounting for maternal history of depression and current maternal depressive symptoms. Results suggest the importance of considering positive affect in the context of family stress as a marker of resilience in adolescents at risk for depression. The current study provides evidence for coping as a protective factor, related to higher levels of positive affect and fewer depressive symptoms, in adolescents exposed to maternal depressive symptoms.     

Concurrent Treatment of Depression in Parents and Adolescents: A Case Example

The detrimental influence of parent psychopathology—and depression, in particular—on adolescent mental health has been well documented. Routes of transmission include both direct and indirect factors, such as poor parent–adolescent communication, ineffective parenting practices, modeling ineffective coping skills, increased family discord and stress, inadvertent reinforcement of adolescent depressed mood and suicidal ideation and behavior, and decreased treatment adherence. This paper introduces a novel treatment to concurrently treat both a depressed adolescent as well as a depressed parent. This approach improves upon traditional cognitive-behavioral therapy by targeting relational factors of each adolescent–parent dyad while simultaneously addressing each individual’s depression. Principles of case conceptualization and treatment planning using this novel approach are illustrated using a case example.     

Effects of amount of helplessness training and internal-external locus of control on mood and performance.

Based on Wortman and Brehm's integration of reactance theory with Seligman's model of learned helplessness, an investigation was conducted to examine the effects of amount of helplessness training and internal--external locus of control on subsequent task performance and on self-ratings of mood. Subjects were divided into "internal" and "external" groups and were then given either high, low, or no helplessness training on a series of concept-formation problems. After completing a mood checklist, all subjects worked on an anagram task presented as a second experiment by a second experimenter. The results revealed that internals exhibited greater performance decrements and reported greater depression under high helplessness than did externals. In the low helplessness conditions, internals tended to perform better than control subjects, while externals tended to perform worse than control subjects; low helplessness subjects also reported the highest levels of hostility. The results are discussed within the context of Wortman and Brehm's integration of reactance and learned helplessness theories.     

Coping and sensitivity to aversive events

To test further the sensitivity to aversive events hypothesis, males and females varying in level of depressed mood listened to positive, negative, and neutral social scenes while psychophysiological measurements were obtained. In addition, the relations among response styles, coping strategies, and psychological adjustment were examined. Results indicated that only dysphoric females responded in ways consistent with the sensitivity hypothesis, exhibiting greater electrodermal responses to negative social scenes compared to nondysphoric females. No differences in psychophysiological sensitivity were found between dysphoric and nondysphoric males. Dysphoric students engaged in more ruminative type responses in reaction to their depressed mood and reported using more avoidant coping strategies in response to stress. In particular, females utilized more ruminative strategies in response to a depressed mood and more emotion-focused coping strategies in response to stressful events in general. The implications for these results are discussed within a diathesis-stress framework.     

Sex differences in relationships among anger, depression, and coping strategies of Japanese students

This study investigated sex differences in the relationships among an ger, depression, and coping strategies. Undergraduate students, 77 men and 130 women, 3 not identified by sex, voluntarily participated. Participants made ratings on a self-report about anger, depression, coping strategies, and mental health. Analyses showed that women who reported themselves as angry tended to cope with stress by optimistic and active strategies, while women who reported themselves as depressed tended to cope with stress by withdrawn and passive strategies. Men who reported being depressed tended to select emotion-focused cognitive coping, while men who reported being angry selected no specific coping. Adoption of engaged emotion focused coping strategies were related to mental health only for women.     

Youth with Chronic Pain and Postural Orthostatic Tachycardia Syndrome (POTS): Treatment Mediators of Improvement in Functional Disability

Intensive pain rehabilitation programs are effective in increasing functioning for youth with chronic pain (CP). However, the utility of such programs for youth with CP and co-morbid postural orthostatic tachycardia syndrome (POTS) is rarely examined. In addition, studies examining mediators of treatment for CP are sparse. This paper compares treatment outcomes for youth with CP (n?=?117) and youth with CP?+?POTS (n?=?118). Additionally, depression and pain catastrophizing were tested as potential mediators of treatment effects. Significant treatment improvements were found for functional disability, depression, pain catastrophizing, and perceived pain intensity but with no differences between groups. Improvements in depressed mood, pain catastrophizing (helplessness subscale), and pain severity partially mediated functioning improvement. Pain severity was not a significant mediator in the CP?+?POTS group. We concluded that depression and pain catastrophizing, especially the helplessness domain, can impact functioning improvement in adolescents with CP and POTS and are particularly important to target in treatment.     

Multiaxial taxonomy of fibromyalgia syndrome patients

Pain, disability, and depression are present in various degrees in patients with fibromyalgia syndrome. Cluster analysis was used in this research to ascertain the existence of subgroups of patients in a fibromyalgia sample based on these variables. Two clusters were defined: one characterized by high levels of pain, disability, and depression (n=51) and another characterized by low levels of pain, disability, and depression (n=67). Multivariate analysis of variance (MANOVA) confirmed differences between clusters on these health status factors and a second MANOVA revealed that the subgroup with a poorer health status reported greater passive coping, helplessness, and stress, and less satisfaction with social support, than the subgroup with better health status. Logistic regression indicated that the best discriminator of subgroup membership was helplessness. These results suggest that different approaches to patient management, particularly intervention strategies aimed at reducing helplessness, may be beneficial for patients with high levels of pain, disability, and depression.     

Gender differences in responses to depressed mood in a college sample

Two studies tested the hypothesis that women are more likely than men to focus on themselves and their mood when in a depressed mood, and that this leads them to experience longer periods of depressed mood. In both studies subjects were predominantly Caucasian college students. In our first study, a laboratory study, females chose to engage in an emotion-related task significantly more often than did males, even when this lead them to focus on an existing sad mood. In the second study, a prospective naturalistic study, females were more likely than males to evince an emotion-focused ruminative style of coping with their moods. A ruminative response style at Time 1 was a significant predictor of depression scores at Time 2, even after initial levels of depressed mood were taken into account. Furthermore, once rumination levels were controlled for, gender was no longer a potent predictor of depression outcome. The implications of these response styles for treatment are discussed.We thank Brandi Battistoni, Kim Bergquist, Rachel Carr, Lisa Lougee, and especially Ariel Lang for their invaluable help in data collection. We also thank Chuck Olson, Jannay Morrow, and Rose McDermott for their helpful comments on earlier drafts.     

Passive coping response to depressive symptoms among low-income homebound older adults: Does it affect depression severity and treatment outcome?

Due to their homebound state, lack of financial resources, and/or other life demands, a significant proportion of depressed, low-income homebound older adults experience depression. Because of their limited access to psychotherapy, most of these older adults self-manage their depressive symptoms. The purposes of this study were to examine (1) the relationship between homebound older adults' coping responses to depressed mood and the severity of their depressive symptoms at baseline (n = 121), and (2) the moderating effect of passive coping responses on the relationship between participation in problem-solving therapy (PST: in-person or telehealth delivery) and depressive symptoms at 12- and 24-week follow-ups. Controlling for the effects of demographic and disability characteristics, cognitive passive coping was significantly associated with baseline depressive symptoms, while behavioral passive coping was not. The main effect of baseline cognitive passive coping response was also significant in mixed-effects regression analysis, but the interaction between coping pattern and group was not significant. The results point to a possibility that cognitive passive copers may have benefited as much from PST as the rest of the PST participants. Further research needs to examine the moderating effect of coping responses to depressive symptoms on treatment efficacy of PST and other psychosocial interventions for late-life depression.