Preventing depression: A review of cognitive-behavioral and family interventions

Depression is one of the most common psychological disorders. It is associated with tremendous costs in terms of suffering, decrease in productivity, and loss of life. For many individuals, depression is a disorder that will recur throughout life. Recent findings suggest that the prevalence of depression is on the rise, particularly in young people. Clearly, depression prevention is an important goal. Can depression be prevented? In this article we review research on interventions designed to prevent episodes and symptoms of unipolar depression in adults and children. Our review focuses specifically on cognitive-behavioral and family interventions. We discuss what researchers have learned about the prevention of depression and conclude with recommendations for future investigations.     

We should screen for major depression

This article is a response to Coyne, Thompson, Palmer, Kagee, and Maunsell's (2000) article, “Should We Screen for Depression? Caveats and Potential Pitfalls.” We address four points that we view as central to their argument: (1) current screening measures are inadequate; (2) correct identification of depressed patients does not result in improved clinical outcomes; (3) screening is too expensive; and (4) screening may have harmful negative effects. We discuss the following important issues: (1) screening and prevention are still in the research and development phase; (2) the kindling phenomenon is an important reason to screen; (3) there is a need to focus screening and prevention efforts on ethnic minorities; and (4) high depressive symptoms have a substantial public health impact. Finally, we present reasons why screening is advisable, both for prevention and treatment purposes, and provide our recommendations. Our stance is that, in order for screening and prevention to become practical, they need to be implemented in both research and practice contexts. Therefore, we should make screening for major depression a priority.     

An evolutionary function of the depressive reaction: the cognitive map hypothesis

Existing hypotheses for an evolutionary function of depression are insufficient, primarily because they fail to show convincingly the advantages that might compensate for the high evolutionary costs of its features, such as general passivity, decreased appetite and sex drive.In this article, it is shown that depression may have the function of motivating a period of reduced activity after a major loss. It thus allows for time out to update the cognitive structures for altered circumstances, and avoids dangerous actions based on the use of inadequate cognitive maps. This cognitive map hypothesis provides a viable evolutionary explanation for the high incidence of depression reaction, in spite of its apparently unfavorable characteristics. The article discusses how this hypothesis may also shed light on the occurrence of clinical depression, proposing that it is caused by a failure to update complex conceptual cognitive structures. Finally, recommendations for the treatment of depression that derive from this hypothesis are presented.     

A Review and Meta‐Analysis Examining Conceptual and Operational Definitions of Problematic Internet Use

This study examined different conceptual and operational definitions of problematic Internet use (PIU). 3 perspectives of PIU are described along with a meta‐analytic review (K = 112) conducted to explore the implications stemming from how PIU is measured. The results offer evidence to support the construct validity of measures developed from the impulse control disorder and relationship resource deficits traditions but raise questions about substance dependence measures of PIU. Additionally, there were small but noteworthy differences in the associations between PIU and key antecedents and outcomes that could be attributed to PIU measurement tradition. Suggestions for developing a more robust body of scholarship on PIU are offered.     

Attributional style, dreaming and depression

The relationship between attributional style, depression and dreaming was explored by analysing dream reports from 80 subjects for evidence of attributional style using the Content Analysis of Verbatim Material (CAVE) technique. These scores were then compared with a waking measure of attributional style—the Expanded Attributional Style Questionnaire (EASQ) and with levels of depression as measured by the BDI. Contrary to expectations, dream attributional style did not correlate with waking attributional style, nor was there a significant correlation between internal, global and stable attributional style in dreams and level of depression. Results did support previous research that an internal, stable and global waking attributional style correlates with depression.     

Examining the role of positive and negative metacognitive beliefs in depression

Many psychological models have been developed to explain the development and maintenance of depression. The most widely evaluated model is the cognitive model of depression, and it is against this model that emerging models should be compared. Accordingly, this cross‐sectional study examined whether metacognitive beliefs, as specified in the metacognitive model of depression, would explain additional variance in depressive symptoms over dysfunctional attitudes; the core feature of the cognitive model. Moreover, mediational relationships between metacognitive beliefs, rumination, and depressive symptoms, predicted by the metacognitive model were also explored, whilst controlling for dysfunctional attitudes. A sample of 715 students completed self‐report questionnaires measuring depressive symptoms, rumination, dysfunctional attitudes, and metacognitive beliefs. Regression analyses showed that metacognitive beliefs made a significant statistical contribution to depressive symptoms, after controlling for age, gender, rumination and dysfunctional attitudes. Furthermore, as predicted by the metacognitive model, the relationship between positive metacognitive beliefs and depressive symptoms was fully mediated by rumination, whilst the relationship between negative metacognitive beliefs about uncontrollability and danger and depressive symptoms was partially mediated by rumination. The results provide further empirical support for the metacognitive model of depression and indicate that positive and negative metacognitive beliefs play an integral role in the maintenance of depressive symptoms.     

Detention conditions’ impact on anxiety and depression levels of prisoners

IntroductionThe mortality rate in Portuguese prisons is the highest of the European Community. Two thirds of these deaths concern individuals in preventive detention, who have not yet faced trial.ObjectiveOur objective is to examine the impact of different detention conditions on the anxiety and depression rates of inmates. We predict that the anxiety and depression rates would be higher for inmates in preventive detention.ResultsResults have shown that the depression rates of inmates in open detention were the lowest. Depression rates were highest among inmates in preventive detention.DiscussionThe results do not allow us to confirm our hypothesis regarding anxiety rates. Considering our results, inmates in preventive detention seem to represent the most vulnerable population of the prison in relation to the two other groups.     

The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

“God loves me no matter how I am”: a phenomenological analysis of the religious and spiritual experiences of HIV-infected African-American women with depression

Depression is associated with increased HIV morbidity and mortality, particularly among African-American women (AAW) in the United States. The purpose of this qualitative study was to explore religious practices, spiritual beliefs, and experiences among AAW with co-occurring HIV infection and depression. A transcendental phenomenological study design was used to explore the experiences of AAW's religion and spirituality after an HIV diagnosis and living with depression. The four themes that were identified included: Religious Conflict and Return to Religious Practices; Religious Fortitude Broken and Feeling Judged; Spiritual Connection is More Powerful than Attending Church Services; and Spiritual Healing and Re-Connecting with Spirituality. These findings suggest that the distinction between internal and external manifestations of spirituality is important and that given the current religious climate, interventions that focus on supporting internal spiritual practice may be a more important and effective approach for AAW with co-occurring HIV infection and depression.     

MATERNAL SELF‐REPORTED DEPRESSIVE SYMPTOMS AND MATERNAL CORTISOL LEVELS INTERACT TO PREDICT INFANT CORTISOL LEVELS

Three basic findings have emerged from research on maternal depressive symptoms and offspring hypothalamic–pituitary–adrenal functioning: (a) Mothers’ depressive symptoms are positively associated with their offsprings’ cortisol stress response, (b) numerous individual and interpersonal maternal characteristics moderate this association, and (c) maternal and infant cortisol levels are highly correlated. In combination, these findings have suggested that maternal cortisol levels may moderate the relation between maternal depressive symptoms and infant cortisol responsivity; the current study assessed this hypothesis. Participants were 297 mother–infant dyads who were recruited from the community. Maternal depressive symptoms were assessed via self‐report. Dyads participated in two differentially stressful infant challenges when infants were 16 and 17 months old. Mother and infant salivary cortisol was collected before and after challenges. Results indicate that maternal cortisol levels moderated associations between maternal depressive symptoms and infant cortisol levels across both challenges. Infants showed higher cortisol levels if their mothers had both higher depressive symptoms and higher cortisol levels, as compared to infants of mothers with higher depressive symptoms and lower cortisol, and to infants of mothers with lower depressive symptoms and either higher or lower cortisol levels. We discuss findings in relation to environmental and biological factors that may contribute to the intergenerational transmission of depressive symptoms.