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Tadi NF, Pillay K, Ejoke UP, Khumalo IP. Sex Differences in Depression and Anxiety Symptoms: Measurement Invariance, Prevalence, and Symptom Heterogeneity Among University Students in South Africa. Front Psychol 2022; 13:873292. [PMID: 35712197 PMCID: PMC9195165 DOI: 10.3389/fpsyg.2022.873292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022] Open
Abstract
Adequate measurement is an essential component of the assessment of mental health disorders and symptoms such as depression and anxiety. The present study investigated sex-specific differences in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This comprehensive cross-sectional design study pursued four objectives: measurement invariance of PHQ-9 and GAD-7 between male and female; depression and anxiety prevalence differences; cross-sex differences in the relationship between depression and anxiety; and a comparison of symptom heterogeneity. A sample of 1966 (male = 592; female = 1374; mean age = 21 years) students from South Africa completed the PHQ-9 and the GAD-7. Data analyses for measurement invariance, latent class analysis, inter-variable correlations and group comparisons were conducted in Mplus. The two-dimensional PHQ-9 achieved scalar invariance, while the GAD-7 yielded metric invariance. The somatic and non-somatic latent dimensions of depression were compared and showed no significant difference between male and female groups. The positive relationship between depression and anxiety was also not significantly different between the two groups. While the PHQ-9 symptoms formed three classes in the male group, and four classes in the female group, the GAD-7 had the same number of classes (three) and a similar pattern between the two groups. These findings hold implications for the measurement, assessment and understanding of symptom manifestation and distribution, as well as the treatment of depression and anxiety in South Africa.
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Affiliation(s)
- N. Florence Tadi
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Kaylene Pillay
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Ufuoma P. Ejoke
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Itumeleng P. Khumalo
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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Marchetti I, Pössel P. Cognitive Triad and Depressive Symptoms in Adolescence: Specificity and Overlap. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01323-w. [PMID: 35184227 DOI: 10.1007/s10578-022-01323-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/27/2022]
Abstract
Adolescence is a critical period for the development of depressive symptoms and the understanding of vulnerability factors that facilitate their onset is pivotal. In this study, we focused on Beck's cognitive triad, namely its three-fold structure, comprising views of the self, world, and future. Despite its crucial role in the cognitive theory of depression, the relationship between the cognitive triad and depressive symptoms in adolescence is still unclear. In our study, we adopted a meta-analytic commonality analysis approach, in order to clarify whether the three components of the triad overlap in accounting for depressive symptoms, or they show distinct profiles of association. By relying on six independent samples of early adolescents (age range = 13-14: n = 174, 66% female, n = 347, 41% female), mid adolescents (age range = 15-17: n = 304, 61% female; n = 92, 34% female), and late adolescents (age range = 18-21: n = 217, 84% female, n = 101, 56% female), we showed that the views of the self, world, and future substantially overlap in accounting for depressive symptoms, although specific areas of distinctiveness could be detected. Moreover, the association between the cognitive triad and depressive symptoms appeared to be a function of both the developmental phase and gender. Furthermore, the cognitive triad emerged as specifically related to symptoms related to negative mood, absence of positive mood, and negative appraisal of the past. These findings advance our understanding of cognitive vulnerability for depressive symptoms in adolescence.
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Affiliation(s)
- Igor Marchetti
- Psychology Unit, Department of Life Sciences, University of Trieste, Via Edoardo Weiss, 21, 34128, Trieste, Italy.
| | - Patrick Pössel
- Department of Counseling and Human Development, University of Louisville, Louisville, KY, USA
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Stress events and Changes in Dysfunctional Attitudes and Automatic Thoughts Following Recovery from Depression in Inpatient Psychotherapy: Mediation Analyses with Longitudinal Data. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background
Stressful event exposure, dysfunctional attitudes (DA), negative automatic thoughts (NAT), and declining positive automatic thoughts (PAT) have been associated with depressive relapse/recurrence. Few studies have investigated the course of these variables and their relevance for relapse/recurrence in remitted depression.
Methods
Following successful inpatient treatment, in 39 remitted depressive patients, stressful events, DA, NAT, PAT, and depressive relapse/recurrence were assessed five times during a 16-month follow-up. Data were analyzed with mixed effect models, and mediation effects were tested.
Results
Stressful events after discharge correlated with depressive relapse/recurrence. This association was mainly mediated by a stress-related decline of PAT within four months post discharge. Patients’ DA were relatively stable during the observation period and did not depend on stressful events, indicating DA as a risk trait for depressive relapse/recurrence. Mediation analyses revealed that independent of stress, DA were linked to depressive relapse/recurrence through more NAT.
Conclusion
Our findings suggest stressful events evoke relapse/recurrence in remitted depression through rapid deterioration of PAT after discharge from inpatient therapy. DA are expressed through NAT which additionally contribute to higher risk of depressive relapse/recurrence. Consequently, maintenance therapy requires techniques to promote the maintenance of PAT, and to effectively restructure DA and NAT.
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The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study. Res Child Adolesc Psychopathol 2020; 49:267-281. [PMID: 33294967 PMCID: PMC7826312 DOI: 10.1007/s10802-020-00733-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 01/04/2023]
Abstract
Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck’s cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.
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Abstract
AbstractThe Beijing Twin Study (BeTwiSt), which was established in 2006, is an ongoing study aiming to investigate the genetic and environmental etiology of adolescent psychopathology. Resting-state brain imaging datasets have been examined for same-sex twins, and other psychological traits and emotional and behavioral variables have been examined for all twins. Based on the registry, the main findings regarding the etiological mechanism underlying adolescent development, magnetic resonance imaging results, and genetic and environmental influences on other psychological traits have been published. This article summarizes the key findings in these three areas and discusses future plans for the BeTwiSt.
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Barreto IS, Teodoro MLM, Ohno PM, Froeseler MVG. Cognitive Vulnerability and Stress for Emotional and Behavioral Problems in Children and Adolescents: A Longitudinal Study. J Cogn Psychother 2018; 32:272-284. [PMID: 32746407 DOI: 10.1891/0889-8391.32.4.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study investigated Beck's cognitive diathesis-stress theory (1967, 1987) for the prediction of emotional and behavioral problems in childhood. The study included 218 participants aged 10 to 16 years (M = 12.38, SD = 1.16) who underwent two evaluations with an interval of 8.4 months between them. In the first evaluation, sample was divided according to the participants' cognitive vulnerability (vulnerable, moderate, resilient) and in the second, by their experience of stressful events in recent months (low risk, moderate risk, high risk). The groups were compared by variation in the intensity of the symptoms over time. Results showed that high-risk cognitively vulnerable children had increased externalizing symptoms and children with moderate and high cognitive vulnerability had increased internalizing symptoms at Time 2. These results suggest the importance of considering dysfunctional cognitions and the existence of a certain level of stressful events for the development of psychopathology in childhood.
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Integrating the Hopelessness Model and the Response Style Theory in an Adolescent Sample. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 47:695-706. [PMID: 30105612 DOI: 10.1007/s10802-018-0465-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Integrations of cognitive models of depression, specifically, the hopelessness model (Abramson et al. Psychological Bulletin, 96, 358-372, 1989) and the response style theory (Nolen-Hoecksema et al. Journal of Abnormal Psychology, 101, 405-422, 1992) have been suggested but no previous study has compared the integrations of these models with each other and the original models. Further, previous studies only tested the associations between composite scores of inferences, from the hopelessness model, and rumination (incl. brooding and reflection), from the response style theory. Thus, a 3-wave study using self-report instruments with 519 adolescents was conducted (mean ageWave 1 = 16.09 years; SD = 0.70; 62.7% female; 72.8% European American, 14.7% African-American, 5.4% Latino, 4.4% mixed race/ethnicity, 1.4% Asian/Pacific Islander, 0.8% Native American, and 0.6% identified as "other"). The school serves predominantly working to middle class families and almost one third of the students were eligible for free or reduced lunch programs. AMOS and RMediation were used to calculate and compare five different theory-driven models. The findings of the study provide support for an integrated model in which both brooding and reflection are influenced by individual inferences and interact with individual inferences while affecting depressive symptoms. In addition, reflection plays an unexpectedly important role in this integrated model. Age and cognitive development are discussed as possible explanations for this finding.
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Pössel P, Winkeljohn Black S. Can the Hopelessness Model of Depression and Response Style Theory Be Integrated? JOURNAL OF COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jcad.12130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Patrick Pössel
- Department of Counseling and Human Development; University of Louisville
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Rojas R, Ilg T, Geissner E, Hautzinger M. Auswirkungen von automatischen Gedanken und psychologischer Flexibilität auf die depressive Symptomatik und Rückfallwahrscheinlichkeit remittiert Depressiver. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000452920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Emotion Regulation Strategies in Depressive and Anxiety Symptoms in Youth: A Meta-Analytic Review. J Youth Adolesc 2016; 46:261-276. [DOI: 10.1007/s10964-016-0585-0] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
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Grierson AB, Hickie IB, Naismith SL, Scott J. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. Psychol Med 2016; 46:2467-2484. [PMID: 27352637 PMCID: PMC4988274 DOI: 10.1017/s0033291716001392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 01/04/2023]
Abstract
Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in individuals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only amplifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.
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Affiliation(s)
- A. B. Grierson
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - S. L. Naismith
- Charles Perkins Centre & Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - J. Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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