Cognitive vulnerability to depression: exploring risk and resilience

Cognitive disengagement syndrome and depressive symptoms in early adolescents: Examining the moderating role of a negative interpretation bias

BACKGROUND

Despite previous research demonstrating an independent association between cognitive disengagement syndrome (CDS; previously termed sluggish cognitive tempo) and depressive symptoms, studies have yet to examine what factors may moderate this link. A negative interpretation bias (i.e., maladaptive information processing whereby emotionally aversive meaning is perceived in ambiguous situations) is associated with the development and maintenance of depression and may moderate the association between CDS and depression. Using a multi-informant, multi-method design, this study examined whether negative interpretation bias exacerbated the association between CDS and depressive symptoms.

METHODS

336 adolescents (ages 10-12 years; 52.7% female; 61.9% White) and their caregivers completed measures of CDS and depressive symptoms. Adolescents completed the Scrambled Sentences Test, a task-based measure of interpretation bias. Regression analyses were conducted to examine interpretation bias as a potential moderator of the association between CDS and depressive symptoms.

RESULTS

For adolescent-reported depressive symptoms, higher caregiver- and adolescent-reported CDS symptoms and interpretation bias scores were each independently associated with higher depressive symptoms (all ps < .01), but CDS and interpretation bias did not interact in predicting depression (ps > .05). By contrast, significant CDS symptoms × interpretation bias interactions were found in models using both caregiver- and adolescent-reported CDS symptoms in relation to caregiver-reported depressive symptoms (ps = .01 and .003, respectively), such that CDS was more strongly associated with depression at higher levels of interpretation bias.

CONCLUSIONS

Negative interpretation bias strengthens the association between CDS symptoms and depressive symptoms when depressive symptoms are rated by caregivers, but not by adolescents. Findings highlight the importance of multiple informants when examining CDS and internalizing symptoms, with a need for longitudinal research to examine CDS and interpretation bias in relation to the progression and maintenance of depression across adolescence.

Clinical and psychological factors associated with resilience in patients with schizophrenia: data from the Italian network for research on psychoses using machine learning

BACKGROUND

Resilience is defined as the ability to modify thoughts to cope with stressful events. Patients with schizophrenia (SCZ) having higher resilience (HR) levels show less severe symptoms and better real-life functioning. However, the clinical factors contributing to determine resilience levels in patients remain unclear. Thus, based on psychological, historical, clinical and environmental variables, we built a supervised machine learning algorithm to classify patients with HR or lower resilience (LR).

METHODS

SCZ from the Italian Network for Research on Psychoses (N = 598 in the Discovery sample, N = 298 in the Validation sample) underwent historical, clinical, psychological, environmental and resilience assessments. A Support Vector Machine algorithm (based on 85 variables extracted from the above-mentioned assessments) was built in the Discovery sample, and replicated in the Validation sample, to classify between HR and LR patients, within a nested, Leave-Site-Out Cross-Validation framework. We then investigated whether algorithm decision scores were associated with the cognitive and clinical characteristics of patients.

RESULTS

The algorithm classified patients as HR or LR with a Balanced Accuracy of 74.5% (p < 0.0001) in the Discovery sample, and 80.2% in the Validation sample. Higher self-esteem, larger social network and use of adaptive coping strategies were the variables most frequently chosen by the algorithm to generate decisions. Correlations between algorithm decision scores, socio-cognitive abilities, and symptom severity were significant (pFDR < 0.05).

CONCLUSIONS

We identified an accurate, meaningful and generalizable clinical-psychological signature associated with resilience in SCZ. This study delivers relevant information regarding psychological and clinical factors that non-pharmacological interventions could target in schizophrenia.

Resilience as a mediator of interpersonal relationships and depressive symptoms amongst 10th to 12th grade students

BACKGROUND

The aim of this study was to explore the associations among interpersonal relationships, resilience and depressive symptoms, and to examine if resilience is a mediator between interpersonal relationships and depressive symptoms in senior high school students.

METHODS

Of 463 randomly selected participants from among 3,900 high school students, 450 (97.19%) consented to and completed a structured 4-part questionnaire consisting of demographic items, Inventory of Adolescent Resilience, Taiwan Relationship Inventory for Children and Adolescents, and Center for Epidemiologic Studies Depression Scale for Children. The associations between interpersonal relations and resilience and their associations with depressive symptoms were analyzed using MPlus 8.0 software for structural equation modeling.

RESULTS

Results from structural equation modeling indicate that resilience and interpersonal relationships were negatively associated with students' depressive symptoms, and resilience partially mediated the associations between interpersonal relationships and depressive symptoms after controlling for demographics.

CONCLUSION

Findings support that resilience and better interpersonal relationships are protective factors against depressive symptoms in adolescents. The positive association between the two protectors implies that interpersonal relationships might increase resilience and then alleviate depression amongst adolescents.

A negative cognitive style is associated with greater insomnia and depression symptoms: The mediating role of sleep reactivity

Insomnia and depression are distinct clinical phenomena, yet they are highly comorbid. One potential explanation for the high comorbidity rates is the overlap in risk factors. Atypical responses to stress, for example, place individuals at greater risk for both insomnia and depression. The goal of the present study was to simultaneously assess vulnerability to stress-related sleep disturbance (sleep reactivity) and the tendency to make negative attributions about stressful events (negative cognitive style), and how they relate to insomnia and depression. Study participants included 224 undergraduate students recruited from a large, public university in the United States. Sleep reactivity and negative cognitive style were assessed using the Ford Insomnia Response to Stress Test (FIRST) and the Cognitive Style Questionnaire (CSQ), respectively. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI), and depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Sleep reactivity was independently associated with greater insomnia and depression symptoms. Additionally, a negative cognitive style was related to greater depressive symptoms, and this effect was partially mediated by sleep reactivity. The current findings suggest that sleep reactivity may contribute to the development of disorders beyond insomnia. These findings further support the use of an interdisciplinary approach to investigating etiological models, and more specifically, the further exploration of how multiple stress responses (in terms of cognitions, sleep, etc.) place individuals at greater risk for developing psychopathology.

Resilience as a Mediator Between Interpersonal Risk Factors and Hopelessness in Depression

Several studies investigated the role of resilience as a mediating factor for psychopathological phenotypes. The aim of the current study is to explore the putative role of resilience as a mediator between different vulnerability factors and depressive symptoms. One hundred and fifty patients with a major depressive disorder diagnosis have been evaluated on the basis of humiliation (Humiliation Inventory), adverse past family experiences (Risky Family Questionnaire), hopelessness (Beck Hopelessness Scale), and resilience (Resilience Scale for Adult) scores. A multiple regression analysis and a bootstrapping method were carried out to assess the hypothesis that resilience could mediate the relationships between these risk factors as predictors and hopelessness as a dependent variable. Our results show that resilience has a mediating role in the relationship between several risk factors that are specifically involved in interpersonal functioning and hopelessness. The main limitations of the study are the cross-sectional nature of the study, the use of self-report instruments, the lack of personality assessment, and the consideration of the resilience as a unique construct. The understanding of the mechanisms through which resilience mediates the effects of different interpersonal risk factors is crucial in the study of depression. In fact, future prevention-oriented studies can also be carried out considering the mediating role of resilience between interpersonal risk factors and depressive symptoms.

Antecedents of depression in children and adolescents

Depression in children and adolescents is a growing health problem in the 21^st century. There is growing evidence that depression poses a significant risk in the developmental trajectory of children and adolescents. It is important to identify the antecedents of depression in this vulnerable group of individuals so as to develop specific and effective preventable techniques and strategies. In this brief review, we have tried to highlight the specific antecedents of childhood and adolescence depression on which evidence is available in a structured manner. Antecedents identified in childhood and adolescent depression were categorized into biological factors, temperament, cognitive vulnerability, family factors, sociodemographic factors, academic factors, changing social milieu, school factors, and peer group influence along with the emergence of the recentproblem of excessive social networking use. Biological and psychosocial factors are equally important in the development of depression in this age group. Antecedents of childhood and adolescence depression can be targeted both to prevent and intervene depression in this population.

Using a smartphone app to reduce cognitive vulnerability and mild depressive symptoms: Study protocol of an exploratory randomized controlled trial

Background

Depression is a major challenge worldwide, with significant increasing personal, economic, and societal costs. Although empirically supported treatments have been developed, they are not always available for patients in routine clinical care. Therefore, we need effective and widely accessible strategies to prevent the onset of the very first depressive symptoms. Mental health apps could prove a valuable solution for this desideratum. Although preliminary research has indicated that such apps can be useful in treating depression, no study has attempted to test their utility in preventing depressive symptoms. The aim of this exploratory study is to contrast the efficacy of a smartphone app in reducing cognitive vulnerability and mild depressive symptoms, as risk factors for the onset of depression, against a wait-list condition. More specifically, we aim to test an app designed to (1) decrease general cognitive vulnerability and (2) promote engagement in protective, adaptive activities, while (3) counteracting (through gamification and customization) the tendency of premature dropout from intervention.

Methods/design

Romanian-speaking adults (18 years and older) with access to a computer and the Internet and who own a smartphone are included in the study. Two parallel randomized clinical trials are conducted: in the first one, 50 participants free of depressive symptoms (i.e., who obtain scores ≤4 on the Patient Health Questionnaire, PHQ-9) will be included, while in the second one 50 participants with minimal depressive symptoms (i.e., who obtain PHQ-9 scores between 5 and 9) will be included. Participants undergoing therapy, presenting with substance abuse problems, psychotic symptoms, and organic brain disorders, or serious legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active intervention will autonomously use the smartphone app for 4 weeks, while the others will be given access to the app after 4 weeks from randomization. The primary outcomes are (1) cognitive vulnerability factors as defined within the cognitive behavioral therapy (CBT) paradigm (i.e., dysfunctional cognitions, irrational beliefs, and negative automatic thoughts) (for the first trial), and (2) level of depressive symptomatology (for the second trial). The app includes self-help materials and exercises based on CBT for depression, presented in a tailored manner and incorporating gamification elements aimed at boosting motivation to use the app.

Discussion

This study protocol is the first to capitalize on the ubiquity of smartphones to large-scale dissemination of CBT-based strategies aimed at preventing depression in non-clinical populations.

Trial registration

ClinicalTrials.gov: NCT02783118. Registered on 26 May 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1740-3) contains supplementary material, which is available to authorized users.

Childhood cognition and lifetime risk of major depressive disorder in extremely low birth weight and normal birth weight adults

In general population samples, better childhood cognitive functioning is associated with decreased risk of depression in adulthood. However, this link has not been examined in extremely low birth weight survivors (ELBW, <1000 g), a group known to have poorer cognition and greater depression risk. This study assessed associations between cognition at age 8 and lifetime risk of major depressive disorder in 84 ELBW survivors and 90 normal birth weight (NBW, ⩾2500 g) individuals up to 29-36 years of age. The Wechsler Intelligence Scale for Children, Revised (WISC-R), Raven's Coloured Progressive Matrices and the Token Test assessed general, fluid, and verbal intelligence, respectively, at 8 years of age. Lifetime major depressive disorder was assessed using the Mini International Neuropsychiatric Interview at age 29-36 years. Associations were examined using logistic regression adjusted for childhood socioeconomic status, educational attainment, age, sex, and marital status. Neither overall intelligence quotient (IQ) [WISC-R Full-Scale IQ, odds ratios (OR)=0.87, 95% confidence interval (CI)=0.43-1.77], fluid intelligence (WISC-R Performance IQ, OR=0.98, 95% CI=0.48-2.00), nor verbal intelligence (WISC-R Verbal IQ, OR=0.81, 95% CI=0.40-1.63) predicted lifetime major depression in ELBW survivors. However, every standard deviation increase in WISC-R Full-Scale IQ (OR=0.43, 95% CI=0.20-0.92) and Performance IQ (OR=0.46, 95% CI=0.21-0.97), and each one point increase on the Token Test (OR=0.80, 95% CI=0.67-0.94) at age 8 was associated with a reduced risk of lifetime depression in NBW participants. Higher childhood IQ, better fluid intelligence, and greater verbal comprehension in childhood predicted reduced depression risk in NBW adults. Our findings suggest that ELBW survivors may be less protected by superior cognition than NBW individuals.

Efficacy of a self-help manual in increasing resilience in carers of adults with depression in Thailand

Caring for a person with a mental illness can have adverse effects on caregivers; however, little is known about how best to help such caregivers. The aim of the present study was to examine the efficacy of a cognitive behaviour therapy-guided self-help manual in increasing resilience in caregivers of individuals with depression, in comparison to caregivers who receive routine support only. A randomized, controlled trial was conducted, following CONSORT guidelines, with 54 caregivers allocated to parallel intervention (self-help manual) (n = 27) or control (standard support) (n = 27) groups. Resilience was assessed at baseline, post-test (week 8), and follow up (week 12). Intention-to-treat analyses were undertaken. Repeated-measures ANOVA indicated a significant difference in resilience scores between the three time points, showing a large effect. Pairwise comparisons between intervention and control groups indicated resilience to be significantly different between baseline and post-test, and between baseline and follow up, but not between post-test and follow up. Overall, the intervention group showed a slightly greater increase in resilience over time than the control group; however, the time-group interaction was not significant. Guided self-help is helpful in improving caregivers' resilience and could be used as an adjunct to the limited support provided to carers by mental health nurses and other clinicians.

Vulnerability to Stress-Related Sleep Disturbance and Insomnia: Investigating the Link with Comorbid Depressive Symptoms

Greater sleep difficulty following a challenging event, or a vulnerability to stress-related sleep disturbance (i.e., sleep reactivity), is characteristic of insomnia. However, insomnia is rarely observed in isolation; rather it is frequently seen in combination with other problems, such as depression. Despite the link between depression and increased sensitivity to stress, relatively little is known about the role sleep reactivity has in explaining variability in depressive symptoms. Therefore, the current study examined whether sleep reactivity was associated with depressive symptoms, and whether this relationship was mediated by insomnia. We assessed sleep reactivity, insomnia, and depressive symptoms among 2250 young adults (1244 female; M_age = 23.1, SD_age = 2.97) from the Colorado Longitudinal Twin Study and Community Twin Study. Results indicated that greater sleep reactivity was significantly associated with elevated depressive symptoms, and that this link was partially mediated by insomnia. This is one of the first studies to demonstrate an independent association between sleep reactivity and depressive symptomatology. These findings suggest that a greater sensitivity to stress-related sleep disturbance may also be a predisposing factor to depression, and highlight the need for a better understanding of sleep reactivity, as it may represent a more global vulnerability construct.

Depression as a mediator of negative cognitive style and hopelessness in stress generation

Over the past 20 years, there has been considerable interest in the role of cognitive factors in the stress generation process. Generally, these studies find that depressed individuals, or individuals at cognitive risk for depression, are more likely to experience stressful life events that are in part influenced by their own characteristics and behaviours (i.e., negative dependent events). However, there is still much to be learnt about the mediators of these effects. For example, does the development of depression symptoms explain why individuals at cognitive risk for depression experience increased negative dependent events? Or, is it that increases in cognitive risk explain why depressed individuals experience increased negative dependent events? To explore these questions, a short-term prospective study was conducted with 209 college students who were given measures of depression, depressogenic risk factors (i.e., negative cognitive style and hopelessness), and negative dependent events at two time points 6 weeks apart. Support was found for three models: (1) depression symptoms mediated the relationship between negative cognitive style and negative dependent events; (2) depression symptoms mediated the relationship between hopelessness and negative dependent events; and (3) first hopelessness and then depression symptoms mediated the relationship between negative cognitive style and negative dependent events in a multiple-step model. In contrast, the reverse models were not confirmed, suggesting specificity in the direction of the mediational sequence.

Effects of parental alcoholism, sense of belonging, and resilience on depressive symptoms: a path model

This paper explored the relationships between parental alcoholism, sense of belonging, resilience, and depressive symptoms among Koreans in the U.S. Data from 206 Koreans (Mean age = 28.4 years; 59.8% females) living in a Midwestern state were collected in 2009, using a web-based survey, which included Children of Alcoholic Screening Test, Sense of Belonging Instrument, Connor-Davidson Resilience Scale, and Beck Depression Inventory-II. Path analysis results revealed sense of belonging as the most powerful, and resilience as the second important factor, resisting depressive symptoms associated with parental alcoholism. Implications for practice and research and study limitations are discussed. The study's limitations are noted.

Motion as motivation: using repetitive flexion movements to stimulate the approach system

Research suggests that having a healthy approach system is critical for adaptive emotional functioning. The goal of the current study (n=186 undergraduates) was to determine the efficacy of an easy-to-disseminate and cost-efficient strategy for stimulating this system. The experiment tested the effects of repeated flexion movements (rFM) on approach system activation as measured by both self-report (BAS scales) and behavior. The results showed that rFM increased approach system motivation in men but not women. Men who completed the rFM task reported significantly greater levels of fun-seeking motivation than men in the control task. Moreover, the rFM task led to changes in actual behavior. Men who completed the rFM task exhibited significantly greater persistence on a difficult laboratory task than men in the control task. In contrast, women who completed the rFM task reported significantly lower levels of fun seeking and tended to exhibit less persistence on a difficult laboratory task than women in the control task. These results provide support for embodied theories of emotion as well as additional evidence for a gender difference in approach-avoidance tendencies.

Predicting resilient adolescents and youths: validation of a screening test in Colombia

BACKGROUND

This article presents the validation of the Child and Youth Resilience Measure-58 (CYRM-58) in the Colombian context and in Spanish language.

METHODS

CYRM-58 has 58 questions and was developed by an international team of researchers coordinated by the Resilience Research Centre (Dalhousie University, Canada). Simplified CYRM Colombia is a test that uses 7 questions of CYRM-58; for its validation we tested reproducibility in 22 persons aged 14 to 23 years.

RESULTS

We validated content and internal consistency in 39 resilients, 43 youth with deviant behaviors, and 66 controls matched by age and sex. We estimated internal consistency by non-parametric factorial analysis, and we assessed content validity by means of the Mann-Whitney test, bootstrap regression and logistic regression. The reproducibility was found to be in the range of 75-86%. Correlation between measurements was 75%.

CONCLUSION

The best predictive model or Simplified CYRM Colombia was found to have seven questions (sensitivity = 96%, specificity = 76%, power = 80%).

The social ecology of resilience: addressing contextual and cultural ambiguity of a nascent construct

More than two decades after E. E. Werner and R. S. Smith (1982), N. Garmezy (1983), and M. Rutter (1987) published their research on protective mechanisms and processes that are most likely to foster resilience, ambiguity continues regarding how to define and operationalize positive development under adversity. This article argues that, because resilience occurs even when risk factors are plentiful, greater emphasis needs to be placed on the role social and physical ecologies play in positive developmental outcomes when individuals encounter significant amounts of stress. Four principles are presented as the basis for an ecological interpretation of the resilience construct: decentrality, complexity, atypicality, and cultural relativity. These 4 principles, and the research upon which they are based, inform a definition of resilience that emphasizes the environmental antecedents of positive growth. This framework can guide future theory development, research, and the design of interventions that promote well-being among populations who experience environments that inhibit resilience-promoting processes.

Resilience and mental health

The relationship between disease and good health has received relatively little attention in mental health. Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Though resilience is a widely-used concept, studies vary substantially in their definition, and measurement. Above all, there is no common underlying theoretical construct to this very heterogeneous research which makes the evaluation and comparison of findings extremely difficult. Furthermore, the varying multi-disciplinary approaches preclude meta-analysis, so that clarification of research in this area must proceed firstly by conceptual unification. We attempt to collate and classify the available research around a multi-level biopsychosocial model, theoretically and semiotically comparable to that used in describing the complex chain of events related to host resistance in infectious disease. Using this underlying construct we attempt to reorganize current knowledge around a unitary concept in order to clarify and indicate potential intervention points for increasing resilience and positive mental health.