Toward an assessment of escape/avoidance coping in depression

The relationship between anxiety and depression in adolescent depression patients: The mediating effect of hope level and coping modes

Background

Adolescents diagnosed with depression are particularly susceptible to anxiety and depressive symptoms, this vulnerability often diminishes their future expectations and overall outlook on life. The objective of this research was to scrutinize the associated risk factors of adolescent depression and delineated the interplay between anxiety and depressive symptoms. Concurrently, it sought to ascertain the latent mediating effects of hope levels and coping strategies within this framework.

Methods

A mixed-methods research approach was employed. For the qualitative component, 18 adolescents with depression were interviewed following a semi-structured interview guide, with sessions audio-recorded. The data were subsequently transcribed and subjected to thematic content analysis. In the quantitative phase, a cross-sectional online survey was administered to 210 adolescents diagnosed with depression using Questionnaire Star, with data analysis performed using SPSS25.0 and AMOS 24.0.

Results

The qualitative analysis identified three major themes and nine categories as key risk factors influencing the onset of adolescent depression. Three major themes were generated: school factors, family factors, and other factors. Nine categories were generated: heavy academic load, strained peer, and teacher-student relationships; unstable family structures, internal familial conflicts, and high parental expectations; a strong sense of social isolation, insufficient sexual education, and prevalent suicidal ideation or attempts. A nurturing and supportive school environment significantly bolsters adolescents' sense of hope and coping abilities, while a warm and encouraging family setting effectively mitigates psychological stress. Conversely, heightened loneliness and the onset of suicidal ideation are frequently linked to diminished hope and the adoption of maladaptive coping strategies. Hence, to comprehensively understand the intricate interplay of these factors, this study concentrated on the levels of hope and coping mechanisms, investigating their potential mediating role in adolescent anxiety and depression. Quantitative analysis revealed a positive correlation between anxiety and depression (r = 0.767, p＜0.01). Additionally, it was found that hope levels and coping strategies mediated the relationship between anxiety and depressive symptoms (β = -0.24-0.84 = 0.20, p < 0.001; β = 0.19-0.51 = -0.10, p < 0.01), with the mediating influence of hope levels being more significant than that of coping strategies.

Conclusion

Enhancing hope levels and fostering positive coping strategies are instrumental in aiding adolescents with depression to alleviate their anxiety and depressive symptoms. Moreover, this study underscored the importance of focusing on adolescents' mental health and providing them with emotional support, thereby increasing their hope levels and encouraging the adoption of positive coping mechanisms to effectively address their challenges.

CBT for difficult-to-treat depression: self-regulation model

BACKGROUND

Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat.

AIM

The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT.

METHOD

The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components.

RESULTS

A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation.

CONCLUSIONS

A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going.

Working hard to avoid: Fixed-ratio response effort and maladaptive avoidance in humans

Maladaptive avoidance of safe stimuli is a defining feature of anxiety and related disorders. Avoidance may involve physical effort or the completion of a fixed series of responses to prevent occurrence of, or cues associated with, the aversive event. Understanding the role of response effort in the acquisition and extinction of avoidance may facilitate the development of new clinical treatments for maladaptive avoidance. Despite this, little is known about the impact of response effort on extinction-resistant avoidance in humans. Here, we describe findings from two laboratory-based treatment studies designed to investigate the impact of high and low response effort on the extinction (Experiment 1) and return (Experiment 2) of avoidance. Response effort was operationalised as completion of fixed-ratio (FR) reinforcement schedules for both danger and safety cues in a multi-cue avoidance paradigm with behavioural, self-report, and physiology measures. Completion of the FR response requirements cancelled upcoming shock presentations following danger cues and had no impact on the consequences that followed safety cues. Both experiments found persistence of high response-effort avoidance across danger and safety cues and sustained (Experiment 1) and reinstated (Experiment 2) levels of fear and threat expectancy. Skin conductance responses evoked by all cues were similar across experiments. The present findings and paradigm have implications for translational research on maladaptive anxious coping and treatment development.

Related factors to the coping style of patients with sudden sensorineural hearing loss

BACKGROUND

Coping style can affect the patient's physical and mental health management. Therefore this study aimed to identify factors related to the coping style of young and middle-aged sudden sensorineural hearing loss (SSNHL) patients to provide reference for clinical nursing practice.

METHODS

A cross-sectional study was conducted on young and middle-aged SSNHL patients hospitalized in the otolaryngology departments of four hospitals in Suzhou City, China. A paper-based self-administered questionnaire investigated the patient's coping style and related factors. Multiple linear stepwise regression analysed the effective related factors in patients' coping styles.

RESULTS

Among 872 patients, 866 completed the survey, with an average age of 37.27 y. Factors related to the coping style of these patients included gender, chronic diseases, history of trauma, social support and type D personality (p<0.05). Female patients adopt more negative coping styles than male patients. Patients with chronic diseases or a history of trauma had more positive coping styles. Higher social support scores were related to improvements in coping style. Patients with type D personality were more likely to adopt negative coping styles.

CONCLUSIONS

This study suggests that psychological assessment of patients, chronic diseases, history of trauma, social support and type D personality may benefit the understanding of these patients' coping styles and, as a consequence, may improve their stress management.

Word usage in spontaneous speech as a predictor of depressive symptoms among youth at high risk for mood disorders

BACKGROUND

We examined whether digital phenotyping of spontaneous speech, such as the use of specific word categories during speech samples, was associated with depressive symptoms in youth who were at familial and clinical risk for mood disorders.

METHODS

Participants (ages 13-19) had active mood symptoms, mood instability, and at least one parent with bipolar or major depressive disorder. During a randomized trial of family-focused therapy, participants were instructed to make weekly calls to a central voice server and leave speech samples in response to automated prompts. We coded youths' speech samples with the Linguistic Inquiry and Word Count system and used machine learning to identify the combination of speech features that were most closely associated with the course of depressive symptoms over 18 weeks.

RESULTS

A total of 253 speech samples were collected from 44 adolescents (mean age = 15.8 years; SD = 1.6) over 18 weeks. Speech containing affective processes, social processes, drives toward risk or reward, nonfluencies, and time orientation words were correlated with depressive symptoms at concurrent time periods (ps < 0.01). Machine learning analyses revealed that affective processes, nonfluencies, drives and risk words combined to most strongly predict changes in depressive symptoms over 18 weeks of treatment.

LIMITATIONS

Study results were limited by the small sample and the exclusion of paralinguistic or contextual variables in analyzing speech samples.

CONCLUSIONS

In youth at high risk for mood disorders, knowledge of speech patterns may inform prognoses during outpatient psychosocial treatment.

A bidirectional association between smartphone addiction and depression among college students: A cross-lagged panel model

Background

Smartphone addiction (SA) is associated with adverse consequences, especially for freshmen. Evidence indicates that SA is associated with depression, and it is necessary to conduct a longitudinal study to explore the association further.

Methods

SA (measured by the Smartphone Addiction Scale-Short Version) and depression (measured by the Zung's Self-Rating Depression Scale) among 1,186 freshmen were surveyed at baseline and a respective 12-month follow-up for each participant. The application of a cross-lagged panel model approach (CLPM) revealed an association between SA and depression after adjusting for demographic variables.

Results

The CLPM results showed a significant path from baseline SA to follow-up depression (β = 0.08, P < 0.001) and a significant path from baseline depression to follow-up SA (β = 0.08, P < 0.001). Compared with the overall cross-lagged model, the cross-lagged coefficient of the path from baseline SA to follow-up depression increased in the female group (β = 0.10, P = 0.015), and the cross-lagged coefficient of the path from baseline depression to follow-up SA also increased significantly (β = 0.15, P < 0.001). In contrast, the cross-lagged model in the male group showed no predictive effect between SA and depression (P > 0.05).

Conclusions

The current study showed a significant bidirectional association between smartphone addiction and depression among freshmen, but only in the female population.

No joy - why bother? Higher anhedonia relates to reduced pleasure from and motivation for threat avoidance

Anhedonia impairs various components of the pleasure cycle, including wanting, liking, and the learning of pleasure-related associations. While successfully controlling threats might be inherently pleasurable, it remains unclear whether anhedonia affects this form of pleasure as well. With aversive pictures as threats, we conducted an online study ( N = 200) to investigate the role of anhedonia during active avoidance learning process. Participants first learned cue-threat associations for different cues (threat vs. safety cues). In a subsequent avoidance learning phase, these cues signaled either avoidable, unavoidable, or no threat; participants could perform avoidance responses to prevent the upcoming threats during those cue presentations. Subjective relief pleasantness was measured after each threat omission. We found that higher trait anticipatory and consummatory anhedonia were both associated with lower relief pleasantness. Higher trait anticipatory anhedonia was also associated with fewer avoidance attempts. Since reduced threat-controlling behavior is reminiscent of a learned-helplessness state, the current results contribute to a better understanding of the connections between anhedonia and learned helplessness that have mostly been studied separately in the context of mood disturbance.

Quality of Life, Depressive Symptoms, and Personality Traits in Syrian Refugee Adolescents

PURPOSE

Refugee adolescents' quality of life (Qol) was not investigated during the Covid-19 pandemic which have a potential impact on refugee adolescents' Qol. In this study, it is planned to investigate refugee adolescents' Qol and its association with depression and quality of life.

METHODS

301 refugee adolescents aged between 14 and 18 who immigrated from Syria was included in the study. Personality Inventory for DSM-5 Brief Form (PID-5 BF), Beck Depression Scale, and Life Quality Scale was used as assessment tools. The data were tested using structural equation modeling.

RESULTS

Both depressive symptoms and personality traits are associated with low Qol. Also, depression mediated the relationship between personality disorder and Qol.

CONCLUSION

This is the first study that investigates Qol in Syrian refugee adolescents during the pandemic. This study draws attention to the importance of depressive symptoms and personality traits management for improvement of Qol in Syrian refugee adolescent population.

HIGHLIGHTS

• Depressive symptoms are associated with low Qol in refugee adolescents.• Personality traits are associated with low Qol in refugee adolescents.• Depressive symptoms have a mediator role between personality traits and Qol.

Larval Zebrafish as a Model for Mechanistic Discovery in Mental Health

Animal models are essential for the discovery of mechanisms and treatments for neuropsychiatric disorders. However, complex mental health disorders such as depression and anxiety are difficult to fully recapitulate in these models. Borrowing from the field of psychiatric genetics, we reiterate the framework of 'endophenotypes' - biological or behavioral markers with cellular, molecular or genetic underpinnings - to reduce complex disorders into measurable behaviors that can be compared across organisms. Zebrafish are popular disease models due to the conserved genetic, physiological and anatomical pathways between zebrafish and humans. Adult zebrafish, which display more sophisticated behaviors and cognition, have long been used to model psychiatric disorders. However, larvae (up to 1 month old) are more numerous and also optically transparent, and hence are particularly suited for high-throughput screening and brain-wide neural circuit imaging. A number of behavioral assays have been developed to quantify neuropsychiatric phenomena in larval zebrafish. Here, we will review these assays and the current knowledge regarding the underlying mechanisms of their behavioral readouts. We will also discuss the existing evidence linking larval zebrafish behavior to specific human behavioral traits and how the endophenotype framework can be applied. Importantly, many of the endophenotypes we review do not solely define a diseased state but could manifest as a spectrum across the general population. As such, we make the case for larval zebrafish as a promising model for extending our understanding of population mental health, and for identifying novel therapeutics and interventions with broad impact.

The Berlin Misophonia Questionnaire Revised (BMQ-R): Development and validation of a symptom-oriented diagnostical instrument for the measurement of misophonia

Misophonia is a clinical syndrome which is characterized by intense emotional and physical reactions to idiosyncratic sounds. However, its psychometric measurement is still in the early stages. This study describes the optimization of a self-report instrument, the Berlin Misophonia Questionnaire (BMQ), and addresses its strengths in comparison to existing psychometric measures. This new measure integrates contemporary empirical findings and is based on the latest criteria of misophonia. A cross-sectional online study was conducted using data of 952 affected as well as non-affected individuals. The final BMQ-R consists of 77 items in 21 scales, which were selected using a probabilistic item selection algorithm (Ant Colony Optimization). The results of confirmatory factor analyses, the assessment of reliability, and an extensive construct validation procedure supported the reliability and validity of the developed scales. One outstanding strength of the BMQ-R is its comprehensive measurement of misophonic emotional and physical responses. The instrument further allows for distinguishing between behavioral, cognitive, and emotional dysregulation; the measurement of clinical insight and significance; as well as discerning reactive and anticipating avoidance strategies. Our work offers several improvements to the measurement of misophonia by providing a reliable and valid multidimensional diagnostical instrument. In line with the scientific consensus on defining misophonia, the BMQ-R allows to formally recognize individuals with misophonia and so to compare findings of future studies. Undoubtedly, this measure fills a research gap, which we hope will facilitate the investigation of causes and treatment of misophonia.

Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses

BACKGROUND

Myriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD).

METHODS

In a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview - Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity.

RESULTS

FOAVE mediated the T1 MDD-T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16-21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement.

CONCLUSIONS

The use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.

Interactions Between Experience, Genotype and Sex in the Development of Individual Coping Strategies

Coping strategies, the first line of defense against adversities, develop through experience. There is consistent evidence that both genotype and sex contribute to the development of dysfunctional coping, leading to maladaptive outcomes of adverse experiences or to adaptive coping that fosters rapid recovery even from severe stress. However, how these factors interact to influence the development of individual coping strategies is just starting to be investigated. In the following review, we will consider evidence that experience, sex, and genotype influence the brain circuits and neurobiological processes involved in coping with adversities and discuss recent results pointing to the specific effects of the interaction between early experiences, genotype, and stress in the development of functional and dysfunctional coping styles.

Repetitive and Inflexible Active Coping and Addiction-like Neuroplasticity in Stressed Mice of a Helplessness-Resistant Inbred Strain

Dysfunctional coping styles are involved in the development, persistence, and relapse of psychiatric diseases. Passive coping with stress challenges (helplessness) is most commonly used in animal models of dysfunctional coping, although active coping strategies are associated with generalized anxiety disorder, social anxiety disorder, panic, and phobias as well as obsessive-compulsive and post-traumatic stress disorder. This paper analyzes the development of dysfunctional active coping strategies of mice of the helplessness–resistant DBA/2J (D2) inbred strain, submitted to temporary reduction in food availability in an uncontrollable and unavoidable condition. The results indicate that food-restricted D2 mice developed a stereotyped form of food anticipatory activity and dysfunctional reactive coping in novel aversive contexts and acquired inflexible and perseverant escape strategies in novel stressful situations. The evaluation of FosB/DeltaFosB immunostaining in different brain areas of food-restricted D2 mice revealed a pattern of expression typically associated with behavioral sensitization to addictive drugs and compulsivity. These results support the conclusion that an active coping style represents an endophenotype of mental disturbances characterized by perseverant and inflexible behavior.

Maladaptive blame-related action tendencies are associated with vulnerability to major depressive disorder

Biases towards self-blaming emotions, such as self-contempt/disgust, were previously associated with vulnerability to major depressive disorder (MDD). Self-blaming emotions are thought to prompt specific action tendencies (e.g. "feeling like hiding"), which are likely to be more important for psychosocial functioning than the emotions themselves. Systematic investigations, however, of these action tendencies in MDD are lacking. Here, we investigated the role of blame-related action tendencies for MDD vulnerability and their relationship with blame-related emotions. 76 participants with medication-free remitted MDD and 44 healthy control (HC) participants without a history of MDD completed the value-related moral sentiment task, which measured their blame-related emotions during hypothetical social interactions and a novel task to assess their blame-related action tendencies (feeling like hiding, apologising, creating a distance from oneself, attacking oneself, creating a distance from other, attacking other, no action). As predicted, the MDD group showed a maladaptive profile of action tendencies: a higher proneness to feeling like hiding and creating a distance from themselves compared with the HC group. In contrast, feeling like apologising was less common in the MDD than the HC group. Apologising for one's wrongdoing was associated with all self-blaming emotions including shame, guilt, self-contempt/disgust and self-indignation. Hiding was associated with both shame and guilt. Our study shows that MDD vulnerability was associated with specific maladaptive action tendencies which were independent of the type of emotion, thus unveiling novel cognitive markers and neurocognitive treatment targets.

Predicting University Adjustment from Coping-Styles, Self-Esteem, Self-Efficacy, and Personality: Findings from a Survey in a Sample of Italian Students

Starting university life requires that students learn to cope with several personal, academic, and social challenges. A wide array of variables affects how students adjust to university life. This study was aimed to investigate which factors among coping styles, self-esteem, self-efficacy, and personality traits (i.e., diligence, relational availability, mental flexibility, activity, and emotional stability) best predicted the levels of university adjustment in a sample of university freshmen (N = 204, 63% women). Data were collected using self-report instruments. Multiple regressions analyses were conducted to identify the most significant predictors of adjustment to college. Our findings reported that self-efficacy, task-, and emotion-oriented coping were the most significant predictors, together with relational availability and mental flexibility. These findings might improve the growing knowledge concerning university adjustment, supporting main previous research. The observed relationships between university adjustment and the measured variables suggest intriguing considerations about the importance for schools and universities of providing interventions for students that aim to develop and strengthen the investigated personality facets, reducing withdrawal, behavioral and/or mental disengagement, and promoting academic achievement and success.

Is the Association between Postpartum Depression and Early Maternal-Infant Relationships Contextually Determined by Avoidant Coping in the Mother?

This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother-baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23-42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother's self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother's self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother-infant relationship.

The Effects of Aversive Mood State on the Affective Anticipation and Perception: An Event-Related Potential Study

Deficits in the anticipation and experience of affective events represent a key risky factor for a variety of mental disorders, such as anxiety and depression. Here, we examined temporal dynamics underlying the modulations of the aversive mood state on neural responses of anticipating and perceiving affective pictures. Participants were asked to perform an affective cueing paradigm in both threat and safe contexts. In the task, a cue (S1) signaled the subsequent presentation of positive/negative event (e.g., happy or fearful faces) as an affective target stimulus (S2), and participants were instructed to indicate their subjective feelings in response to the target stimuli while electroencephalography (EEG) was recording. Our findings revealed that threat context compared with the safe context attenuated the contingent negative variation (CNV) responses to the cues of positive expressions, and decreased differential late positive potential (LPP) responses to the perception of negative and positive events. These findings suggest that aversive mood dampens the anticipation of positive events and inhibits the elaboration of negative events. The current findings do not only advance our understanding on the temporal characteristics of affective anticipation and experience but also have implications on the emotional deficits across various mental disorders characterized by chronic mood disturbances.

Contextualising video game engagement and addiction in mental health: the mediating roles of coping and social support

INTRODUCTION

A challenge in defining Internet Gaming Disorder (IGD) is discriminating pathological gameplay from an excessive, yet benign, involvement in video games. Although previous research has explored this theoretical distinction in the context of general computing activities, it merits consideration with regards to online gaming. Additionally, whilst comorbidities of addicted gaming and mental health outcomes have been robustly demonstrated, few studies have examined the role of mediating factors that may contextualise this relationship. As such, the present study aims to validate the distinction between addiction and engagement in online gaming, by considering the mediating roles of coping and social online and offline support in mental health.

METHOD

One hundred and thirty-five participants completed the Computer Engagement/Addiction Questionnaire (CEAS), Depression-Anxiety-Stress Scale (DASS-21), Brief Approach-Avoidance Coping Questionnaire (BACQ) and two versions of the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Correlational analyses showed a clear distinction between gaming addiction and engagement in the context of all of depression, stress and in particular anxiety (DAS) not found in previous studies. Multiple mediation analysis showed a significant mediating effect of coping, (specifically withdrawal/resignation coping) on the relationship between video game addiction and symptoms of DAS. Offline perceived social support was a significant partial mediator in the relationship between gaming addiction and depression, as compared to any kind of online social support. The results support the distinction of the addiction and engagement concepts in gaming. This study may inform future clinical classifications of IGD, with implications on how pathological gaming is treated.

Depression development: From lifestyle changes to motivational deficits

Until now, depression research has taken a surprisingly narrow approach to modelling the disease, mainly focusing on some form of psychomotor retardation within a mechanistic framework of depression etiology. However, depression has many symptoms and each is associated with a vast number of substrates. Thus, to deepen our insights, this SI ("Depression Symptoms") reviewed the behavioral and neurobiological sequelae of individual symptoms, specifically, psychomotor retardation, sadness, low motivation, fatigue, sleep/circadian disruption, weight/appetite changes, and cognitive affective biases. This manuscript aims to integrate the most central information provided by the individual reviews. As a result, a dynamic model of depression development is proposed, which views depression as a cumulative process, where different symptoms develop at different stages, referred to as early, intermediate, and advanced, that require treatment with different pharmaceutical agents, that is, selective serotonin reuptake inhibitors early on and dopamine-based antidepressants at the advanced stage. Furthermore, the model views hypothalamic disruption as the source of early symptoms and site of early intervention. Longitudinal animal models that are capable of modelling the different stages of depression, including transitions between the stages, may be helpful to uncover novel biomarkers and treatment approaches.