Borderline personality disorder and age of onset in major depression

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we tested the hypothesis that borderline personality disorder (BPD) accounts for the observed differences between early and late onset major depressive disorder (MDD). A total of 440 depressed outpatients were evaluated with semistructured interviews. Patients were subdivided by age of onset and the presence or absence of comorbid BPD. The overall pattern of clinical and demographic variables differed and two separate, multiple, logistic regression analyses addressed the association between age of onset and BPD in MDD patients. Comorbid BPD was not significant in the multivariable age of onset equation and the results of the multivariable analyses support the idea of difference between subtypes. It is concluded that although early age of onset is predictive of BPD, BPD is not a universal feature of early-onset MDD.     

Information processing in patients with first episode major depression

Hammar, Å., Kildal, A. B. & Schmid, M. (2012). Information processing in patients with first episode major depression. Scandinavian Journal of Psychology 53, 445–449. Few studies have investigated cognitive functioning in a group of patients experiencing a first episode of depression. The aim of this study was to investigate how patients diagnosed with a first episode of depression perform in effortful and non‐effortful information processing compared to healthy controls. An experimental paradigm based on a visual search test was applied. Thirty‐one patients and thirty‐one healthy controls were included in the study. All patients experienced a severe level of symptom load at the time of testing. Results showed no significant differences between groups under any of the conditions. Findings in the present study indicate that patients with a first episode of depression perform equally to healthy controls in tasks requiring visual attention in both effortful and non‐effortful information processing.     

Predictors of first onset and recurrence of major depression in young women during the 5 years following high school graduation

Although most depressive episodes in adulthood are recurrences of the disorder, lifetime history of major depression (MD) is often neglected in predictive models. On the basis of research and theory suggesting differential prediction of MD across the course of the disorder, the authors explored whether factors that predict a first MD onset would not predict MD recurrence. Predictors of MD were examined longitudinally in a sample of 128 young women followed for 5 years. Controlling for lifetime MD history, 5-year MD was predicted by the presence before study entry of 3 variables: having witnessed family violence before age 16, having a parent with a psychiatric disorder, and having a nonmood Axis I disorder. During the follow-up period, chronic and episodic stress predicted MD. Prior lifetime MD interacted with both chronic stress and parental psychopathology to predict MD, such that first onsets, but not recurrences, were predicted by these risk variables.     

Cognitive functioning and cortisol profiles in first episode major depression

Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty‐one patients meeting the DSM‐IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after Dexamethasone and cognitive measures. The results indicate impairment on HPA‐axis functioning in first episode MDD patients, with less suppression functioning compared to healthy controls, but no relationship between cortisol profile and cognitive functioning in EF or Memory.     

Life events and depression in adolescence: relationship loss as a prospective risk factor for first onset of major depressive disorder

Although stressful life events have consistently been linked to the onset of major depressive disorder (MDD), most research has not distinguished 1st episodes from recurrences. In a large epidemiologic sample of older adolescents (N = 1,470) assessed at 2 time points, the risk conferred by a recent romantic break-up was examined as a predictor of 1st onset versus recurrence of MDD. Results indicated a heightened likelihood of 1st onset of MDD during adolescence if a recent break-up had been reported; in contrast, a recent break-up did not predict recurrence of depression. These results held for both genders and remained significant after controlling for gender. Additional analyses to determine the discriminant validity and specificity of these findings strongly supported the recent break-up as a significant risk factor for a 1st episode of MDD during adolescence. Implications of these findings and subsequent research directions are discussed.     

Observed maternal responses to adolescent behaviour predict the onset of major depression

Two mechanisms have been proposed regarding relations between parental responses to adolescent affective behaviours and the development of depression: the elicitation of parental negativity and the suppression of parental aggression. This study aimed to investigate the boundary conditions under which these two mechanisms operate in relation to the prospective prediction of Major Depressive Disorder (MDD) onset in adolescence. A community sample of 159 adolescents (aged 11–13 years) with no history of MDD completed a family interaction assessment with their mothers, and were followed-up with a diagnostic interview 2–3 years later. Results showed that onset of MDD was prospectively predicted by the elicitation of maternal aggression in response to adolescent aggression (in girls only) and maternal dysphoria in response to adolescent aggression, as well as the suppression of maternal aggression and dysphoria in response to adolescent dysphoria. Thus, support was obtained for both the elicitation of negativity mechanism in relation to maternal responses to adolescents’ aggressive behaviours, and the suppression of aggression mechanisms in relation to maternal responses to adolescents’ dysphoric behaviours. Mothers’ responses to adolescents’ aggressive and dysphoric behaviours may differentially influence the risk of MDD onset for adolescents over time.     

Interference resolution in major depression

In two experiments, we investigated individual differences in the ability to resolve interference in participants diagnosed with major depressive disorder (MDD). Participants were administered the “Ignore/Suppress” task, a short-term memory task composed of two steps. In Step 1 (“ignore”), participants were instructed to memorize a set of stimuli while ignoring simultaneously presented irrelevant material. In Step 2 (“suppress”), participants were instructed to forget a subset of the previously memorized material. The ability to resolve interference was indexed by response latencies on two recognition tasks in which participants decided whether a probe was a member of the target set. In Step 1, we compared response latencies to probes from the to-be-ignored list with response latencies to nonrecently presented items. In Step 2, we compared response latencies to probes from the to-be-suppressed list with response latencies to nonrecently presented items. The results indicate that, compared with control participants, depressed participants exhibited increased interference in the “suppress” but not in the “ignore” step of the task, when the stimuli were negative words. No group differences were obtained when we presented letters instead of emotional words. These findings indicate that depression is associated with difficulty in removing irrelevant negative material from short-term memory.     

Cognitive deficits in major depression

Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from wide-spread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results.     

Rumination and attention in major depression

Up until recently, it had been assumed that attentional biases for negative information do not exist in depression. However studies using post-conscious exposure durations have produced contradictory results. The limitations of common attentional tasks, suitability of stimulus materials and differences in stimulus duration times may have contributed to these inconsistencies. We aimed to address many of these issues and examine attentional responses in major depression at two post-conscious exposure times. We also investigated possible roles for rumination and distraction in increasing and lessening attentional biases for negative information. We used a fully controlled experimental design to test the effects of both induced and trait rumination and distraction on attention in patients with major depression and healthy controls. Attention was assessed using the dot-probe task. The findings revealed an attentional bias for negative information in depressed patients only at the longer post-conscious exposure duration. Furthermore although this bias was not influenced by either induced or trait distraction, it was related to trait rumination. Overall, the results showed that depression is associated with a strategic attentional bias towards negative information and that this bias is stronger in individuals who habitually ruminate.     

A colonial mentality model of depression for Filipino Americans

Many cultural and ethnic minorities have extensive experiences of being oppressed, which they may eventually internalize. However, psychology has yet to actively incorporate various forms of internalized oppression (e.g., colonial mentality [CM]) into the etiological conceptualizations of psychopathology. Using a sample of 248 Filipino Americans, the author tested a more complete and sociopolitically informed cultural model of depression symptoms. Results with structural equation modeling showed that a conceptual model that includes CM better explained depression symptoms among Filipino Americans than the model without CM and revealed that CM had a significant direct effect on Filipino Americans' experiences of depression symptoms. It is argued, through this illustrative case of depression symptoms among Filipino Americans, that incorporating the psychological effects of oppressive historical and contemporary conditions into our conceptualizations of ethnic minority mental health may lead to a more culturally accurate etiological understanding of psychopathology among historically oppressed groups.     

Perceptions of Women Condom Proposers Among Chinese Americans,Japanese Americans,and European Americans1

This study was a comparison of the judgments made about a sexually active female condom proposer by men and women of 3 ethnic groups: Chinese Americans, European Americans, and Japanese Americans. Results indicate that Chinese Americans reacted more negatively to the female condom proposer than did European Americans. Japanese Americans could not be distinguished between either of the groups on most measures. However, Japanese Americans did perceive the female condom proposer to be less sexually attractive than did the other 2 groups. These findings underscore the importance of distinguishing among subgroups of Asian Americans, especially when considering issues related to gender and sexuality.     

Ambivalence over emotional expression in major depression

High ambivalence over the expression of emotions (AEE) has consistently been associated with high levels of depression in previous research. However, there is a lack of studies examining this construct and its associations in a clinical sample of patients with major depressive disorder (MDD). Therefore, the present study compared 76 MDD with 77 non-depressed controls (NC) regarding AEE. As expected, MDD reported greater AEE as compared to ND. Furthermore, levels of AEE and levels of depression were positively correlated in the MDD group. These findings extend previous work and underline the importance of AEE as a central construct in depression. Targeting AEE in treatments of depression may help to modify maladaptive interpersonal patterns of emotional expression.     

Intrusive images and memories in major depression

Individuals with current major depression were interviewed to investigate the prevalence of distressing intrusive mental imagery among depressed patients and study the phenomenology of these intrusions. Of the 39 currently depressed patients, 17 experienced some form of repetitive intrusive imagery (i.e., either an intrusive memory or image), with intrusive memories being more common than images. The intrusive imagery was experienced as highly uncontrollable and interfered significantly with patients' everyday lives. The intrusions were experienced with a sense of 'nowness', as well as physical and emotional re-experiencing. Despite high levels of re-experiencing, levels of dissociation were very low. The intrusive imagery was in some patients part of a wider network of key defining autobiographical memories, consistent with the idea that it is likely to play a significant role in maintaining the patient's depressive mood. Interventions targeting these intrusions could potentially result in a positive shift in depressed mood.     

Diagnosis of major depression by self-report

The Symptom Checklist-90 (SCL-90), Millon Clinical Multiaxial Inventory (MCMI), and Minnesota Multiphasic Personality Inventory (MMPI) test profiles of inpatients and outpatients with DSM-III major depression (n = 48) were contrasted with the test profiles of a control group of patients with diverse psychiatric disorders (n = 68). In addition, the diagnostic efficiency of the relevant depression subscales for the diagnosis of major depression were examined. The results indicated that the three self-report tests may be used to diagnose DSM-III major depression, and that the depressed patients had characteristic test profiles.     

Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depression. The validity of the distinction between DSM-III-R chronic major depression (CMD) and major depression superimposed on dysthymia (double depression, DD) was examined. Participants were 635 patients with chronic depression in a 12-week trial of antidepressant medications. Patients with CMD, DD, and a 3rd group with a chronic major depressive episode superimposed on dysthymia (DD/CMD) were compared on demographic and clinical characteristics, family history, and response to treatment. Few differences were evident, although the depression of patients with DD/CMD tended to be more severe.     

Age of onset of marijuana use and executive function

[Correction Notice: An Erratum for this article was reported in Vol 26(3) of Psychology of Addictive Behaviors (see record 2011-29227-001). Figure 1 should have been presented in color. All versions of this article have been corrected.] Marijuana (MJ) remains the most widely abused illicit substance in the United States, and in recent years, a decline in perceived risk of MJ use has been accompanied by a simultaneous increase in rates of use among adolescents. In this study, the authors hypothesized that chronic MJ smokers would perform cognitive tasks, specifically those that require executive function, more poorly than control subjects and that individuals who started smoking MJ regularly prior to age 16 (early onset) would have more difficulty than those who started after age 16 (late onset). Thirty-four chronic, heavy MJ smokers separated into early and late onset groups, and 28 non-MJ smoking controls completed a battery of neurocognitive measures. As hypothesized, MJ smokers performed more poorly than controls on several measures of executive function. Age of onset analyses revealed that these between-group differences were largely attributed to the early onset group, who were also shown to smoke twice as often and nearly 3 times as much MJ per week relative to the late onset smokers. Age of onset, frequency, and magnitude of MJ use were all shown to impact cognitive performance. Findings suggest that earlier MJ onset is related to poorer cognitive function and increased frequency and magnitude of MJ use relative to later MJ onset. Exposure to MJ during a period of neurodevelopmental vulnerability, such as adolescence, may result in altered brain development and enduring neuropsychological changes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Predictors of the first onset of a major depressive episode and changes in depressive symptoms across adolescence: stress and negative cognitions

This 6-year longitudinal study examined stressors (e.g., interpersonal, achievement), negative cognitions (self-worth, attributions), and their interactions in the prediction of (a) the first onset of a major depressive episode (MDE), and (b) changes in depressive symptoms in adolescents who varied in risk for depression. The sample included 240 adolescents who were first evaluated in Grade 6 (M = 11.86 years old; SD = 0.57; 54.2% female) and then again annually through Grade 12. Stressful life events and depressive diagnoses were assessed with interviews; negative cognitions and depressive symptoms were assessed with self-report questionnaires. Discrete time hazard modeling revealed a significant interaction between interpersonal stressors and negative cognitions, indicating that first onset of an MDE was predicted by high negative cognitions in the context of low interpersonal stress, and by high levels of interpersonal stressors at both high and low levels of negative cognitions. Analyses of achievement stressors indicated significant main effects of stress, negative cognitions, and risk in the prediction of an MDE, but no interactions. With regard to the prediction of depressive symptoms, multilevel modeling revealed a significant interaction between interpersonal stressors and negative cognitions such that among adolescents with more negative cognitions, higher levels of interpersonal stress predicted higher levels of depressive symptoms, whereas at low levels of negative cognitions, the relation between interpersonal stressors and depression was not significant. Risk (i.e., maternal depression history) and sex did not further moderate these interactions. Implications for intervention are discussed.