Implicit and explicit self-esteem in remitted depressed patients

Relationship of explicit/implicit self-esteem discrepancies, suicide ideation, and suicide risk in patients with major depressive disorder

The present study was conducted to explore the associations between explicit self-esteem (ESE), implicit self-esteem (ISE), ESE/ISE discrepancies, depression severity, suicidal ideation (SI), and suicide risk among patients with major depressive disorder (MDD). To this end, 36 MDD patients with SI, 35 MDD patients without SI, and 32 healthy controls were recruited. All participants were interviewed using the Mini International Neuropsychiatric Interview (MINI), and they also completed the Beck Depression Inventory (BDI). The Beck Scale for Suicide Ideation-Chinese Version (BSI-CV) and the Rosenberg Self-Esteem Scale (SES) were used for the analysis. Further, the Implicit Association Test (IAT) was conducted to assess participants' ISE. The study revealed significant differences in ESE among the three groups, F(2, 90) = 44.88, p < .001. In particular, the group of MDD patients with SI had the lowest score. The interaction between the size and direction of ESE/ISE discrepancy was associated with depression severity, β = -.50, p = .004, and SI, β = -.39, p = .045. Among the four types of self-esteem, individuals with diminished self-esteem had the highest SI score whereas individuals with low congruent self-esteem had the highest suicide risk score. Based on these findings, the study suggested that diminished self-esteem could help in the early detection of depression and SI. Low-congruent self-esteem may also be considered a screening factor for suicide risk.

The Neural Correlates of the Abnormal Implicit Self-Esteem in Major Depressive Disorder: An Event-Related Potential Study

Implicit self-esteem (ISE) has been considered a critical factor in the development and maintenance of major depressive disorder (MDD). Further investigating the event-related potential (ERP) characteristics underlying abnormal ISE in MDD would be helpful for understanding the neural mechanism of MDD. For this purpose, 32 MDD patients and 31 age- and sex-matched healthy controls (HCs) were enrolled in this study. The Rosenberg Self-Esteem Scale (RSES) was used to evaluate explicit self-esteem (ESE), and a self-esteem go/no-go association task (GNAT) was used to assess ISE. Electroencephalograms were synchronously recorded when performing the self-esteem GNAT. Behavioral data and ERP characteristics under different conditions were analyzed and compared within and across groups. The results showed that compared to HCs, MDD patients had significantly lower RSES scores and self-D scores of GNAT, which reflected lower levels of ESE and ISE, respectively. No significant correlation was found between RESE and self-D scores, and only RESE scores were significantly negatively correlated with the Hamilton Depression Rating Scale (HAMD) score. The averaged centroparietal go-P3 amplitude under the self-positive condition was significantly smaller in MDD than in HCs. Moreover, HCs had a significantly larger average centroparietal go-P3 amplitude in self-positive than in self-negative conditions, while this pattern was opposite in the MDD group. The neural activity patterns for other conditions were similar between MDD and HCs. Our results suggested that patients with MDD have a decreased level of both ESE and ISE, and ISE might be more independent of clinical symptoms. Decreased neural processing that implicitly associate self with positive conditions (and relatively increased implicit association between self and negative conditions) might be important neural correlates for abnormal ISE in MDD.

The Impact of Attachment on Depression in Married Seniors: Chain Mediating Effects of Self-Esteem and Rumination

In this study, we discuss the effects of attachment on depression and the mediating roles of self-esteem and rumination in Chinese seniors. We assessed 431 using the Experiences in Close Relationships Inventory, the Rosenberg Self-Esteem Scale, the Ruminative Responses Scale, and the Short Form of Center for Epidemiologic Studies Depression Scale. Both attachment anxiety and attachment avoidance significantly predicted depression in seniors. Attachment anxiety and attachment avoidance positively predicted rumination but negatively predicted self-esteem. Structural equation models showed that rumination and self-esteem fully mediated the effects of attachment anxiety and attachment avoidance on depression. The attachment of seniors is related to depression, and self-esteem and rumination have chain mediating effects between attachment and depression.

Brain responses of dysphoric and control participants during a self-esteem implicit association test

Previous studies have reported lowered implicit self-esteem at the behavioral level among depressed individuals. However, brain responses related to the lowered implicit self-esteem have not been investigated in people with depression. Here, event-related potentials were measured in 28 dysphoric participants (individuals with elevated amounts of depressive symptoms) and 30 control participants during performance of an implicit association task (IAT) suggested to reflect implicit self-esteem. Despite equivalent behavioral performance, differences in brain responses were observed between the dysphoric and the control groups in late positive component (LPC) within 400-1,000 ms poststimulus latency. For the dysphoric group, self-negativity mapping stimuli (me with negative word pairing and not-me with positive word pairing) induced significantly larger LPC amplitude as compared to self-positivity mapping stimuli (me with positive pairing and not-me with negative pairing), whereas the control group showed the opposite pattern. These results suggest a more efficient categorization toward implicit self-is-negative association, possibly reflecting lower implicit self-esteem among the dysphoric participants, in comparison to the controls. These results demonstrate the need for further investigation into the functional significance of LPC modulation during IAT and determination of whether LPC can be used as a neural marker of depressive-related implicit self-esteem.

Discrepant negative self-associations as a risk factor for depressive deterioration after outpatient psychotherapy

BACKGROUND AND OBJECTIVES

This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome.

METHODS

One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects.

RESULTS

We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up.

LIMITATIONS

The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment.

CONCLUSIONS

Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression.

Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study

BACKGROUND

There is a prevalence peak of depression in the perimenopause, with this reproductive phase being considered a window of vulnerability due to major biopsychosocial changes. Depression has been associated with physical and psychosocial impairment. Prior depression has been shown to be a risk factor for the development of several somatic and mental diseases. We assume that women with prior depression will exhibit increased burdensome symptoms in the perimenopause compared to women without prior depression.

METHODS

A total of 135 perimenopausal women aged 40-56 years participated in the longitudinal Swiss Perimenopause Study. For the purpose of this investigation, a cross-sectional design was chosen. A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression regarding their experience of the perimenopause. Findings were statistically adjusted for multiple testing.

RESULTS

Women with prior depression showed significantly more depressive symptoms (U = 1215.5, p < .01), more menopausal symptoms (U = 1395.0, p < .01), and more sleep disturbances (U = 1583.5, p < .05) than women without prior depression. Moreover, women with a history of depression reported lower subjective mental health (U = 1573.0, p <  05) and felt more isolated (U = 1524.0, p < .05) than those without prior depression.

LIMITATIONS

Self-report data may affect the results. Furthermore, due to the cross-sectional design, causality cannot be inferred.

CONCLUSIONS

Prior depression affects women's experience of the perimenopause. Women with prior depression exhibit significantly more negative health outcomes in the perimenopause than those without prior depression.

Implicit Social Cognition

In the last 20 years, research on implicit social cognition has established that social judgments and behavior are guided by attitudes and stereotypes of which the actor may lack awareness. Research using the methods of implicit social cognition has produced the concept of implicit bias, which has generated wide attention not only in social, clinical, and developmental psychology, but also in disciplines outside of psychology, including business, law, criminal justice, medicine, education, and political science. Although this rapidly growing body of research offers prospects of useful societal applications, the theory needed to confidently guide those applications remains insufficiently developed. This article describes the methods that have been developed, the findings that have been obtained, and the theoretical questions that remain to be answered.

The relationship between explicit self-esteem and subjective well-being: The moderating effect of implicit self-esteem

Explicit self-esteem (ESE) is an important factor influencing subject well-being (SWB). However, the relationship between ESE and SWB is not clear. Due to the complex nature of self-esteem, implicit self-esteem (ISE) might moderate the relationship between ESE and SWB. Furthermore, providing the consistency between ISE and ESE, the interacting effect of ISE and ESE would only be significant for the cognitive component of SWB rather than the emotional component. To examine these assumptions, the present study recruited a total of 134 undergraduate students and measured their ISE, ESE, and SWB using Implicit Association Test (IAT) and self-report measures. The results showed that (a) ESE, rather than ISE, was significantly correlated to SWB; and (b) the interaction between ISE and ESE could significantly predict the cognitive components of SWB rather than the emotional components. Those findings contribute to the further understanding of the relationship between self-esteem and SWB.

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive–compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.

Review of Abnormal Self-Knowledge in Major Depressive Disorder

Background: Major depressive disorder (MDD) is an affective disorder that is harmful to both physical and mental health. Abnormal self-knowledge, which refers to abnormal judgments about oneself, is a core symptom of depression. However, little research has summarized how and why patients with MDD differ from healthy individuals in terms of self-knowledge. Objective: To gain a better understanding of MDD, we reviewed previous studies that focused on the behavioral and neurological changes of self-knowledge in this illness. Main Findings: On the behavioral level, depressed individuals exhibited negative self-knowledge in an explicit way, while more heterogeneous patterns were reported in implicit results. On the neurological level, depressed individuals, as compared with non-depressed controls, showed abnormal self-referential processing in both early perception and higher cognitive processing phases during the Self-Referential Encoding Task. Furthermore, fMRI studies have reported aberrant activity in the medial prefrontal cortex area for negative self-related items in depression. These results revealed several behavioral features and brain mechanisms underlying abnormal self-knowledge in depression. Future Studies: The neural mechanism of implicit self-knowledge in MDD remains unclear. Future research should examine the importance of others' attitudes on the self-concept of individuals with MDD, and whether abnormal self-views may be modified through cognitive or pharmacological approaches. In addition, differences in abnormal self-knowledge due to genetic variation between depressed and non-depressed populations remain unconfirmed. Importantly, it remains unknown whether abnormal self-knowledge could be used as a specific marker to distinguish healthy individuals from those with MDD. Conclusion: This review extends our understanding of the relationship between self-knowledge and depression by indicating several abnormalities among individuals with MDD and those who are at risk for this illness.

Longitudinal investigation into implicit stigma of epilepsy among Japanese medical students before and after mass media coverage of car accidents associated with people with epilepsy

OBJECTIVE

Public attitudes and stigma toward epilepsy may limit patient motivation for treatment and participation in social activities. Stigma research requiring individuals to report personal beliefs is useful but is subject to social desirability bias. Self-reporting methods often do not capture implicit attitudes; therefore, in this study, implicit stigma was measured using the implicit association test (IAT), which is a word sorting task to minimize this bias. Recently, in Japan, several serious car accidents caused by people with epilepsy (PWE) resulted in pedestrian fatalities. Traffic accidents involving PWE have been reported extensively and repeatedly in the media since 2011. The present study aimed to examine differences in implicit stigma toward epilepsy among medical students in 2010, 2013, and 2016.

METHODS

We recruited 41 medical students in 2010, 44 medical students in 2013 and 42 medical students in 2016. We investigated the strength of conceptual associations between the words "Epilepsy" or "Hypertension", and "Safety" or "Danger" in the IAT.

RESULTS

The association between the words "Epilepsy" and "Danger" was stronger in 2013 compared with that in 2010; however, the association was weaker in 2016 compared with that in 2013. There was no significant difference between 2010 and 2016.

CONCLUSION

The change in IAT results between 2010 and 2013 might be due to the traffic accident involving PWE in Japan. However, the result in 2016 might indicate that the implicit attitudes toward epilepsy were improved to the same level as those in 2010.