Childhood and adult sexual abuse, rumination on sadness, and dysphoria

Childhood emotional abuse and depression among Chinese adolescent sample: A mediating and moderating dual role model of rumination and resilience

BACKGROUND

Childhood emotional abuse (CEA) has been identified as a distal risk factor for later depression in adolescents. However, the underlying psychological mechanisms between CEA and adolescent depression are still poorly understood.

OBJECTIVES

This study aimed to explore the roles of rumination and resilience played in the association between CEA and depression among Chinese adolescents.

PARTICIPANTS AND SETTING

The sample included 919 students (52.56 % boys) with an average age of 13.47 years from a central province in China.

METHODS

Participants completed multiple measurements of CEA, rumination, resilience, and depression. Multivariate path analysis was applied to examine the relations among these variables.

RESULTS

Results showed (a) CEA was significantly positively related to adolescent depression; (b) Rumination partially mediated the relationship between CEA and depression and moderated the relationship between resilience and depression; (c) Resilience partially mediated the relationship between CEA and depression and moderated the relationship between rumination and depression.

CONCLUSIONS

The results revealed that both rumination and resilience played not only mediating but also moderating roles in the relationship between CEA and depression among Chinese adolescent sample, suggesting that the indirect effects of CEA on depression via resilience and rumination are dependent on each other. Hence, these findings deepened the understanding of the psychological mechanisms between CEA and depression and had several practical implications.

Trait anxiety and depressive rumination mediate the effect of perceived childhood rearing on adulthood presenteeism

AIM

Productivity loss in the workplace due to physical or mental health problems, which is called presenteeism, leads to large financial losses. Personal and work environment factors, as well as physical and mental illnesses are associated with presenteeism, but the detailed underlying mechanism remains unclear. In this study, we analyzed the effects of perceived childhood rearing on the presenteeism of adult workers, and the mediating effects of trait anxiety and depressive rumination.

METHODS

In 2017 and 2018, a cross-sectional paper-based survey was conducted, and written consent from 447 adult workers was obtained. Demographic information and results from the Parental Bonding Instrument, trait anxiety of State-Trait Anxiety Inventory Form Y, Ruminative Responses Scale, and Work Limitations Questionnaire were surveyed. Multiple regression analyses and structural equation modeling were conducted.

RESULTS

The low perceived quality of rearing from parents in childhood, i.e., low care and high overprotection, indirectly worsened current presenteeism via trait anxiety and depressive rumination. Presenteeism was directly worsened by trait anxiety and depressive rumination, and the low perceived quality of rearing from parents directly affected trait anxiety and depressive rumination, and trait anxiety affected depressive rumination.

CONCLUSION

The results of this study clarified the long-term influences of the low perceived quality of rearing experienced in childhood on adulthood presenteeism via trait anxiety and depressive rumination. Therefore, assessing the quality of childhood rearing, trait anxiety, and depressive rumination of individuals may help to elucidate the causes of presenteeism in the workplace, and how to manage it effectively.

Mediating Effects of Trait Anxiety and State Anxiety on the Effects of Physical Activity on Depressive Symptoms

BACKGROUND

Previous studies have reported that physical activity can prevent the onset of depression and reduces anxiety. In the present study, the hypothesis that total physical activity time influences depressive symptoms via state and trait anxiety was tested by a path analysis.

METHODS

Self-administered questionnaires were used to survey 526 general adult volunteers from April 2017 to April 2018. Demographic information, physical activity, and state and trait anxiety were investigated.

RESULTS

The association between physical activity time and depressive symptoms was expressed as a U-shape curve. The results of the covariance structure analysis showed that differences from the optimal physical activity time (DOT) had direct positive effects on state and trait anxiety. DOT affected depressive symptoms only via trait anxiety, and this was a complete mediation model.

CONCLUSION

The present study suggests that an optimal physical activity time exists for depressive symptoms. The path model demonstrated an association between the three factors of optimal physical activity time, trait anxiety, and depressive symptoms, and the effect was fully mediated by trait anxiety.

Child abuse and automatic emotion regulation in children and adolescents

Child abuse is associated with elevated risk for psychopathology. The current study examined the role of automatic emotion regulation as a potential mechanism linking child abuse with internalizing psychopathology. A sample of 237 youth aged 8-16 years and their caregivers participated. Child abuse severity was assessed by self-report questionnaires, and automatic emotion regulation was assessed using an emotional Stroop task designed to measure adaptation to emotional conflict. A similar task without emotional stimuli was also administered to evaluate whether abuse was uniquely associated with emotion regulation, but not cognitive control applied in a nonemotional context. Internalizing psychopathology was assessed concurrently and at a 2-year longitudinal follow-up. Child abuse severity was associated with lower emotional conflict adaptation but was unrelated to cognitive control. Specifically, the severity of emotional and physical abuse, but not sexual abuse, were associated with lower emotional conflict adaptation. Emotional conflict adaptation was not associated with internalizing psychopathology prospectively. These findings suggest that childhood emotional and physical abuse, in particular, may influence automatic forms of emotion regulation. Future work exploring the socioemotional consequences of altered automatic emotion regulation among youth exposed to child abuse is clearly needed.

Self-compassion and Shame Among Rape Survivors

Women are at increased risk for post-traumatic stress disorder (PTSD) and depression associated with rape, and shame plays a vital role in the development and maintenance of PTSD and depression. Thus, there is a need to identify factors that may decrease shame among female survivors of adult rape. Self-compassion may be one such factor. The present study used path analysis in MPlus version 7.3 to examine the indirect effect of self-compassion on PTSD and depression via rape-related shame. We hypothesized that higher levels of self-compassion would be associated with lower levels of rape-related shame, which in turn would be associated with lower levels of PTSD and depression. College women (N = 305) who reported experiencing rape completed anonymous online surveys assessing rape, self-compassion, rape-related shame, PTSD, and depression. Consistent with our hypothesis, results indicated that self-compassion was negatively associated with assault-related shame, which in turn was positively associated with PTSD and depression. There was also a significant indirect effect of self-compassion on PTSD and depression via rape-related shame. Further, rape-related shame fully explained the relation between self-compassion and PTSD. Findings suggest that self-compassion may be an appropriate target to reduce rape-related shame and may subsequently facilitate reductions in PTSD and depression symptoms.

Sex and Urban–Rural Differences in the Relationship between Childhood Sexual Abuse and Mental Health among Chinese College Students

This study aimed to reveal sex and urban–rural differences in the association between childhood sexual abuse (CSA) and mental health among Chinese college students. The study used data from the “National College Student Survey on Sexual and Reproductive Health 2019”, a cross-sectional study conducted in all 31 provinces of mainland China. Weighted logistic regression analysis was conducted to determine the association between CSA (noncontact CSA, contact CSA, and penetrative CSA) and mental health (suicide attempts and mental disorders). Among 49,728 students, 39.42% of the male participants and 43.55% of the female participants had ever experienced CSA. According to the OR results of logistic regression analysis, compared to females, males in the contact CSA group (AOR: 3.49, 95% CI: 1.95–6.23) and the penetrative CSA group (AOR: 8.79, 95% CI: 3.15–24.52) had higher odds of suicide attempts. Participants from rural and suburban areas that were categorized in the penetrative CSA group were more likely to report suicide attempts (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban AOR: 4.86, 95% CI: 2.52–9.36) and mental disorders (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban: AOR: 4.86, 95% CI: 2.52–9.36). In conclusion, the findings revealed a high prevalence of CSA in both sexes and reported that males are more vulnerable to the adverse effects of CSA. In addition, we also found that undergraduates growing up in rural and suburban areas are more vulnerable to the adverse psychological effects of CSA. Policymakers should pay more attention to this vulnerable population and implement effective measures to alleviate mental trauma.

Understanding associations between rumination and inflammation: A scoping review

A growing body of evidence suggests that rumination, or focused attention on mental representations of negative events, may have physiological consequences that adversely affect long term health. We conducted a scoping review on quantitative studies of humans examining associations between rumination and inflammation, which included 13 studies representing 14 samples and 1,102 unique participants. The review included 8 biomarkers measured in plasma, serum and saliva (C reactive protein, and C-C motif chemokine 11, interleukin (IL)- 1β, IL-4, IL-6, IL-8, IL-10 and tumor necrosis factor alpha). More consistent findings of an association between greater rumination and increased inflammation were found in studies that used experimental designs and manipulated rumination. Emerging research suggests rumination may interact with other factors (e.g., socioeconomic status, anxiety) to predict inflammation. This review offers an up to date synthesis of the emerging research focused on rumination and inflammation. The relationship between inflammation and rumination may be contingent on how rumination is conceptualized and measured, as well as the measure of inflammation (i.e., at rest/ in response to stress).

Suicidal ideation among Chinese survivors of childhood sexual abuse: Associations with rumination and perceived social support

BACKGROUND

Although previous studies have shown that childhood sexual abuse (CSA) experiences might be related to suicidal ideation in later life, its associations with rumination and perceived social support (PSS) remain unclear.

OBJECTIVE

The present study aimed to expand prior findings among Chinese survivors of CSA to investigate rumination's effect on the association between CSA and suicidal ideation, and the potential moderating role of PSS in this relationship.

METHODS

The Childhood Sexual Abuse Questionnaire, the Ruminative Response Scale, the Multi-dimensional Scale of Perceived Social Support, and the Symptom Checklist were completed by 6834 college students (56.61% females).

RESULTS

In all, 1400 (20.76%) students reported experiences of CSA. The rate of CSA in males was higher than that in females (24.23% vs. 18.10%). Students with CSA experiences reported a higher level of suicidal ideation than those without such experiences. CSA and rumination were positively related to suicidal ideation, and PSS were negatively related to CSA, rumination and suicidal ideation. CSA predicted suicidal ideation both directly and indirectly through rumination. PSS moderated the effect of rumination on suicidal ideation.

CONCLUSIONS

This study provides evidence for the effects of rumination on the association between CSA and suicidal ideation, and the buffering role of PSS on the relationship between rumination and suicidal ideation in Chinese survivors with CSA experiences. These findings suggest that developing adaptive emotional regulation strategies and enhancing the level of PSS might contribute to the alleviation of negative influences from CSA.

Child maltreatment and cognitive vulnerabilities: Examining the link to posttraumatic stress symptoms

Research attempting to identify pathways from childhood maltreatment to adulthood posttraumatic stress symptoms (PTSS) implicates cognitive vulnerabilities that may increase risk for mental health concerns. The present study examined two cognitive vulnerabilities and their relation to PTSS amongst individuals with and without childhood maltreatment histories: attentional control and repetitive negative thinking (RNT). This research surveyed college students (N = 376) on constructs of interest. Results revealed that attentional control and RNT demonstrated significant indirect effects on PTSS (95% CI =.0003, .0336 and 95% CI =.0643, .1857, respectively). Findings suggest that childhood maltreatment severity was related to decreased attentional control and increased RNT, which were then both related to increased PTSS. Interventions for increasing attentional control and decreasing RNT should be implemented and evaluated for young adults with early adversity currently experiencing PTSS.

Social Support Is Related to the Use of Adaptive Emotional Regulation Strategies in Ecuadorian Adolescents in Foster Care

Adolescents in foster care are exposed to maltreatment and inadequate social support which can have lasting repercussions on their emotional development. The aim of this study was to examine the effect of social support on the use of emotional regulation strategies in Ecuadorian adolescents in foster care and non-foster peers. This study recruited 181 adolescents, 56 in foster care and 123 non-foster peers, from various locations in Quito, Ecuador. Participants completed the Cognitive Emotion Regulation Questionnaire (CERQ) and the Multidimensional Scale of Perceived Social Support (MSPSS). Using linear regression, we found that being in foster care was related to lower perceived social support. The non-foster care control group reported using more emotion regulation strategies, both adaptive and maladaptive (acceptance, rumination, refocusing to planning, and self-blaming), than the foster care group. Greater social support was associated with the use of more positive strategies (reappraisal, positive refocusing, and refocusing to planning) and less maladaptive strategies (catastrophizing). Youth in foster care have less social support than their non-foster peers. This puts them at risk, as social support has an important role in the use of healthy emotion regulation skills in adolescents.

Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review

BACKGROUND

It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'.

RESULTS

A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression.

CONCLUSION

Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.

Association between childhood adversities and psychopathology onset throughout the lifespan: Findings from a large metropolitan population

BACKGROUND

Childhood adversities (ECA) are deleterious experiences that can occur during individuals' development, which has been associated with several negative health outcomes.

AIM

Analyze the effect of ECA on the onset of DSM-IV disorders throughout life.

METHOD

The Composite International Diagnostic Interview (CIDI) was used in a stratified, multistage area probability sample of 5037 individuals aged 18 or more to assess the presence of childhood adversities, 20 psychiatric disorders and their ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Data are from the São Paulo Megacity Mental Health Survey, the Brazilian branch of the World Mental Health Survey Initiative.

FINDINGS

53.6% of the sample experienced at least one ECA, and parental death (16.1%) and physical abuse (16%) were the most reported occurrences. Parental mental illness (OR = 1.99 to 2.27) and family violence (OR = 1.55 to 1.99) were the adversities most consistently associated with psychopathology across all age groups, while economic adversities (OR = 2.71 to 3.30) and parent criminality (OR = 1.72 to 1.77) were associated with psychopathology in individuals whose onset of disorder occurred from age 13 years on. Parental mental disorders and economic adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined in multivariate models controlled for the clustering of adversities. Physical abuse was associated with externalizing disorders, while sexual abuse with internalizing disorders.

INTERPRETATION

Childhood adversities were consistently associated with mental disorders. Economic adversities and parent mental disorders were predictive of psychopathology even if controlled for type (additive) and type and number of adversities (interactive models). Parental mental disorder and family violence were the main predictors of psychopathology onset across all age groups. Parental mental disorder was the only adversity that predicted all classes of disorders investigated.

Rumination Mediates the Effects of Childhood Maltreatment and Trait Anxiety on Depression in Non-Clinical Adult Volunteers

BACKGROUND

Several psychological studies have shown that depressive rumination is associated with the onset and severity of depression. However, it is unclear how rumination interacts with other predisposing factors to cause depression. In this study, we hypothesized that rumination mediates the association between depression and two predisposing factors of depression, ie, childhood maltreatment and trait anxiety.

SUBJECTS AND METHODS

Between 2017 and 2018, 473 adult volunteers were surveyed using self-report questionnaires regarding the following: demographic information, rumination (Ruminative Responses Scale), trait anxiety (State-Trait Anxiety Inventory-Y), and the experience of childhood maltreatment (Child Abuse and Trauma Scale). The effects of these factors on depression (Patient Health Questionnaire-9) were analyzed by multiple regression and path analysis to analyze the mediating effects of rumination. This study was conducted with approval from the relevant ethics committee.

RESULTS

Multiple regression analysis using depression as a dependent variable demonstrated that trait anxiety, rumination, childhood maltreatment, and living alone were significantly associated with depression. Path analysis showed that childhood maltreatment had a positive effect on trait anxiety, rumination, and depression; trait anxiety had a positive effect on rumination and depression; and rumination had a positive effect on depression. Regarding indirect effects, the experience of childhood maltreatment increased rumination and depression indirectly via trait anxiety. Furthermore, the experience of childhood maltreatment increased depression indirectly via rumination, and trait anxiety significantly increased depression via rumination. In other words, rumination mediated the indirect effects of abusive experiences and trait anxiety on depression. This model accounted for 50% of the variance in depression in adult volunteers.

CONCLUSION

Our results suggest that rumination mediates the association between childhood maltreatment, trait anxiety, and depression in adulthood.

Factors Associated With Ruminative Thinking in Individuals With Gender Dysphoria

This study aimed to examine psychosocial factors and medical history as well as symptoms of depression, anxiety, and stress associated with ruminative thinking in transgender people with gender dysphoria (GD) before undergoing gender affirmation surgery (GAS). This study evaluated 189 participants with GD (111 trans women and 78 trans men) from a specialized service for GAS in southern Brazil. Semi-structured interviews were conducted, and participants were asked to complete self-report questionnaires. We recovered participants' sociodemographic and psychosocial data (e.g., history of sexual abuse, expulsion from home, and history of drug use) and data regarding their clinical history (e.g., medication, history of suicidal ideation and attempted suicide, and HIV status). Further, we implemented the Depression, Anxiety and Stress Scale (DASS-21) to examine participants' psychological state, as well as the Ruminative Response Scale (RRS) to assess ruminative thinking, which includes brooding and reflection. The predictor variables were those that exhibited a minimum level of significance of p ≤ 0.05 in multivariate linear regression. The ruminative thinking scores for trans women were higher than those of trans men (Brooding p = 0.014; Reflection p = 0.052).In the multivariate model, suicidal ideation, moderate depression, and severe/very severe anxiety were associated with both brooding and reflection. Feminine gender identity and stress symptoms moderated only brooding, while anxiety symptoms moderated only reflection. Our findings show that trans women had the highest ruminative thinking scores, and that depression, anxiety, stress, and suicidal ideation were associated with ruminative thinking in total sample. Psychological symptoms should be examined in the context of gender affirmation surgery to minimize the possibility of adverse mental health outcomes. Follow-up studies are required to measure ruminative thinking levels more accurately and to identify its predictors.

A Transdiagnostic Approach to Sexual Distress and Sexual Pleasure: A Preliminary Mediation Study with Repetitive Negative Thinking

Sexual distress is a core characteristic of sexual dysfunction; however, little is known about its correlates. In the current study, we aimed to contribute to the understanding of both sexual distress and its positive counterpart, sexual pleasure, by taking a transdiagnostic approach to sexual distress using two types of repetitive negative thinking: worry and rumination. Because sexual activity mostly occurs in a dyadic context, we also looked at the potential mediating effect of co-worry and co-rumination, and we used them as mediators. Our preliminary exploratory quantitative study used a cross-sectional design, with a sample of 206 partnered heterosexual people. We used path analysis with parallel mediation, with structural equation modelling being performed using lavaan designed for R environment. Overall, our results show that repetitive negative thinking is associated with both sexual distress and sexual pleasure, and that neither co-rumination nor co-worry mediates these associations. The exception is the indirect effect of rumination on sexual pleasure that is mediated by co-rumination. These results demonstrate that a transdiagnostic approach to sexual distress is a new field worth exploring, and they contribute to establishing the relevance of a cognitive approach to sexual dysfunction.

The developmental origins of ruminative response style: An integrative review

Rumination has been conceptualized as a stable, trait-level response style involving repetitive and passive focus on the symptoms of distress and the possible causes and consequences of those symptoms. This theoretical review examines developmental risk factors of ruminative response style, incorporating a developmental psychopathology perspective. A model integrating these developmental factors within a conceptual framework is proposed, wherein risk factors for distress (i.e., temperamental negative affectivity, stressful environments, parenting, and genetic vulnerability) lead to engagement in rumination. We propose that when rumination is well-practiced, it will consolidate into a trait-like response style, especially among adolescents who experience cognitive control deficits. Reciprocal relationships and moderators that may contribute to the formation of a ruminative response style are also included. To understand how these factors converge and influence the formation of ruminative response styles, we review patterns of stability and change in physical and cognitive development to demonstrate that individual differences in rumination may emerge and consolidate into enduring, trait-level response styles during early adolescence.

The Role of Metacognitions and Thinking Styles in the Negative Outcomes of Adolescents' Peer Victimization

Psychological mechanisms that may explain the link between peer victimization and its adverse outcomes are still understudied. The current study aimed to apply the Self-Regulatory Executive Function (S-REF) model of psychopathology (Wells & Matthews, 1994, 1996) to help explain this link in a sample of adolescents. A total of 1,169 Italian adolescents (47.7% females; M_age = 15.79, SD = 1.07) completed self-report measures of peer victimization, metacognitions, thinking styles (worry and rumination), and adjustment indices (somatic symptoms, anxiety, depression). The hypothesized model based on the S-REF model was tested through path analysis. Results confirmed that peer victimization was positively associated with both positive and negative metacognitions that, in turn, were linked to worry and rumination, which were associated with higher psychological and somatic problems. The strongest indirect links were found between peer victimization and anxiety via negative metacognitions and worry, and between victimization and depression via negative metacognitions and rumination. Overall, the results support to the application of the S-REF model to peer victimization experiences during adolescence. The clinical implications of these findings are discussed.

Difficulties with emotion regulation as a transdiagnostic mechanism linking child maltreatment with the emergence of psychopathology

Childhood maltreatment is associated with increased risk for most forms of psychopathology. We examine emotion dysregulation as a transdiagnostic mechanism linking maltreatment with general psychopathology. A sample of 262 children and adolescents participated; 162 (61.8%) experienced abuse or exposure to domestic violence. We assessed four emotion regulation processes (cognitive reappraisal, attention bias to threat, expressive suppression, and rumination) and emotional reactivity. Psychopathology symptoms were assessed concurrently and at a 2-year longitudinal follow-up. A general psychopathology factor (p factor), representing co-occurrence of psychopathology symptoms across multiple internalizing and externalizing domains, was estimated using confirmatory factor analysis. Maltreatment was associated with heightened emotional reactivity and greater use of expressive suppression and rumination. The association of maltreatment with attention bias varied across development, with maltreated children exhibiting a bias toward threat and adolescents a bias away from threat. Greater emotional reactivity and engagement in rumination mediated the longitudinal association between maltreatment and increased general psychopathology over time. Emotion dysregulation following childhood maltreatment occurs at multiple stages of the emotion generation process, in some cases varies across development, and serves as a transdiagnostic mechanism linking child maltreatment with general psychopathology.

[Cognitive therapy of depressive rumination]

Modern approaches to the therapy of depressive ruminations are reviewed. Depressive ruminations are thought to underlie and maintain depression. The authors describe different forms of ruminations and present the analysis of depressive ruminations and the role of childhood experience in their development as well as cognitive-behavioral techniques used for their correction.

Cumulative trauma, emotion reactivity and salivary cytokine levels following acute stress in healthy women

BACKGROUND AND OBJECTIVES

To better understand how trauma leads to poor health, this study examined whether cumulative trauma and emotion reactivity contribute to pro- (IL-1β) and anti-inflammatory (IL-10) salivary cytokine levels after stress.

DESIGN

Seventy-three women, screened to be physically and mentally healthy, completed an acute stress paradigm and measures of lifetime trauma exposure.

METHOD

Saliva was collected 10 min before (i.e., baseline) and 35 min after the onset of a 10-min stressor. State negative and positive emotion were measured at baseline and post-stress.

RESULTS

Most participants reported exposure to at least one trauma, with a mean of five. Cumulative trauma was associated with higher post-stress IL-1β and IL-1β/IL-10, but not with IL-10 or changes in emotion. Declines in positive emotion correlated with greater post-stress IL-1β.

CONCLUSIONS

These findings suggest that both cumulative trauma exposure and positive emotion have implications for salivary cytokine responses to acute stress. The inclusion of healthy women strengthens internal validity, and increases confidence that observed associations between trauma and salivary cytokine responses can be attributed to trauma, rather than to confounding health problems. This study adds to the growing literature examining how trauma may connect to cytokines, and ultimately, poor health.

The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models

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.

Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.

Future Directions in Childhood Adversity and Youth Psychopathology

Despite long-standing interest in the influence of adverse early experiences on mental health, systematic scientific inquiry into childhood adversity and developmental outcomes has emerged only recently. Existing research has amply demonstrated that exposure to childhood adversity is associated with elevated risk for multiple forms of youth psychopathology. In contrast, knowledge of developmental mechanisms linking childhood adversity to the onset of psychopathology-and whether those mechanisms are general or specific to particular kinds of adversity-remains cursory. Greater understanding of these pathways and identification of protective factors that buffer children from developmental disruptions following exposure to adversity is essential to guide the development of interventions to prevent the onset of psychopathology following adverse childhood experiences. This article provides recommendations for future research in this area. In particular, use of a consistent definition of childhood adversity, integration of studies of typical development with those focused on childhood adversity, and identification of distinct dimensions of environmental experience that differentially influence development are required to uncover mechanisms that explain how childhood adversity is associated with numerous psychopathology outcomes (i.e., multifinality) and identify moderators that shape divergent trajectories following adverse childhood experiences. A transdiagnostic model that highlights disruptions in emotional processing and poor executive functioning as key mechanisms linking childhood adversity with multiple forms of psychopathology is presented as a starting point in this endeavour. Distinguishing between general and specific mechanisms linking childhood adversity with psychopathology is needed to generate empirically informed interventions to prevent the long-term consequences of adverse early environments on children's development.

Reducing specificity of autobiographical memory in nonclinical participants: The role of rumination and schematic models

Two experiments are reported in which nondysphoric participants, not prone to excessive levels of rumination in everyday life, were asked to retrieve autobiographical memories using the Williams and Broadbent ( 1986 ) procedure (AMT). In the first experiment, two variants of a self-related category fluency task were interleaved among sets of autobiographical memory cues. In one variant (blocked) a normal model of analytic rumination was induced by grouping prompts on a single superordinate theme together. In the other (intermixed) prompts from several different themes were grouped together. It was predicted that the blocked variant would reduce the number of specific memories recollected and increase the number of categoric memories relative to the intermixed variant. This prediction was confirmed and provides the first demonstration of a bidirectional causal influence of analytic rumination on the balance between specific and categoric retrievals. A second experiment showed no alteration in this balance when the same fluency manipulation involved animal-related categories rather than self-related ones. The results support a two component model of autobiographical retrieval being driven in part by the extent to which an analytic mode of processing is adopted in the short term and in part by the level of differentiation in self-related schematic models.

Rumination in bipolar disorder: a systematic review

OBJECTIVE

To conduct a systematic review of the literature about the symptom of rumination in bipolar disorder (BD).

METHODS

We searched the MEDLINE (PubMed), ISI Web of Knowledge, PsycINFO, and SciELO databases using the descriptors "rumination" and "bipolar disorder" and no time limits. This strategy yielded 105 references, of which 74 were selected. Inclusion criteria were studies involving patients with BD and the use of at least one validated scale for the assessment of rumination. Review articles were excluded. Seventeen articles were ultimately analyzed and included in the review.

RESULTS

Rumination is present in all BD phases, is a stable interepisodic symptom, is associated with symptoms of depression, anxiety, and hypomania, and may occur in response to both positive and negative affect. There is no research on rumination and neurobiological findings in patients with BD.

CONCLUSIONS

Rumination seems to be independent of mood state, but shows close relationship with it. It is possible that rumination has a negative impact on cognitive and executive functions, particularly inhibitory control. Finally, rumination is an important symptom in both phases of BD, and, therefore, may be a useful target for further exploration as a dimensional domain and a transdiagnostic phenomenon in Research Domain Criteria (RDoC) projects.

The association between childhood maltreatment and emotion regulation: two different mechanisms contributing to depression?

BACKGROUND

Childhood maltreatment is an established distal risk factor for later emotional problems, although research suggests this relationship is mediated by proximal factors. However, it is unclear if different forms of childhood maltreatment are related to unique emotion regulation strategies. In this study, we examined whether avoidance and rumination, two emotion regulation strategies strongly associated with depression, were associated with different forms of childhood maltreatment, and whether these strategies, in turn, mediated the relationship between childhood maltreatment and current depressive symptoms.

METHODS

Participants were a community sample of pregnant, primarily low-income women, 55 of whom met criteria for Major Depressive Disorder (MDD) and 85 who had elevated levels of depressive symptoms but did not meet criteria for MDD.

RESULTS

Significant rates of childhood maltreatment were reported. Childhood emotional neglect was related to behavioural avoidance, and childhood emotional abuse was related to rumination. In path analyses, behavioural avoidance mediated the relationship between childhood emotional neglect and depression. Rumination was a partial mediator of childhood emotional abuse and depression.

LIMITATIONS

The data were correlational in nature, and replication with a larger sample will help validate the model.

DISCUSSION

In a clinical, community-based sample different types of childhood maltreatment are related to unique emotion regulation strategies. Implications for understanding the developmental antecedents of emotion regulation and depression are discussed.

Cognitive styles and clinical correlates of childhood abuse in bipolar disorder

OBJECTIVES

In a relatively small number of previous studies, childhood abuse has been found to be associated with more severe symptom course, earlier onset, greater comorbidity, and greater suicidality in those diagnosed with bipolar disorder. There have been no prior reports looking for any association between childhood abuse and cognitive style. This study aimed to examine the relationship between cognitive factors, such as response styles to depressed mood and dysfunctional attitudes, clinical features, and childhood physical and sexual abuse in this population.

METHODS

A total of 157 adult participants diagnosed with DSM-IV bipolar disorder I or II were assessed on clinical features of this condition and measures of childhood sexual and physical abuse. Participants also completed self-report questionnaires covering areas such as symptom measures of depression, anxiety and stress, dysfunctional attitudes, and response styles to depressed mood.

RESULTS

Seventy-four participants (37%) reported having experienced either sexual or physical abuse. Those who reported physical or sexual abuse were significantly more likely to report self-harm or suicidal behaviors and showed higher stress scores. Specifically, those who reported sexual abuse were more likely to have simple phobias, to have attempted suicide, and to have had more hospitalizations for depression. After controlling for current mood severity, there were no significant differences on the self-report cognitive style measures for those who reported childhood sexual or physical abuse compared to those who did not report abuse.

CONCLUSIONS

Cognitive styles were not found to be associated with childhood sexual or physical abuse in participants with bipolar disorder. Stress may be important to target in psychological interventions, whilst special attention should also be paid to those with a history of sexual abuse given the greater likelihood of suicide attempt.

Rumination mediates the association between cyber-victimization and depressive symptoms

The current study examined the 3-week prospective associations between cyber-victimization and both depressive symptoms and rumination. In addition, a mediation model was tested, wherein rumination mediated the association between cyber-victimization and depressive symptoms. Participants (N = 565 college-age young adults) completed online surveys at two time points 3 weeks apart. Results indicated that cyber-victimization was associated with increases in both depressive symptoms and rumination over time. Furthermore, results of the path analysis indicated that cyber-victimization was associated with increases in rumination over time, which were then associated with greater depressive symptoms, providing support for the proposed mediation effect for women, but not men. Findings extend previous correlational findings by demonstrating that cyber-victimization is associated with increases in symptomatology over time. Findings also suggest that the negative consequences of cyber-victimization extend beyond mental health problems to maladaptive emotion regulation. In fact, rumination may be a mechanism through which cyber-victimization influences mental health problems, at least for women. Mental health professionals are encouraged to assess cyber-victimization as part of standard victimization assessments and to consider targeting maladaptive emotion regulation in addition to mental health problems in clients who have experienced cyber-victimization.

Emotions and emotion regulation in survivors of childhood sexual abuse: the importance of "disgust" in traumatic stress and psychopathology

BACKGROUND

Childhood sexual abuse (CSA) has the potential to compromise socio-emotional development of the survivor resulting in increased vulnerability to difficulties regulating emotions. In turn, emotion regulation is thought to play a key part in a number of psychological disorders which CSA survivors are at increased risk of developing. A better understanding of the basic emotions experienced in this population and emotion regulation strategies will inform current treatment.

OBJECTIVE

This paper examines the relationships between type of emotions experienced, emotion regulation strategies, and psychological trauma symptoms in a sample of survivors of CSA.

METHOD

A consecutive case series of CSA survivors (n=109) completed the Basic Emotions Scale (BES)-Weekly, General, and Coping versions; the Regulation of Emotions Questionnaire; the Post-traumatic Stress Checklist-Civilian Version (PCL-C); and the Clinical Outcomes in Routine Evaluation Outcome Measure.

RESULTS

Significantly higher levels of disgust than other levels of emotions were reported on the weekly version of the BES. In addition, significantly higher levels of disgust and lower levels of happiness were reported on the BES-General subscale. Regression analyses revealed that sadness, fear, disgust, and external dysfunctional coping strategies predicted global post-traumatic stress disorder and re-experiencing symptomatology measured by the PCL-C. Global distress, as measured by CORE, was predicted by the emotions of sadness, disgust, and low happiness, as well as dysfunctional regulatory strategies. In addition, preliminary exploratory factor analyses supported the structure of all three versions of the BES, with disgust explaining the largest percentage of variance, followed by happiness.

CONCLUSIONS

The findings highlight the utility of profiling basic emotions in understanding the strong associations between emotional phenomena, particularly the emotion of disgust and psychopathology in CSA survivors.

Unwanted sexual experiences and cognitive appraisals that evoke mental contamination

BACKGROUND

Mental contamination is a psychological sense of contamination that involves an internal, emotional feeling of dirtiness that may be evoked by unwanted thoughts and images, such as sexual assaults.

AIMS

This study aimed to investigate which types of unwanted sexual experiences evoke the strongest mental contamination, and to test the hypothesis that cognitive appraisals of an unwanted sexual experience predict indices of mental contamination (i.e. feeling of dirtiness, urge to wash, internal negative emotions, and external negative emotions).

METHOD

148 female participants were asked to recall their most distressing unwanted sexual experiences. Indices of mental contamination and cognitive appraisals of the experience were then assessed.

RESULTS

Our findings indicated that individuals recalling experiences related to rape felt more intense feelings of dirtiness than individuals recalling other types of unwanted sexual experience, such as verbal sexual assault, visual sexual assault, and forcible touching/frottage. In addition, hierarchical regression analyses demonstrated that a cognitive appraisal of perceived violation predicted all of the indices of mental contamination after controlling anxiety, depression, and fear of contact contamination.

CONCLUSIONS

The present study demonstrated that an individual is at greatest risk of mental contamination if she has experienced rape/attempted rape, and if she makes a cognitive appraisal of violation regarding the incident.

A Heuristic for Developing Transdiagnostic Models of Psychopathology

Transdiagnostic models of psychopathology are increasingly prominent because they focus on fundamental processes underlying multiple disorders, help to explain comorbidity among disorders, and may lead to more effective assessment and treatment of disorders. Current transdiagnostic models, however, have difficulty simultaneously explaining the mechanisms by which a transdiagnostic risk factor leads to multiple disorders (i.e., multifinality) and why one individual with a particular transdiagnostic risk factor develops one set of symptoms while another with the same transdiagnostic risk factor develops another set of symptoms (i.e., divergent trajectories). In this article, we propose a heuristic for developing transdiagnostic models that can guide theorists in explicating how a transdiagnostic risk factor results in both multifinality and divergent trajectories. We also (a) describe different levels of transdiagnostic factors and their relative theoretical and clinical usefulness, (b) suggest the types of mechanisms by which factors at 1 level may be related to factors at other levels, and (c) suggest the types of moderating factors that may determine whether a transdiagnostic factor leads to certain specific disorders or symptoms and not others. We illustrate this heuristic using research on rumination, a process for which there is evidence it is a transdiagnostic risk factor.

Prevalence and consequences of adult sexual assault of men: review of empirical findings and state of the literature

Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Further, commonly-held myths about sexual assault suggest that men cannot be victims or that, if men are victims, they are relatively physically and emotionally unharmed by sexual assault. The goal of this paper was to systematically review the empirical literature on ASA among men to evaluate the veracity of these myths. This paper also sought to examine the methodological quality of the body of research in this area, identify limitations and gaps in the current literature, and suggest directions for future research. Eighty-seven relevant studies were identified through a systematic review of the literature. The reported prevalence of men's sexual aggression varied widely depending on the methods used and the population studied; some populations (e.g., veterans, prison inmates, and gay and bisexual men) reported higher rates of ASA than men in the general population. Few studies have systematically examined the consequences of male ASA; however, those that have suggest that ASA can have notable adverse physical and psychological consequences for some men.

How does sexual minority stigma "get under the skin"? A psychological mediation framework

Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol-use disorders.

Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process

A sample of 116 patients with unipolar mood disorders referred to a specialist research clinic were assessed to investigate (a) whether rumination is a transdiagnostic process that is related to co-morbid Axis I and II symptoms and diagnosis in depressed patients; (b) whether common findings in the depressive rumination literature could be replicated in a recurrent depressed sample. Consistent with the transdiagnostic hypothesis, rumination was positively associated with both depression and anxiety, brooding was related to co-morbid obsessive-compulsive disorder and generalized anxiety disorder, and rumination was associated with traits associated with borderline personality disorder, most notably self-report of unstable relationships and inconsistent sense of self. As predicted, rumination was equivalent in currently depressed and formerly depressed patients, suggesting that rumination is not simply dependent on mood state or clinical status. As predicted, the brooding subtype most strongly correlated with depressed and anxious symptoms, consistent with previous observations that brooding is the more maladaptive form of rumination. As predicted, rumination was associated with reports of sexual abuse. Inconsistent with previous findings, there was no gender difference in rumination.

Ruminative thought style and depressed mood

Recent research has suggested that the measure most commonly used to assess rumination, the Response Style Questionnaire (RSQ; L. D. Butler & S. Nolen-Hoeksema, 1994), may be heavily biased by depressive symptoms, thereby restricting the scope of research exploring this construct. This article offers a broader conceptualization of rumination, which includes positive, negative, and neutral thoughts as well as past and future-oriented thoughts. The first two studies describe the development and evaluation of the Ruminative Thought Style Questionnaire (RTS), a psychometrically sound measure of the general tendency to ruminate. Further, the scale is comprised of a single factor and shows high internal consistency, suggesting that rumination does encompasses the factors mentioned. The final study involved a longitudinal diary investigation of rumination and mood over time. Results suggest that the RTS assesses a related, but separate, construct than does the RSQ. RTS scores predicted future depressed mood beyond the variance accounted for by initial depressed mood whereas RSQ scores did not. The implications of these results and directions for future research are discussed.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.