Self-Efficacy and Depression

Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting

INTRODUCTION

Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda.

METHODS

The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD).

RESULTS

For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression.

LIMITATIONS

The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms.

CONCLUSION

Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.

The Research on Risk Factors for Adolescents' Mental Health

There is a growing tendency for mental health disorders to emerge during adolescence. These disorders impair emotional, cognitive, and behavioral functioning, such as unsatisfying peer relationships, disruptive behavior, and decreased academic performance. They also contribute to vulnerability in later adulthood which negatively influences life-long well-being. Thus, research into etiology is imperative to provide implications for prevention and intervention within family and school practices. It is suggested that the onset of psychological disorders, such as depression and anxiety, is closely related to stress levels and patterns of stress reaction. Therefore, considerable research has investigated the link between hereditary factors, economic status, dispositional vulnerability, social relationships, and stress levels. The current study examines existing evidence and identifies multifaceted risk factors for adolescents' mental problems across three layers, including individual traits and personality, family status and practices, as well as peer relationships, and school climate. It is also suggested that factors from these three perspectives interact and are closely interconnected, directly or indirectly contributing to adolescent psychopathology. The implications for future development of prevention and intervention programs, as well as therapy, are discussed.

Effects of a brief online emotion word learning task on negative emotion differentiation, emotional self-efficacy, and prospective distress: Preliminary findings

BACKGROUND

Disruptions in emotion processing are common across psychological disorders. Research suggests that emotion differentiation (ED; specificity in language used to characterize one's emotional experience) and emotional self-efficacy (ESE; perceived ability to understand and manage one's emotions) are important transdiagnostic factors associated with various psychological benefits. Whether ED and ESE can be improved in adults remains largely unclear.

METHODS

Using a longitudinal prospective design, we tested a brief online training targeting emotion word knowledge (vs. a control condition) to see if it improved negative ED (NED) and ESE in a college sample. Moreover, we tested if changes in NED or ESE mediated the effects of the training on levels of psychological distress one week and two-months post-intervention.

RESULTS

Findings provided partial support for our hypotheses. Individuals whose ESE increased post-intervention reported lower levels of distress two months later. Moreover, exploratory analyses revealed those who demonstrated greater training engagement experienced increases in NED that in turn predicted lower distress one-week post-intervention. However, there were no direct effects of intervention group on NED or ESE and distress.

CONCLUSIONS

These findings highlight the potential of a remotely-administered emotion-language intervention to influence key dimensions of emotion processing and suggest avenues for further refinement. Both NED and ESE may be malleable for some, and that enhancements in ESE may produce long-term psychological benefits.

A prospective longitudinal study of depression, perceived stress, and perceived control in resettled Syrian refugees' mental health and psychosocial adaptation

This prospective study examined the psychosocial adaptation of a community sample of newly resettled Syrian refugees in Canada (N = 235). Specifically, depressive symptoms, perceived stress, and perceived control were collected in Arabic at baseline and 1-year follow-up. Two theory-informed, cross-lagged panel models demonstrated that higher baseline depressive symptoms predicted lower perceived self-efficacy and lower perceived control at 1-year follow-up. Similarly, baseline depressive symptoms were concurrently correlated with higher perceived helplessness, lower perceived self-efficacy, and lower perceived control. Secondary regression analyses further demonstrated that baseline depressive symptoms predicted lower perceived social support and higher anxiety symptoms, though neither were assessed at baseline. Empirical results identify a potentially broad, precipitating, and persistent effect of depressive symptoms on Syrian refugees' psychosocial resources and adaptation post-migration, which is consistent with both the transactional model of stress and coping and the self-efficacy theory of depression, respectively. Clinically, the study results highlight the importance of early screening for depressive symptoms among refugee newcomers within a culturally and trauma-informed, integrated health setting. Furthermore, this study underscores the value and need for theoretically guided longitudinal studies to advance future research on refugee mental health and psychosocial adaptation.

Effectiveness of an Internet-Based Self-Guided Program to Treat Depression in a Sample of Brazilian Users: Randomized Controlled Trial

BACKGROUND

Depression is undertreated in Brazil. Deprexis is a self-guided internet-based program used to treat depressive symptoms based on empirically supported integrative and cognitive behavioral therapy. Evidence from a meta-analysis supports Deprexis' efficacy in German-speaking countries and the United States, but no study has been conducted using this program in countries with low literacy rates and large social disparities. Furthermore, few studies have investigated whether internet-based interventions ameliorate the psychological processes that might underlie depressive symptomatology, such as low perceived self-efficacy.

OBJECTIVE

The main objective of this study was to replicate in Brazil previously reported effects of Deprexis on depressive symptom reduction. Therefore, the main research question was whether Deprexis is effective in reducing depressive symptoms and the general psychological state in Brazilian users with moderate and severe depression in comparison with a control group that does not receive access to Deprexis. A secondary research question was whether the use of Deprexis affects perceptions of self-efficacy.

METHODS

We interviewed 312 participants recruited over the internet and randomized 189 participants with moderate to severe depression (according to the Patient Health Questionnaire-9 and a semistructured interview) to an intervention condition (treatment as usual plus immediate access to Deprexis for 90 days, n=94) or to a control condition (treatment as usual and delayed access to Deprexis, after 8 weeks, n=95).

RESULTS

Participants from the immediate access group logged in at Deprexis an average of 14.81 (SD 12.16) times. The intention-to-treat analysis using a linear mixed model showed that participants who received Deprexis improved significantly more than participants assigned to the delayed access control group on the primary depression self-assessment measure (Patient Health Questionnaire-9; Cohen d=0.80; P<.001) and secondary outcomes, such as general psychological state measure (Clinical Outcome in Routine Evaluation-Outcome Measurement; Cohen d=0.82; P<.001) and the perceived self-efficacy measure (Cohen d=0.63; P<.001). The intention-to-treat analyses showed that 21% (20/94) of the participants achieved remission compared with 7% (7/95) in the control group (P<.001). The deterioration rates were lower in the immediate access control group. The dropout rate was high, but no differences in demographic and clinical variables were found. Participants reported a medium to high level of satisfaction with Deprexis.

CONCLUSIONS

These results replicate previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months in depressed samples of Brazilian users. From a public health perspective, this is important information to expand the reach of internet-based interventions for those who really need them, especially in countries with less access to mental health care. This extends previous research by showing significant effects on perceived self-efficacy.

TRIAL REGISTRATION

Registro Brasileiro de Ensaios Clíncos (ReBec) RBR-6kk3bx UTN U1111-1212-8998; https://ensaiosclinicos.gov.br/rg/RBR-6kk3bx/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1590/1516-4446-2019-0582.

Psychological distress and bowel cancer screening participation

OBJECTIVE

To better understand barriers to participation in mail-out bowel cancer screening programs, two survey studies tested the relationship between psychological distress and self-reported bowel cancer screening.

METHODS

First, a nationally representative sample of Australians N = 5421 completed measures of bowel cancer screening and psychological distress (using the Kessler Psychological Distress Scale; K10). Second, N = 479 completed a survey measuring participation in the National Bowel Cancer Screening Program (NBCSP) and psychological distress using the Depression, Anxiety and Stress Scale. In both studies, logistic regressions were conducted to test relationships between psychological distress and self-reported screening participation.

RESULTS

Study one found that psychological distress had a significant quadratic effect on having ever screened for bowel cancer, where screening rates were similar for those with low, moderate, or high levels of distress, but were lower for those with very high levels of distress. In study two, depression scores had a negative linear relationship with NBCSP participation (higher depression levels were associated with lower screening participation), and anxiety had a quadratic effect whereby NBCSP participation rates were higher with increasing levels of anxiety except in the severe category, where participation was significantly lower.

CONCLUSIONS

Findings indicate that psychological distress has a complex relationship with screening, and those with extreme levels of distress consistently show lower participation rates. Special efforts to encourage screening may be required for those experiencing extreme psychological distress and mental health disorders.

Self-care and lifestyle interventions of complementary and integrative medicine during the COVID-19 pandemic-A cross-sectional study

Background

Complementary and Integrative Medicine (CIM), including self-care healthy life-style promotion strategies, is widely used in Germany. Aim of this study was to assess the use of self-care and lifestyle interventions as well as mental/emotional state experienced during the COVID-19 pandemic.

Methods

An exploratory cross-sectional online study was conducted with adults in Germany through an online survey. Custom-developed questions in respiratory disease-status (including COVID-19), CIM-based self-care/lifestyle interventions and dietary patterns, and mental/emotional state as well as parameters for wellbeing (World Health Organization Well-Being Index, WHO-5) and self-efficacy (General Self-Efficacy Short Scale, GSE-3) were assessed. Data was analyzed using frequency and parametric measures.

Results

The online survey was performed from January to March 2021 and included 1,138 participants (81.5% female; mean age: 49.2 ± 13.7 years; 54.9% holding a university degree) living in Germany, of which 62 had had a positive SARS-CoV-2 test, 4 an influenza infection and 375 participants other respiratory infections. The following individual health promotion strategies were reported: spending time in nature (90%; n = 1,024), physical activity (69.3%; n = 789), naturopathic remedies (63.1%; n = 718), plant-based diet (56.3%; n = 640), and Mind-Body interventions (54.7%; n = 623). No differences in strategies between individuals with respiratory diseases or the sample overall were found. Well-being had a mean value of 15.2 ± 5 (WHO-5) and self-efficacy 4.1 ± 0.6 (GSE-3). Nearly 8% reported a low mental/emotional state regarding the COVID-19 pandemic.

Conclusion

Self-care and lifestyle interventions during the COVID-19 pandemic were reported by participants who were predominantly female, middle-aged, and well-educated. Most participants showed an overall balanced mental/emotional state. Further studies should include a representative control group from the general population.

Clinical trial registration

clinicaltrials.gov, identifier NCT04653727.

Differences in central symptoms of anxiety and depression between college students with different academic performance: A network analysis

Objective

The prevalence of anxiety and depressive symptoms for Chinese college students are high. Academic pressure is one of the prominent risk factors of psychological well-beings for Chinese college students. The application of network analysis provides researchers a more comprehensive understanding of symptom-symptom interaction in mental disorders. This study aims to find out whether there is a difference in central symptoms between students with different academic performance.

Method

A total sample of 1,291 college students was included in our study. Anxiety and depressive symptoms were measured by PHQ-9 and GAD-7. Central symptoms were identified through centrality indices. Network stability was examined using the case-dropping method.

Results

For the poor academic group, the most central symptom is PHQ-2 (feeling depressed). The most central symptom of the good academic group is GAD-2 (uncontrolled worry). The least central symptom for both groups is PHQ-9 (suicidal thought). Network structure is statistically different between two groups, global strength is not statistically different between two groups.

Conclusion

The pertinent symptom is feeling depressed, followed by uncontrolled worry and poor appetite, and for the good academic group, the pertinent symptom is an uncontrolled worry, theoretical explanation and clinical implications is discussed.

The Within-Person Effect of Psychological Distress on Social Self-Efficacy: A Random Intercept Cross-Lagged Panel Model

This study investigated the temporal relationship between social self-efficacy and psychological distress during 3 years in middle to late adolescence. The sample comprised 1508 participants (60.7% female; baseline mean age = 16.33, SD = .62; 52.9% high perceived family wealth; 70.6% born in Norway). We used a random intercept cross-lagged panel model to investigate the concurrent and subsequent associations between the two constructs. The results indicated (1) small to moderate and negative associations between the trait-like components and within-person fluctuations of social self-efficacy and psychological distress, (2) positive and significant carry-over stability effects on both constructs across time, and (3) that psychological distress predicted subsequent social self-efficacy more consistently across four time points, than social self-efficacy predicted later psychological distress.

Entwicklung und psychometrische Überprüfung eines Kurzfragebogens zur Selbstwirksamkeitserwartung im Umgang mit psychisch belastenden Situationen (SWEP)

Ziel der Studie Entwicklung und psychometrische Überprüfung eines 6-Item-Instruments zur Erfassung von Selbstwirksamkeitserwartung, sich in psychisch belastenden Situationen Unterstützung suchen zu können (SWEP).

Methodik Entwicklung von Items, Ermittlung von Verteilungscharakteristika, Faktorenstruktur und interner Konsistenz der Skala anhand einer Paper-Pencil-Befragung (N=269) und einer Untersuchung einer Online-Intervention zur Suizidprävention (N=802). Bestimmung der Retest-Reliabilität und diskriminanten Validität zu Skalen, die suizidspezifisches Wissen und einen Aspekt von Suizidstigma erfassten.

Ergebnisse Die Hauptkomponentenanalyse ergab für die SWEP-Skala ein eindimensionales Konstrukt mit hoher interner Konsistenz (Cronbachs α=0,83 bzw. α=0,89). Es zeigten sich inhaltlich plausible Korrelationen zu anderen Konstrukten und erste Hinweise auf eine hohe Retest-Reliabilität.

Schlussfolgerung Die SWEP-Skala ist ein reliables, augenscheinlich valides, kurzes Instrument zur Erfassung von Selbstwirksamkeitserwartung, sich in psychisch belastenden Situationen Unterstützung suchen zu können.

Influences of depression, self-efficacy, and resource management on learning engagement in blended learning during COVID-19

This study examined the structural relationships among self-efficacy, resource management, and learning engagement during the COVID-19 era based on self-regulation theory. We also investigated whether the level of depression moderates the structural relationships among the factors by comparing a non-depressed group and a moderate-to-high depressed group. This study confirmed that resource management influenced learning engagement regardless of the depression level. Self-efficacy for learning also influenced resource management. The implications of this study are that self-efficacy is a prerequisite for resource management for learning. However, the direct influences of self-efficacy on learning engagement were observed only in the non-depressed group. Self-efficacy for learning indirectly influenced learning engagement through resource management in the depressed group. The self-regulated behaviors, such as resource management should be encouraged to enhance learning engagement of depressed students. Students' depression should also be monitored on a regular basis to help improve learning engagement during as well as after the COVID-19 era.

Explaining interpersonal differences in COVID-19 disease prevention behavior based on the health belief model and collective resilience theory: a cross-sectional study from Bolivia

Background

Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens’ adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen’s disease prevention behavior. These hypotheses deal with how citizens’ vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors.

Methods

From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling.

Results

Regarding a citizen’s vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior.

Conclusions

In the COVID-19 pandemic, a citizen’s low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13068-1.

Predictors of change in depressive symptoms in older and multimorbid patients: a longitudinal analysis of the multicare cohort

BACKGROUND

Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity.

METHODS

Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support.

RESULTS

Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy.

LIMITATIONS

The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression.

CONCLUSIONS

Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms.

Identifying Return to Work Self-Efficacy Trajectories in Employees with Mental Health Problems

Purpose Return to work self-efficacy (RTW-SE) is a strong predictor of return to work (RTW) in employees with mental health problems (MHPs). However, little is known about the development of RTW-SE during the RTW process. In this study, we aimed to identify RTW-SE trajectories in the year following sick leave in employees with MHPs and provided a description of the trajectories in terms of personal and work characteristics, and RTW status. Methods This multi-wave study included 111 employees with MHPs. RTW-SE was measured at baseline, and at 3, 6, and 12 months follow-up with the RTW-SE scale for employees with MHPs. Results Latent class growth analysis revealed six trajectories. In three trajectories employees had increasing RTW-SE scores, namely (class 1) low start, moderate increase, (class 3) moderate start, small increase and (class 5) moderate start, steep increase. The other trajectories were defined by (class 2) persistently high, (class 6) persistently low, and (class 4) decreasing RTW-SE scores over time. Employees across the various trajectories differed significantly with respect to RTW status, and personal and work characteristics measured at baseline, including age, gender, and type of MHP. Less favorable trajectories (class 4 and 6) were characterized by higher age, a higher prevalence of anxiety disorder and lower RTW rates. The most favorable trajectory (class 2) was characterized by a higher proportion of stress-related disorders and less major depression diagnoses. Conclusions Large heterogeneity exists in terms of RTW-SE trajectories in employees with MHPs and significant differences were found across the trajectories regarding personal and work characteristics, and RTW status. Insights into RTW-SE trajectories and their attributes are important to advance more effective and personalized RTW treatment for employees with MHPs.

Loneliness, depression, anxiety, and post-traumatic stress disorder among Chinese adults during COVID-19: A cross-sectional online survey

OBJECTIVES

This study aims to investigate the potential factors associated with mental health outcomes among Chinese adults during the Coronavirus disease 2019 (COVID-19) epidemic.

METHODS

This is an online cross-sectional survey conducted among Chinese adults in February 2020. Outcome measurements included the three-item UCLA Loneliness Scale (UCLA-3), two-item Patient Health Questionnaire (PHQ-2), two-item Generalized Anxiety Disorder Questionnaire (GAD-2), and two items from the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale. COVID-19 related factors, physical health, lifestyle, and self-efficacy were also measured. Univariable and multivariable logistic regressions were performed.

RESULTS

This study included 1456 participants (age: 33.8±10.5 years; female: 59.1%). The prevalence of depressive symptoms, anxiety symptoms, loneliness, and PTSD symptoms were 11.3%, 7.6%, 38.7%, and 33.9%, respectively. In multivariable analysis, loneliness was associated with being single, separated/divorced/widowed, low level of education, current location, medication, more somatic symptoms, lower self-efficacy, and going out frequently. Depression was associated with fear of infection, binge drinking, more somatic symptoms, lower self-efficacy, and longer screen time. Anxiety was associated with more somatic symptoms and lower self-efficacy. PTSD symptoms were associated with more somatic symptoms, lower self-efficacy, higher perceived risk of infection, fear of infection, and self-rated more negative influence due to the epidemic (p<0.05).

CONCLUSIONS

Mental health problems during the COVID-19 epidemic were associated with various biopsychosocial and COVID-19 related factors. Psychological interventions should be aware of these influencing factors and prioritize support for those people at higher risk.

Maternal Substance Abuse and the Mother-Child Relationship in Late Childhood

This study examines the relationship between maternal substance abuse and various aspects of the mother-child relationship in late childhood while accounting for mental health and comorbid substance abuse and mental health among a predominantly racial minority sample. Using 369 mother-child dyads from the Rochester Intergenerational Study (64% Black, 17% Hispanic, and 8% mixed race/ethnicity), multilevel generalized linear models examined the effects of a maternal substance abuse history, a history of clinical depression, and comorbid substance abuse and depression histories on both maternal and child reports of five aspects of the mother-child relationship (i.e. warmth, consistent discipline, maternal knowledge, involvement, and conflict).

RESULTS

A maternal substance abuse history alone was unrelated to each aspect of the mother-child relationship as perceived by the mother or child, with the exception of child perceptions of maternal knowledge of behavior. Alternatively, a history of depression or comorbid histories of substance abuse and depression was negatively related to warmth, consistent discipline, involvement, and conflict but only as perceived by the mother.

CONCLUSIONS

This study reinforces the need for integrated treatment programs for women with substance use problems, particularly programs that incorporate mental health and parenting components. Moreover, it highlights specific targets for intervention that can reduce subsequent maternal substance abuse and improve offspring outcomes. The divergence in observed effects across reporter also suggests that future research should use multiple reporters to examine the interpersonal consequences associated maternal substance abuse.

Investigating Care Dependency and Its Relation to Outcome (ICARE): Results From a Naturalistic Study of an Intensive Day Treatment Program for Depression

Background: This study explores the association of experienced dependency in psychotherapy as measured with the CDQ (Care Dependency Questionnaire) and treatment outcome in depression. Furthermore, the course of care dependency and differences in the CDQ scores depending on the received type of treatment, MCT (metacognitive therapy), or CBASP (cognitive behavioral analysis system of psychotherapy), were investigated. Methods: The study follows a prospective, parallel group observational design. Patients suffering from depression received an 8-week intensive day clinic program, which was either CBASP or MCT. The treatment decision was made by clinicians based on the presented symptomatology and with regard to the patients' preferences. The patients reported depressive symptoms with the QIDS-SR16 (Quick Inventory of Depressive Symptomatology) and levels of experienced care dependency with the German version of the CDQ on a weekly basis. Mixed-model analyses were run to account for the repeated-measures design. Results: One hundred patients were included in the analyses. Results indicate that higher levels of care dependency might predict a less favorable outcome of depressive symptomatology. Levels of care dependency as well as depressive symptoms decreased significantly over the course of treatment. There was no significant between-group difference in care dependency between the two treatment groups. Conclusion: The results suggest that care dependency might be associated with a worse treatment outcome in depressed patients. In general, care dependency seems to be a dynamic construct, as it is changing over time, while the levels of care dependency seem to be independent from the received type of treatment. Future research should continue investigating the mechanisms of care dependency in a randomized controlled design. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier: DRKS00023779.

Perfectionism, efficacy, and daily coping and affect in depression over 6 months

OBJECTIVE

This study examined how perfectionism and efficacy impacted the maintenance of daily coping and affect in depression over six months.

METHOD

Forty-six depressed patients (69.6% female, mean age = 41.11 years) completed measures of perfectionism dimensions (self-critical, personal standards), efficacy, and depressive severity at Time 1. Participants then completed daily diaries of stress appraisals, coping, and affect for 7 consecutive days at Time 1 and Time 2, 6 months later.

RESULTS

Perfectionism dimensions and efficacy were differentially correlated with appraisals, coping, and affect across Times 1 and 2. Behavioral disengagement tendencies mediated the relation between self-critical perfectionism and daily negative affect over 6 months, controlling for depressive severity. Efficacy was related to daily positive affect over 6 months through problem-focused coping tendencies.

CONCLUSIONS

Results highlight the importance of addressing perfectionism, efficacy, and daily coping tendencies to more effectively reduce distress and bolster resilience in people with depression.

Building the bond: Predictors of the alliance in neurorehabilitation

BACKGROUND

Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance, during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants' feelings towards their group members, were investigated, together with predictors of patient engagement.

METHODS

Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants' engagement.

RESULTS

Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction.

CONCLUSION

High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment.

Preference for free or forced choice in Sumatran orangutans (Pongo abelii)

Empirical investigations of humans, pigeons, rats, and monkeys have indicated that these species will select free over forced choice, even when faced with identical outcomes. However, the same has yet to be quantitatively confirmed in nonhuman great apes. This experiment is the first systematic investigation of preference for free or forced choice in great apes using a paradigm in which extraneous variables are highly controlled. Three orangutans were given a choice of one of two virtual routes, one that provided a choice and one that did not via a touchscreen computer program. Choice of either route was rewarded with the same type and quantity of food. Initial results indicated a preference for free choice across all three participants. However, in two control conditions, orangutans' preferences varied, suggesting a weaker tendency to exercise choice than species previously tested. We suggest further investigation of preference for free and forced choice in orangutans and other great apes through alternative experimental paradigms that focus on increasing the fidelity of free and forced choice options.

Factors associated with disease self-efficacy in individuals aging with a disability

Self-management of a disability consists of treatment adherence, obtaining information about the disease and treatment options, caring for oneself, participating in decisions, and maintaining social relationships and emotional balance. Understanding and measuring an individual's beliefs about their ability to successfully self-manage and live well with a disability allows researchers and clinicians to better target interventions aimed at increasing disability management self-efficacy (DMSE). The purpose of this study was to examine the associations between demographic and clinical indicators, and self-efficacy for DMSE in individuals with chronic physical conditions. Adults (N = 815) with muscular dystrophy, multiple sclerosis, spinal cord injury, or post-polio syndrome completed a self-report mailed survey assessing DMSE, perceived social support, depression symptoms, resilience, fatigue, pain interference, satisfaction with participation in social roles, physical function, and demographics. A cross-sectional regression model was used to examine the associations between the clinical and demographic factors, and DMSE. The model explained 67% of the variance in DMSE. Satisfaction with participation in social roles, resilience, pain interference, social support, and fatigue were statistically significant. Better social functioning, more resilience, and less pain and fatigue were most strongly associated with DMSE. Interventions aimed at increasing DMSE should include strategies for improving social participation.

Psychometric Validation of the Moorong Self-Efficacy Scale in People With Spinal Cord Injury

The main study objective was to further evaluate the factorial validity of the Moorong Self-Efficacy Scale (MSES) with 266 Canadians with spinal cord injuries (SCI). Exploratory factor analysis yielded three reliable factors (Interpersonal, Instrumental, and Participation Self-Efficacy) building on earlier studies that extracted two factors. The MSES appears to be a promising rehabilitation assessment tool for individuals with SCI.

Relationship of perceived stress with depression: complete mediation by perceived control and anxiety in Iran and the United States

This study sought to clarify the importance and cross-cultural relevance of associations between generalized perceived stress and depression. Also tested was the hypothesis that perceived stress would correlate more strongly with anxiety than with depression, whereas control would be more predictive of depression than of anxiety. Relationships between perceived stress, anxiety, depression, and perceived control were examined in samples of Iranian (n = 191) and American (n = 197) undergraduates. Correlations among these variables were generally similar across the two societies. Perceived stress did predict anxiety better than depression, but perceptions of control predicted depression significantly better than anxiety only in the United States. Best fitting structural equation models revealed that anxiety and perceived control completely accounted for the linkage between perceived stress and depression in both societies. An equally acceptable and more parsimonious model described perceived stress as a consequence rather than as an antecedent of anxiety and perceived control. Structural equation models were essentially identical across the two cultures except that internal control displayed a significant negative relationship with anxiety only in Iran. This result seemed to disconfirm any possible suggestion that a supposedly individualistic process like internal control could have no noteworthy role within a presumably more collectivistic Muslim society like Iran. Overall, these data documented the importance of anxiety and perceived control in explaining the perceived stress-depression relationship cross-culturally and therefore questioned the usefulness of perceived stress in predicting depression. Whether this understanding of the stress-depression relationship deserves general acceptance will require additional studies that measure the frequency of stressful life events and that utilize a longitudinal design.

Self-efficacy as a mediator between maternal depression and child hospitalizations in low-income urban families

The objective of this study is to examine the role of maternal self-efficacy as a potential mediator between maternal depression and child hospitalizations in low-income families. We analyzed data from 432 mother-child pairs who were part of the control-group for the Nurse-Family Partnership trial in Memphis, TN. Low-income urban, mostly minority women were interviewed 12 and 24 months after their first child's birth and their child's medical records were collected from birth to 24 months. We fit linear and ordered logistic regression models to test for mediation. We also tested non-linear relationships between the dependent variable (child hospitalization) and covariates (depressive symptoms and self-efficacy). Elevated depressive symptoms (OR: 1.70; 90% CI: 1.05, 2.74) and lower maternal self-efficacy (OR: 0.674; 90% CI: 0.469, 0.970) were each associated with increased child hospitalizations. When both maternal self-efficacy and depressive symptoms were included in a single model, the depressive symptoms coefficient decreased significantly (OR decreased by 0.13, P = 0.069), supporting the hypothesis that self-efficacy serves as a mediator. A non-linear, inverse-U shaped relationship between maternal self-efficacy and child hospitalizations was supported: lower compared to higher self-efficacy was associated with more child hospitalizations (P = 0.039), but very low self-efficacy was associated with fewer hospitalizations than low self-efficacy (P = 0.028). In this study, maternal self-efficacy appears to be a mediator between maternal depression and child hospitalizations. Further research is needed to determine if interventions specifically targeting self-efficacy in depressed mothers might decrease child hospitalizations.

The confidence to get going: the moderating effects of depressive symptoms on the self-efficacy-activity relationship among youth and adolescents

The purpose of this study was to examine whether the relationship between self-efficacy and physical activity was moderated by the presence of depressive symptoms in a sample of youth and adolescents. Participants (N = 688) from grades 7-12 completed measures of self-efficacy and depressive symptoms at baseline and self-report measures of physical activity 1 month later. Hierarchical regression analyses indicated a moderating effect of depressive symptoms on the self-efficacy-physical activity relationship, with this relationship being even more pronounced among those reporting depressive symptoms. These findings have important implications for the promotion of physical activity among youth and adolescents especially those suffering from depressive symptoms.

Relation of Depression and Affectivity to Career Decision Status and Self-Efficacy in College Students

Further investigations are necessary to explore the interface between personal-emotional and career-related factors. The authors examined links between participants' emotional life, including depression and positive/negative affect, and career decision status and average level of vocationally relevant self-efficacy in a sample of 388 university students. Participants who had made a career decision were significantly less depressed, as measured by the Center for Epidemiologic Studies Depression Scale, than those who were undecided about their career. Furthermore, the authors found no significant difference in the average level of positive affect or negative affect, as measured by the Positive and Negative Affect Schedule, across career choice status groups. Gender accounted for 8.4% of the variation in overall average level of self efficacy, as measured by the Kuder Skills Assessment—College and Adult Version, and positive affect significantly contributed incremental variance (12.7%). The importance of addressing depression and affectivity in vocational research and practice is discussed.

Physical and emotional predictors of depression after radical prostatectomy

Radical prostatectomy commonly results in urinary, sexual, and bowel dysfunction that bothers men and may lead to depressive symptomatology (hereafter depression) that occurs at a rate 4 times greater for men with prostate cancer than healthy counterparts. The purpose of this study was to assess depressive symptoms in men shortly after radical prostatectomy and to identify associated risk factors. Seventy-two men were interviewed 6 weeks after surgery. Measured were depression (Geriatric Depression Scale), self-efficacy (Stanford Inventory of Cancer Patient Adjustment), social support (Modified Inventory of Socially Supportive Behaviors), physical and emotional factors (UCLA Prostate Cancer Index), and social function (SF-36 subscale). Results indicate that men with high self-efficacy and less sexual bother were 45% and 55% less likely to have depressive symptoms, respectively. Findings from this study add to the limited amount of information on the complex relationship between prostate cancer treatment and depression in men.

Self-efficacy and overprotection are related to quality of life, psychological well-being and self-management in cardiac patients

This repeated-measures study explores how self-efficacy and overprotection relate to psychological well-being, health-related quality of life and self-management. Eighty-two cardiac patients, suffering from congestive heart failure (CHF) or myocardial infarction (MI), completed questionnaires at T1 and three months later. Perceived overprotection is associated with concurrent levels of anxiety and depression, and lowered quality of life. Self-efficacy is related to psychological well-being in both patient groups, but only associated with quality of life in CHF patients. In addition, self-efficacy predicts MI patients' self-management behaviours in the medium term. Findings have implications for cardiac rehabilitation, where attention may usefully be focused on enhancing self-efficacy and dealing with issues of support and overprotection by the partner.

EFFECTS OF SELF-EFFICACY AND SOCIAL SUPPORT ON THE MENTAL HEALTH CONDITIONS OF MUTUAL-AID ORGANIZATION MEMBERS

The present study examined the effects of self-efficacy and social support on the mental health of 65 members of a mutual-aid organization in Hong Kong. Participants had anxiety and depressive problems and had received cognitive-behavioral treatment before they joined the mutual-aid groups in the organization. A three-wave design was adopted, and participants filled in measures including the General Health Questionnaire, the State Anxiety Inventory, the Centre of Epidemiologic Studies Depression Scale, the General Self-efficacy Scale, and the Medical Outcomes Study Social Support Survey. Regression analyses showed that residualized self-efficacy was a strong predictor of the mental health variables. Effects of social support, both functional and structural, were mainly mediated by self-efficacy.