Interpersonal perception as a mediator of the depression–interpersonal difficulties link: A review

The unique role of adolescent internalizing and externalizing problems, and maternal-adolescent communication in their association with attachment in early adulthood

Attachment styles influence mental health and relationships through life. Few studies examine the adolescent factors associated with adult attachment styles. This paper examines the association between adolescent emotional and behavioral problems and maternal-adolescent communication with attachment style in early adulthood. Data from 3423 participants in a birth cohort study were examined. At 14-years, participants' mothers completed the Parent-Adolescent Communication Scale. Participants completed the Youth Self-Report at 14-years which measures internalizing and externalizing symptoms, and the Attachment Style Questionnaire (ASQ) at 21-years. The ASQ comprises five domains of internal working models of interpersonal relationships and attachment style: confidence (security), discomfort with closeness and relationships as secondary (avoidance), need for approval and preoccupation with relationships (anxiety). Associations were examined using general linear models. After adjustments, internalizing symptoms score was associated with all domains of attachment and externalizing symptoms score was associated with four domains of attachment insecurity, but not attachment security. Low openness in maternal-adolescent communication was most strongly associated with decreased confidence and high problem maternal-adolescent communication was associated with viewing relationships as secondary. Adolescents with emotional and behavioral problems and maternal-adolescent communication may benefit from attachment-based interventions to support the development of healthy relationships and attachments in young adulthood.

Breaking the vicious cycle: The interplay between loneliness, metabolic illness, and mental health

Loneliness, or perceived social isolation, is a leading predictor of all-cause mortality and is increasingly considered a public health epidemic afflicting significant portions of the general population. Chronic loneliness is itself associated with two of the most pressing public health epidemics currently facing the globe: the rise of mental illness and metabolic health disorders. Here, we highlight the epidemiological associations between loneliness and mental and metabolic health disorders and argue that loneliness contributes to the etiology of these conditions by acting as a chronic stressor that leads to neuroendocrine dysregulation and downstream immunometabolic consequences that manifest in disease. Specifically, we describe how loneliness can lead to overactivation of the hypothalamic-pituitary-adrenal axis and ultimately cause mitochondrial dysfunction, which is implicated in mental and metabolic disease. These conditions can, in turn, lead to further social isolation and propel a vicious cycle of chronic illness. Finally, we outline interventions and policy recommendations that can reduce loneliness at both the individual and community levels. Given its role in the etiology of the most prevalent chronic diseases of our time, focusing resources on alleviating loneliness is a vitally important and cost-effective public health strategy.

Hostility bias or sadness bias in excluded individuals: does anodal transcranial direct current stimulation of right VLPFC vs. left DLPFC have a mitigating effect?

Exclusion has multiple adverse effects on individual's well-being. It induces anger and hostile cognitions leading to aggressive behavior. The purpose of this study was to test whether exclusion would affect recognition of anger on ambivalent faces of the excluders. We hypothesized that exclusion would elicit more anger encoding (hostility bias) than inclusion, but this effect would be mitigated by anodal tDCS of right VLPFC or left DLPFC-regions engaged in negative affect regulation. Participants (N = 96) were recognizing emotions (anger, sadness, happiness) on ambiguous faces of individuals who-as they were told-liked them or not. Results showed that exclusion induced more sadness bias. tDCS to VLPFC decreased anger and increased sadness recognition on excluders' faces compared with includers' faces, expressing a mixture of these two emotions. Additionally, stimulation to VLPFC and DLPFC decreased latencies for faces expressing sadness (sad-angry and happy-sad) but increased for happy-angry faces. Stimulation to VLPFC also increased reaction time to excluders faces while stimulation of DLPFC decreased reaction latency to includers faces. Results were discussed with the reference to the form of exclusion, motivational mechanism affected by disliking but also to lateralization (valence vs. arousal theory) and cortical regions engaged in encoding sadness after a threat to belonging.

Characteristics of implicit schemas in patients with major depressive disorder

Background

Many psychotherapy theories emphasise the importance of self-schema and other-schema, but most previous studies focused on the explicit self-schema in major depressive disorder (MDD). However, the limited studies of implicit self-schema in MDD have shown inconsistencies in their findings. Furthermore, only a few studies have investigated the implicit other-schema, and the pathway illustrating how implicit schemas influence depression remains unclear.

Aims

The primary aim of our study was to explore the characteristics of implicit self-schema and other-schema in patients with MDD. We also examine the chain-mediating effect of attachment relationships and interpersonal trust.

Methods

The present study included 88 patients with MDD and 88 healthy controls (HCs). The Hamilton Depression Rating Scale-17, Experiences in Close Relationships Inventory—Revised Questionnaire, Trust Scale and the Extrinsic Affective Simon Task (EAST) were used to assess depressive symptoms, attachment relationships, interpersonal trust and implicit schemas, respectively. Paired sample t-test was used to compare the reaction time (RT) for positive and negative words within the two groups. Analysis of covariance was used to explore the difference between two groups from the perspective of implicit schemas and interpersonal patterns. The chain mediation model was verified by bootstrap.

Results

(1) For interpersonal patterns, patients with MDD scored significantly higher on attachment anxiety (F=82.150, p<0.001) and attachment avoidance (F=23.192, p<0.001) and scored significantly lower on the predictability (F=30.297, p<0.001), dependence (F=39.728, p<0.001) and faith (F=60.997, p<0.001) dimensions of interpersonal trust. (2) As for implicit schemas, no significant difference was found between the RT for positive self-words and negative self-words in patients with MDD (t=−1.056, p=0.294). However, the HC responded faster to positive self-words than negative self-words (t=−3.286, p=0.001). The RT for positive other-words and negative other-words were significantly different in both patients with MDD (t=2.943, p=0.004) and HCs (t=−2.482, p=0.015), with opposite directions. The EAST effect of other-schema in patients with MDD was significantly different from that in HCs (F=13.051, p<0.001). (3) For the total sample, the EAST effect of other-schema significantly correlated with attachment avoidance, interpersonal trust and depressive symptoms. Attachment avoidance and interpersonal trust were the chain mediators between the EAST effect of other-schema and depressive symptoms (95% CI: −0.090 to −0.008). However, no significant results were found for the EAST effect of other-schema when correlation and mediation analyses were performed for HCs and patients with MDD separately.

Conclusions

This study verified that patients with MDD have abnormal interpersonal patterns and negative implicit schemas. However, no mediating effect of attachment relationships and interpersonal trust was found.

Reduced attention toward faces, intentionality and blame ascription in violent offenders and community-based adults: Evidence from an eye-tracking study

People typically have a strong bias in attention toward faces to help them understand social interactions. Nonetheless some people, like incarcerated offenders and psychopaths, exhibit deficits in "face reading," which may impair their interpretations, especially in case of attribution allocation in harmful events. In these cases, the ascription of intentionality is key in understanding the allocation of blame and structuring social information processing. Consequently, in the current study, in addition to typically studied intentionality and blame ascription levels (subfactors of hostile attributions), we also propose a new indicator of hostile attributions: intentionality/blame isomorphism, indicating reduced differentiation between those two factors. Violent prison inmates (N = 63) and community-based adults without previous history of incarceration (N = 63) took part in an eye-tracking study. In line with our hypotheses, offenders exhibited reduced attention orienting to faces as well as greater intentionality/blame isomorphism. In the case of both groups, people looked longer at the faces of the harm doer compared with the harm receiver. Additionally, greater intentionality/blame isomorphism predicted reduced attention to faces; however, when group status was included in the model, it became the only significant predictor of the attention to faces. Future studies should examine the origins of these gaze and attribution patterns and investigate consequences related to social perception and interactions of people prone to violence.

Comparative study of emotion recognition and theory of mind between major depressive disorder and schizophrenia

BACKGROUND

Social cognition as a transdiagnostic construct between major depressive disorder (MDD) and schizophrenia (SCZ) is not well understood. This may be attributed to the variability of social cognitive measures indexing the same construct. This study aims to compare emotion recognition and theory of mind domains, known to be impaired in SCZ, between MDD and SCZ.

METHODS

Three groups of participants (N_Total = 150) were enrolled in this study: MDD (n = 51), SCZ (n = 50) and healthy controls (HC; n = 49). Emotion recognition was assessed on the Bell Lysaker Emotion Recognition Task (BLERT) and Penn Emotion Recognition Task (ER40); theory of mind was measured on The Awareness of Social Inference Test (TASIT). Mixed ANCOVAs were utilised to compare social cognitive performance across the groups.

RESULTS

SCZ performed poorer in all 3 social cognition tasks compared to both MDD and HC. No statistically significant difference in social cognitive performance was observed between MDD and HC.

CONCLUSIONS

This study serves as an effort towards employing the same standardised social cognitive measures for direct comparison of performance patterns across diagnostic groups. Future work is needed to extend this in larger samples of different illness severity and diagnostic categories.

Victims of Bullying: Emotion Recognition and Understanding

Introduction: Victims of bullying often show interpersonal problems, such as having less high-quality interpersonal relationships compared to non-involved individuals. Research suggests that interpersonal struggles are associated with diminished emotional intelligence and competence and can lead to mental health problems such as depression. Therefore, we examined emotion recognition abilities, empathic accuracy, and behavioral responses to emotions in bullying victims and non-involved individuals. Based on previous research, we expected victims to show diminished skills in all three domains. Methods: Adolescents (Mage=17years; 67% female; no "other" gender participants) with (N=24) and without (N=21) a self-reported history of bullying victimization in high school completed a Virtual Reality facial emotion recognition task (ERT-VR), an empathic accuracy task (EAT) using videos of people recounting real-life autobiographical events, and a computer task in which they indicated their likely behavioral responses to facial emotions. Results: The two groups only significantly differed in recognizing emotions when taking their depression symptoms into account. Across emotions, victims had lower recognition accuracy than non-involved individuals. When examining emotion-specific differences, victims showed lower accuracy for neutral faces which they mainly mistook for angry faces. Conclusion: In contrast to expectations, adolescents with a high-school history of bullying victimization mostly showed similar emotional intelligence and competence skills as non-involved individuals. Nonetheless, we found some subtle differences regarding emotion recognition. Victims misjudged neutral as angry faces. This suggests a hostile attribution bias which might help explain victims' interpersonal problems as well as their increased risk for mental health problems.

Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial

BACKGROUND

Maternal depression is known to be a serious problem with higher rates among poor and racial/ethnic minority mothers that can have numerous negative impacts on their children. These mothers have less access to effective care and may be wary of traditional mental health care because of the stigma. The purpose of this study was to test whether an adaptation of an Interpersonal Psychotherapy group for perinatal depression could be effective in reducing depressive symptoms of mothers whose children were enrolled in Head Start.

METHODS

Forty-nine mothers, randomized by site, were recruited into the intervention group, 70 into the control group. They were measured on depressive symptoms, parenting stress, parenting behavior, and parent child interaction at intake, at end of the group, and 6 months following.

RESULTS

The intervention group was lower in depressive symptoms at the end of treatment with a further decrease 6 months post intervention. There was no change in the control group. The intervention group also improved in parenting stress.

LIMITATIONS

The sample size for the intervention group was smaller than desired.

CONCLUSIONS

This study supports the effectiveness of this 12 session IPT group which was highly effective for a population of Head Start mothers. It is a strategy that can be adapted to other settings that serve low income mothers.

Deficiencies in Theory of Mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature

Deficiencies in Theory of Mind (ToM) are consistently found in individuals with schizophrenia (SZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the character of these deficits and their role in the pathogenesis of mental illness remains poorly understood. This systematic review synthesizes the available secondary literature pertaining to ToM functioning in individuals with MDD, BD, or SZ, and their respective spectrum disorders in order to delineate disorder or symptom specific patterns of ToM impairment. Literature suggests that ToM deficits increase in severity along the affective-psychotic spectrum, with mild deficits in patients with MDD, and severe deficits in patients with mania or psychosis. Furthermore, ToM deficits appear to be part of a broader developmental phenotype associated with SZ and BD, as suggested by findings of attenuated impairments in ToM in remitted patients with SZ or BD, unaffected first-degree relatives of patients, and clinical high-risk groups. Future psychiatric research on ToM should aim to disentangle relationships between ToM deficits and specific symptom dimensions transdiagnostically, and employ standardized, construct-specific ToM tasks.

Depressive symptoms are associated with social isolation in face-to-face interaction networks

Individuals with depressive symptoms are more likely to be isolated in their social networks, which can further increase their symptoms. Although social interactions are an important aspect of individuals' social lives, little is known about how depressive symptoms affect behavioral patterns in social interaction networks. This article analyzes the effect of depressive symptoms on social interactions in two empirical settings (N_total = 123, N_{dyadic relations} = 2,454) of students spending a weekend together in a remote camp house. We measured social interactions between participants with Radio Frequency Identification (RFID) nametags. Prior to the weekend, participants were surveyed on their depressive symptoms and friendship ties. Using state-of-the-art social network analysis methods, we test four preregistered hypotheses. Our results indicate that depressive symptoms are associated with (1) spending less time in social interaction, (2) spending time with similarly depressed others, (3) spending time in pair-wise interactions rather than group interactions but not with (4) spending relatively less time with friends. By "zooming in" on face-to-face social interaction networks, these findings offer new insights into the social consequences of depressive symptoms.

Patient Engagement Activities and Patient Experience: Are Patients With a History of Depression the Canary in the Coal Mine?

Little is known about the effectiveness of primary care practices' efforts to engage patients in their health and health care. We examine the association between patient engagement efforts and patients' experiences of care. We found no association between an unweighted count of patient engagement activities and patient experience. Compared with the bottom quartile of practices, however, the top quartile had better performance on patient experience domains of communication, front-office staff, and organizational access (out of nine domains). Furthermore, patients reporting a diagnosis of depression have higher ratings across five domains of patient experience when in practices with higher levels of patient engagement activities measured using an unweighted scale. Future research is needed to understand how the benefits of patient engagement activities can accrue to more patient subgroups. These promising results suggest that payers and policy makers should continue to support implementation and benchmarking of patient engagement efforts across practices.

Effect of maternal depression and anxiety on mother's perception of child and the protective role of social support

OBJECTIVE

The purpose of this study was to investigate the impact of postpartum depressive and anxiety symptoms on maternal perception of the infant and the protective role of social support.

BACKGROUND

Adverse effects of perinatal depression on mother-child interaction are well documented; however, the role of maternal perception has not been examined.

METHODS

We used the data of 431 women enrolled in a prospective study in a single maternity unit. Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), the State Trait Anxiety Inventory (STAI), and the mother's perception of infant with the Mother's Object Relation Scale (MORS). We used Multidimensional Scale of Perceived Social Support (MSPSS) in order to measure social support.

RESULTS

Depressive and anxiety symptoms were positively associated to less positive emotions and a more dominant attitude of child as perceived by mothers. This association was even more significant in the case of trait anxiety. Perceived social support has been found to be a protective factor which was able to reduce this tendency.

CONCLUSION

The findings have potential implications for our understanding of the impact of maternal depressive and anxiety symptoms on the developing mother-infant relationship.

It's Not Me, It's You: Self- and Partner-Schemas, Depressive Symptoms, and Relationship Quality

Depression is associated with a host of interpersonal difficulties, particularly within intimate relationships. Although a significant body of literature has supported the presence of a highly consolidated negative self-representation or self-schema, no studies have examined whether depression is also associated with a highly organized negative “partner-schema”, and whether this represents a risk factor for relationship distress. Given the high degree of similarity between cognitive representations of self and close others, it was predicted that depression would be associated with a partner-schema structure mirroring that of the self-schema: an organized cognitive structure characterized by tightly interconnected negative information, and loosely dispersed positive information. In a sample of 291 undergraduate students, results supported this hypothesis. The findings also revealed that partner-schema structure was associated with relationship quality and attributions about a partner's behaviors over and above self-schema structure. These findings have important implications for understanding the link between cognitive risk factors, relational dysfunction, and depressive symptoms.

Hostile interpretation bias in depression

BACKGROUND

Research suggests an important relationship between interpretation bias, hostility and Major Depressive Disorder (MDD). Extant literature has yet to examine hostile interpretation bias in clinically depressed samples; the current studies sought to fill this gap.

METHOD

Study 1 participants included undergraduates who met criteria for MDD (n=36) or no anxiety or mood diagnosis (n=35). Each participant completed a structured clinical interview along with measures of depression, hostile interpretation bias, and trait hostility. In Study 2, a sample of treatment-seeking individuals with elevated trait anger completed measures of depression, hostile interpretation bias, and trait anger.

RESULTS

Study 1 demonstrated that, relative to the non-depressed group, individuals with depression displayed greater hostile interpretation bias but comparable levels of trait hostility. In Study 2, greater hostile interpretation bias was associated with greater depressive symptoms, and this relationship was independent of co-occurring trait anger.

LIMITATIONS

The correlational nature of these studies precludes interpretation of causal relationships between constructs. Additionally, replication of these results should be sought in a larger, more diverse sample.

CONCLUSION

Overall, the findings suggest hostile interpretation bias may play a unique role in depression and could be a treatable feature of interpersonal mechanisms maintaining MDD.