Emotion regulation characteristics and cognitive vulnerabilities interact to predict depressive symptoms in individuals at risk for bipolar disorder: a prospective behavioural high-risk study

Orbital frontal cortex functional connectivity during gain anticipation linking the rumination and non-suicidal self-injury in late adolescence

OBJECTIVE

Non-suicidal self-injury (NSSI) is prevalent and especially among the adolescence population. It has been argued that abnormal brain activations in reward processing could be regarded as objective biomarkers in NSSI, but the evidence is mixed. This study aims to explore the reward processing mechanism of NSSI from the perspective of functional brain circuitry and investigate the role of a cognitive factor (rumination).

METHOD

Seventy-one 17-21 years old participants performed a monetary incentive delay (MID) task during functional magnetic resonance imaging scanning. Psychophysiological interaction (PPI) analysis was used to test the inner-group differences of brain functional connectivity. In addition, a mediation model was established with the mediation effect of rumination on the relationship between functional brain circuitry and NSSI.

RESULTS

PPI analysis suggested that functional connectivity of the orbital frontal cortex (OFC) (with precuneus, SMA) was significantly enhanced in NSSI in the gain > loss contrast, but not in the loss > gain contrast. Mediation analysis revealed that rumination mediated the relationship between NSSI and the OFC- precuneus functional connectivity in the gain > loss contrast.

CONCLUSION

Our research revealed that the abnormal OFC functional connectivity in gain (not loss) anticipation can be served as the sensitive biomarkers of NSSI. And there was a chain path for NSSI, that was from functional brain circuitry to negative cognition and then to problem behavior.

Autonomic complexity dynamically indexes affect regulation in everyday life

Affect regulation often is disrupted in depression. Understanding biomarkers of affect regulation in ecologically valid contexts is critical for identifying moments when interventions can be delivered to improve regulation and may have utility for identifying which individuals are vulnerable to psychopathology. Autonomic complexity, which includes linear and nonlinear indices of heart rate variability, has been proposed as a novel marker of neurovisceral integration. However, it is not clear how autonomic complexity tracks with regulation in everyday life, and whether low complexity serves as a marker of related psychopathology. To measure regulation phenotypes with diminished influence of current symptoms, 37 young adults with remitted major depressive disorder (rMDD) and 28 healthy comparisons (HCs) completed ambulatory assessments of autonomic complexity and affect regulation across one week in everyday life. Multilevel models indicated that in HCs, but not rMDD, autonomic complexity fluctuated in response to regulation cues, increasing in response to reappraisal and distraction and decreasing in response to negative affect. Higher complexity across the week predicted greater everyday regulation success, whereas greater variability of complexity predicted lower (and less variable) negative affect, rumination, and mind-wandering. Results suggest that ambulatory assessment of autonomic complexity can passively index dynamic aspects of real-world affect and regulation, and that dynamic physiological reactivity to regulation is restricted in rMDD. These results demonstrate how intensive sampling of dynamic, nonlinear regulatory processes can advance our understanding of potential mechanisms underlying psychopathology. Such measurements might inform how to test interventions to enhance neurovisceral complexity and affect regulation success in real time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Utilizing Random Effects Machine Learning Algorithms for Identifying Vulnerability to Depression

Background

Reliable prediction of clinical progression over time can improve the outcomes of depression. Little work has been done integrating various risk factors for depression, to determine the combinations of factors with the greatest utility for identifying which individuals are at the greatest risk.

Materials and methods

This study demonstrates that data-driven Machine Learning (ML) methods such as Random Effects/Expectation Maximization (RE-EM) trees and Mixed Effects Random Forest (MERF) can be applied to reliably identify variables that have the greatest utility for classifying subgroups at greatest risk for depression. 185 young adults completed measures of depression risk, including rumination, worry, negative cognitive styles, cognitive and coping flexibilities and negative life events, along with symptoms of depression. We trained RE-EM trees and MERF algorithms and compared them to traditional Linear Mixed Models (LMMs) predicting depressive symptoms prospectively and concurrently with cross-validation.

Results

Our results indicated that the RE-EM tree and MERF methods model complex interactions, identify subgroups of individuals and predict depression severity comparable to LMM. Further, machine learning models determined that brooding, negative life events, negative cognitive styles, and perceived control were the most relevant predictors of future depression levels.

Conclusion

Random effects machine learning models have the potential for high clinical utility and can be leveraged for interventions to reduce vulnerability to depression.

Difficulties in emotion regulation in bipolar disorder: A systematic review and meta-analysis

BACKGROUND

Bipolar disorder (BD) is a severe mental disorder characterized by mood swings and functional impairment. Although alterations in emotional regulation (ER) are a key feature, a comprehensive meta-analysis on abnormalities in emotion regulation in BD is still lacking.

METHODS

We performed a random-effects meta-analysis on studies comparing the ER measured with the Difficulties in Emotion Regulation Scale (DERS) in BD and healthy controls (HC) or borderline personality disorder (BPD) and calculated the standardized mean difference (SMD) of the total DERS score between those with BD and HC (primary outcome). Secondary outcomes were the SMD of the DERS subscales between BD and HC, as well as the SMD of the total score of DERS and the subscales between BD and BPD.

RESULTS

Twelve studies (858 BD, 540 BPD, 285 HC) were included. Compared to HC, BD showed significantly higher total DERS score (k=8, SMD 0.962, p<0.001) and subscale scores, including non-acceptance (k=6, SMD=0.85, p<0.001), goal-directed behavior (k=6, SMD=0.894, p<0.001), impulse control (k=6, SMD=1.08, p<0.001), strategies (k=6, SMD=1.25, p<0.001) and emotional clarity (k=6, SMD=0.694, p=0.001). Relative to BPD, BD presented significantly lower scores in all the DERS subscales. Sensitivity analyses confirmed the main analyses. The age of the participants and sample size moderated the primary outcome.

LIMITATIONS

The small number of studies and the cross-sectional design limit the generalizability of the results.

CONCLUSIONS

Our findings suggest that alterations of specific ER abilities are present in BD and their magnitude is smaller relative to BPD. Future therapeutic interventions should target ER strategies.

Altered frontal cortex functioning in emotion regulation and hopelessness in bipolar disorder

OBJECTIVES

Emotion regulation difficulties precipitate and exacerbate acute mood symptoms in individuals with bipolar disorder (BD), and contribute to suicidal behavior. However, few studies have examined regional brain responses in explicit emotion regulation during acute BD mood states, or hopelessness, a major suicide risk factor. We assessed brain responses during explicit emotion regulation, and their relationship with hopelessness, in acutely symptomatic and euthymic individuals with BD.

METHODS

Functional MRI data were obtained from individuals with BD who were either in acute negative (BD-A; n = 24) or euthymic (BD-E; n = 24) mood states, and from healthy volunteers (HV; n = 55), while participants performed a paradigm that instructed them to downregulate their responses to fearful (EmReg-Fear) and happy (EmReg-Happy) facial stimuli. Emotion regulation-related differences in brain responses during negative and euthymic BD states, as well as their associations with negative affective symptoms (hopelessness and depression), were examined.

RESULTS

Decreased responses were observed in ventral and dorsal frontal regions, including medial orbitofrontal (mOFC) and dorsal anterior cingulate cortices, during EmReg-Fear across symptomatic and euthymic states in participants with BD relative to HVs. The lowest responses were observed in the BD-A group. Across BD participants, negative associations were observed between mOFC responses and hopelessness, particularly due to loss of motivation. Differences were not significant during EmReg-Happy.

CONCLUSIONS

Lesser emotion regulation-related ventral and dorsal frontal engagement in BD could represent a trait abnormality that worsens during acute negative states. The reduced mOFC engagement in BD during explicit regulation of negative emotions may contribute to hopelessness particularly in the context of diminished motivation.

Irritability and mood symptoms in adolescent girls: Trait anxiety and emotion dysregulation as mediators

BACKGROUND

Irritability is a common symptom in youth that is thought to be predictive of mood disorders. Its effects on mood are likely to be age-dependent, with direct and indirect mediators. We assessed age-related effects and mediators of irritability in adolescent girls with subthreshold depressive and manic symptoms.

METHODS

We analysed the irritability item from the Mood Disorder Questionnaire in 3 cohorts of girls aged 12-18years (N=229); 12-13years (N=82); 14-15years (N=68); and 16-18years (N=79). They also completed mood, anxiety and emotion regulation questionnaires. MANOVA, correlations and bootstrapped mediation analyses were performed with SPSS®v25 and Hayes Processv3.5®.

RESULTS

Overall, irritable girls had higher depressive and manic symptoms, trait anxiety and emotion dysregulation than those who were not irritable. Significantly higher rates of irritability were observed in mid-adolescents (aged 14-15years; p = 0.001). Notably, irritability exerted effects on depressive symptoms via trait anxiety, non-acceptance of emotions and dysregulation in emotion clarity throughout adolescence. However, irritability directly exerted effects on manic symptoms in mid-adolescence but in older adolescents, their relationship was indirect via impulse control dysregulation.

LIMITATIONS

The cross-sectional design and non-clinical sample limit generalisability of our findings.

CONCLUSIONS

Irritability is involved in subthreshold depressive symptoms, via trait anxiety and perceptual emotion dysregulation. On the other hand, irritability is directly and indirectly associated with subthreshold manic symptoms via dysregulated impulse control depending on age. Therefore, screening for irritability, trait anxiety and emotion dysregulation throughout adolescence may facilitate the early detection of subthreshold depressive and manic symptoms, and the implementation of preventive strategies.

Emotional awareness, affective dysregulation, and bipolar spectrum psychopathology: A path analysis

Affective dysregulation is present in those with subsyndromal symptoms of hypomania and mania and prospectively predicts the development of bipolar spectrum disorders. A crucial, understudied area related to the experience and regulation of emotion in this population is emotional awareness - emotional clarity (Clarity) and attention to emotion (Attention). We examined whether scores on the Hypomanic Personality Scale (HPS) were associated with deficits in emotional awareness and whether these deficits were associated with heightened intensity and instability of negative (NA) and positive affect (PA). Young adults (n=233), oversampled for high HPS scores completed self-reports and 14 days of experience sampling assessing high and low arousal NA and PA. HPS scores were associated with low Clarity and unassociated with Attention. High HPS scores were associated with greater high and low arousal NA intensity and instability only for those at low and mean levels of Attention. In contrast, there was a significant indirect association between HPS scores and intensity of high and low arousal NA and PA, as well as instability of high arousal NA, through low Clarity. Results highlighted that individual differences exist in the extent to which facets of emotional awareness differentially link scores on the HPS to emotional outcomes.

Improving early recognition and intervention in people at increased risk for the development of bipolar disorder: study protocol of a prospective-longitudinal, naturalistic cohort study (Early-BipoLife)

Background

Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset and recurrent, severe episodes or a chronic course with poor psychosocial functioning in a proportion of patients. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD.

Methods

Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15–35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth and young adults consulting early recognition centres/facilities presenting ≥ 1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPIbipolar) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD.

Discussion

Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.

The temporal association between emotional clarity and depression symptoms in adolescents

INTRODUCTION

Low emotional clarity, that is, problems in understanding and identifying one's own emotions, is generally seen as related to depression. Most empirical studies on this topic focused on the link between low levels of emotional clarity predicting depression problems, fewer studies on depression symptoms predicting low emotional clarity. All studies were restricted to unidirectional associations. The present study evaluated the reciprocal associations between emotional clarity and depression symptoms. Additionally, we tested the role of rumination as a mediator of the links between depression symptoms and emotional clarity.

METHODS

For the main analyses, data of 230 Dutch participants (M_age = 13.40, SD = 2.24; 48% girls) over three time points of a 5-year longitudinal study were used. Depression symptoms, emotional clarity, and rumination were self-reported. Cross-lagged panel analysis was used to test a model of reciprocal associations between depression symptoms and emotional clarity against models of unidirectional associations. The role of rumination as mediator and sex as moderator in the links between depression symptoms and emotional clarity were evaluated in separate analyses on a subsample (n = 151).

RESULTS & CONCLUSIONS

A model of reciprocal associations where depression symptoms and low emotional clarity predict relatively high scores of the other over time offered a good representation of the data. Rumination mediated the link between depression symptoms predicting prospective emotional clarity for both sexes. These findings suggest a vicious cycle between depression symptoms and low emotional clarity. We discuss possible implications of these results for the treatment of depression in youth.

Longitudinal changes in the antecedent and early manifest course of bipolar disorder-A narrative review of prospective studies

OBJECTIVE

Prospective study designs ideally allow patients to be followed from the first manifestations of the illness or even from an at-risk stage. It can thus provide data on the predictive value of changes in clinical symptomatology, cognition or further biological markers to broaden our understanding of the etiopathology and symptomatic trajectory of bipolar disorders. The scope of this narrative review is to summarize evidence from prospectively collected data on psychopathological and other clinical and biological changes in the early developmental course of bipolar disorders.

METHODS

The narrative review was based on a literature search conducted in February 2016 within the PubMed library for prospective study data of persons in antecedent and early manifest stages of manifest bipolar disorder published within the last 15 years.

RESULTS

A total of 19 prospective studies were included. Regarding psychopathological features; personality, temperament and character traits as well as changes in sleep and circadian rhythm, the evidence suggests that risk factors for the development of bipolar disorder can already be described and should be studied further to understand their interaction, mediation with other factors and timing in the developmental process of bipolar disorder. Apart from the positive family history, childhood anxiety, sleep problems, subthreshold (hypo)manic symptoms and certain character traits/emotionality should be identified and monitored already in clinical practice as their presence likely increases risk of bipolar disorder. Up to date no substantiated evidence was found from prospective studies addressing cognitive features, life events, immunological parameters and morphological central nervous system changes as potential risk factors for bipolar disorder.

CONCLUSION

For an improved understanding of episodic disorders, longitudinal data collection is essential. Since the etiology of bipolar disorders is complex, a number of potential risk factors have been proposed. Prospective studies addressing this spectrum and resilience factors are critical and will be best conducted within multi-site research networks or initiatives.

Pubertal Development, Emotion Regulatory Styles, and the Emergence of Sex Differences in Internalizing Disorders and Symptoms in Adolescence

Adolescence marks the emergence of sex differences in internalizing symptoms and disorders, with girls at increased risk for depression and anxiety during the pubertal transition. However, the mechanisms through which puberty confers risk for internalizing psychopathology for girls, but not boys, remain unclear. We examined two pubertal indicators (pubertal status and timing) as predictors of the development of emotion regulation styles (rumination and emotional clarity) and depressive and anxiety symptoms and disorders in a three-wave study of 314 adolescents. Path analyses indicated that early pubertal timing, but not pubertal status, predicted increased rumination, but not decreased emotional clarity, in adolescent girls, but not boys. Additionally, rumination mediated the association between early pubertal timing and increased depressive, but not anxiety, symptoms and disorder onset among adolescent girls. These findings suggest that the sex difference in depression may result partly from early maturing girls' greater tendency to develop ruminative styles than boys.

The Relationship Between Family Functioning and Adolescent Depressive Symptoms: The Role of Emotional Clarity

Emotion regulation has been implicated in the etiology of depression. A first step in adaptive emotion regulation involves emotional clarity, the ability to recognize and differentiate one's emotional experience. As family members are critical in facilitating emotional understanding and communication, we examined the impact of family functioning on adolescent emotional clarity and depressive symptoms. We followed 364 adolescents (ages 14-17; 52.5% female; 51.4 % Caucasian, 48.6% African American) and their mothers over 2 years (3 time points) and assessed emotional clarity, depressive symptoms, and adolescents' and mothers' reports of family functioning. Emotional clarity mediated the relationship between adolescents' reports of family functioning and depressive symptoms at all time points cross-sectionally, and according to mothers' reports of family functioning at Time 1 only. There was no evidence of longitudinal mediation for adolescents' or mothers' reports of family functioning. Thus, family functioning, emotional clarity, and depressive symptoms are strongly related constructs during various time points in adolescence, which has important implications for intervention, especially within the family unit.

Identifying a physical indicator of suicide risk: Non-suicidal self-injury scars predict suicidal ideation and suicide attempts

BACKGROUND

Suicide risk is challenging to quantify due to reliance on self-report, which is limited by individuals' lack of insight and the desire to conceal such intentions. Non-suicidal self-injury (NSSI) is one of the most robust predictors of suicidal ideation (SI) and suicide attempts (SA). Although NSSI often leads to permanent scarring, which can be assessed by objective physical examination, no research has examined whether scarring denotes tangible risk for SI and SA. The present study examined whether NSSI scar presence and number predict current SI and SA history. Further, we examined whether brooding would exacerbate the effects of NSSI scarring on SI or SA.

METHODS

Young adults (N=231; M=21.24 years; 78% female) completed self-report questionnaires assessing SA history, frequency of NSSI, presence/number of NSSI scars, brooding, current depressive symptoms, and SI.

RESULTS

NSSI scar presence and number predicted current SI and SA history after controlling for current depressive symptoms. Moreover, scar presence and number predicted current SI over and above the effects of SA history and NSSI frequency, method, and medical severity. Further, NSSI scar presence and number predicted SI more strongly among individuals with greater levels of brooding than among individuals with lower levels of brooding.

CONCLUSIONS

The presence and number of NSSI scars are objective physical indicators of risk for SI and SAs. Brooding may further heighten the risk of SI for individuals bearing NSSI scars.

Cognitive and Emotion-Regulatory Mediators of the Relationship Between Behavioral Approach System Sensitivity and Nonsuicidal Self-Injury Frequency

Nonsuicidal self-injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS-relevant cognitive style of self-criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N = 177) with high and moderate BAS levels completed measures of self-criticism, positive emotion regulation, brooding, and both lifetime and last-year frequency of NSSI. Results indicated that self-criticism and positive emotion dampening independently mediated the relationship between BAS and last-year frequency of NSSI. Self-criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion-regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.

The cyclical nature of depressed mood and future risk: Depression, rumination, and deficits in emotional clarity in adolescent girls

Deficits in emotional clarity, the understanding and awareness of one's own emotions and the ability to label them appropriately, are associated with increased depressive symptoms. Surprisingly, few studies have examined factors associated with reduction in emotional clarity for adolescents, such as depressed mood and ruminative response styles. The present study examined rumination as a potential mediator of the relationship between depressive symptoms and changes in emotional clarity, focusing on sex differences. Participants included 223 adolescents (51.60% female, Mean age = 12.39). Controlling for baseline levels of emotional clarity, initial depressive symptoms predicted decreases in emotional clarity. Further, rumination prospectively mediated the relationship between baseline depressive symptoms and follow-up emotional clarity for girls, but not boys. Findings suggest that depressive symptoms may increase girls' tendencies to engage in repetitive, negative thinking, which may reduce the ability to understand and label emotions, a potentially cyclical process that confers vulnerability to future depression.

Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study

Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

Predicting symptoms of depression from social anhedonia and emotion regulation

The literature examining social anhedonia, emotion regulation, and symptoms of depression in psychiatric inpatients has been limited. However, some studies have shown that difficulties in emotion regulation and social anhedonia were independently associated with depression. The current study attempted to examine the effects of these two potential predictors of unipolar depressed mood. Fifty-nine (73% female) psychiatric inpatients were given the measures of emotion regulation, symptoms of anxiety and depression, and social anhedonia. Results showed that difficulties in emotion regulation, specifically dysfunctional emotion regulation strategies and emotional clarity, served as significant predictors of depressive symptoms above and beyond contributions from social anhedonia. These results highlight the importance of attending to emotion regulation in the study and treatment of depression in inpatient samples.

Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity

Current emotion regulation research in BD has tended to focus on the extent to which patients control their emotions using different cognitive strategies. Fewer studies have investigated whether patients with BD have difficulties in regulating other dimensions of emotion that serve a functional purpose and are thereby more amenable to change. To overcome this paucity of research we utilised a multi-dimensional measure of emotion regulation to characterise the emotion regulation profile of BD, and examine its utility in predicting trait mania and depression propensity. Fifty BD patients and 52 healthy controls completed the Difficulties in Emotion Regulation Scale (DERS) and the General Behaviour Inventory (GBI). Results indicated that patients had difficulties in emotion regulation across a range of dimensions. Impulse control difficulties most parsimoniously predicted trait (hypo)mania propensity in BD patients, whilst poor access to mood regulation strategies predicted depressive propensity. Predictors of the propensity to experience these moods differed in the control group. These findings represent an important step toward informing the development of new treatment strategies to remediate emotion regulation difficulties and improve BD symptomatology.

Deficits in Emotional Clarity and Vulnerability to Peer Victimization and Internalizing Symptoms Among Early Adolescents

Peer victimization is a significant risk factor for a range of negative outcomes during adolescence, including depression and anxiety. Recent research has evaluated individual characteristics that heighten the risk of experiencing peer victimization. However, the role of emotional clarity, or the ability to understand one's emotions, in being the target of peer victimization remains unclear. Thus, the present study evaluated whether deficits in emotional clarity increased the risk of experiencing peer victimization, particularly among adolescent girls, which, in turn, contributed to prospective levels of depressive and anxiety symptoms. In the present study, 355 early adolescents (ages 12-13; 53% female; 51% African American) who were part of the Adolescent Cognition and Emotion project completed measures of emotional clarity, depressive symptoms, and anxiety symptoms at baseline, and measures of peer victimization, depressive symptoms, and anxiety symptoms at follow-up. Moderation analyses indicated that deficits in emotional clarity predicted greater peer victimization among adolescent girls, but not adolescent boys. Moderated mediation analyses revealed that deficits in emotional clarity contributed to relational peer victimization, which, in turn, predicted prospective levels of depressive and anxiety symptoms among adolescent girls, but not boys. These findings indicate that deficits in emotional clarity represent a significant risk factor for adolescent girls to experience relational peer victimization, which, in turn, contributed to prospective levels of internalizing symptoms. Thus, prevention programs should target deficits in emotional clarity to prevent peer victimization and subsequent internalizing symptoms among adolescent girls.

Ein Vergleich verschiedener Kurzversionen des Depressive Experiences Questionnaire (DEQ) zur Erhebung von Selbstkritik und Abhängigkeit

Der Depressive Experiences Questionnaire (DEQ) ist ein Fragebogen zur Erfassung der Persönlichkeitsmerkmale Selbstkritik und Abhängigkeit, die als Vulnerabilitätsfaktoren für Depression gelten. Aufgrund seiner Länge und seiner komplexen Auswertungsprozedur wurden im englischsprachigen Raum verschiedene Kurzversionen des DEQ entwickelt. Das Ziel dieser Studie war die psychometrische Überprüfung der verschiedenen DEQ-Versionen in deutscher Sprache sowie die Validierung einer geeigneten Kurzversion. An insgesamt 708 Personen (404 Patienten und 304 nicht-klinische Personen) wurden die psychometrischen Eigenschaften der verschiedenen Versionen verglichen. Es zeigte sich, dass der Theoretische Depressive Experiences Questionnaire–12 Item Version (TDEQ-12) insbesondere aufgrund seiner faktoriellen Validität die besten psychometrischen Eigenschaften aufwies. Zusätzliche Hinweise für die Validität und Reliabilität des TDEQ-12 konnten in vier weiteren Stichproben (436 nicht-klinische Personen, 23 nicht-depressive Personen, 64 depressive Patienten, 74 Studierende) gewonnen werden. Die vorliegende Studie legt nahe, dass der TDEQ-12 eine reliable, valide und ökonomische Alternative zum DEQ für die Erfassung von Selbstkritik und Abhängigkeit darstellt.

Adaptive cognitive emotion regulation moderates the relationship between dysfunctional attitudes and depressive symptoms during a stressful life period: a prospective study

BACKGROUND AND OBJECTIVES

Dysfunctional cognitions are known to emerge in stressful situations and are critical for the onset of depressive symptoms. The goal of this study is to investigate whether adaptive and/or maladaptive emotion regulation strategies moderate the relationship between dysfunctional attitudes and depressive symptoms under stress.

METHODS

In a longitudinal study, 92 healthy but unselected undergraduates were followed for three months including a stress period (four weeks of examinations).

RESULTS

Our findings demonstrate that the more adaptive emotion regulation strategies are used in daily life (measured at baseline), the weaker the relationship between dysfunctional attitudes and depressive symptoms during stress. Interestingly, no single strategy demonstrates a unique predictive value, but only the combination of several adaptive strategies moderates the relationship between dysfunctional attitudes and depressive symptoms. Although participants with elevated depressive symptoms use more maladaptive emotion regulation strategies, these latter strategies do not moderate the association between dysfunctional attitudes and depressive symptoms.

LIMITATIONS

The use of a sample of undergraduates limits the generalizability and the clinical significance of our results.

CONCLUSIONS

Altogether, although dysfunctional attitudes are activated and accessible in response to certain life stressors, the strategies that healthy individuals use to adaptively regulate these cognitions seem important in determining the likelihood of depressive symptoms.

Rumination and overgeneral autobiographical memory in adolescents: an integration of cognitive vulnerabilities to depression

During adolescence, rates of depression dramatically increase and girls become twice as likely as boys to develop depression. Research suggests that overgeneral autobiographical memory and rumination are vulnerability factors for depressive symptoms in adolescence that may be triggered by stressful life events. The current longitudinal study included 160 early adolescents (Mage = 12.44 years, 60.0 % African American, 40.0 % Caucasian, and 56.2 % female). At baseline, adolescents completed measures of current depressive symptoms, rumination, and specificity of autobiographical memories. Approximately 9 months later, the adolescents completed measures of current depressive symptoms and stressful life events that had occurred between baseline and follow-up. Analyses indicated that girls with more overgeneral autobiographical memories in combination with higher levels of rumination were most vulnerable to experiencing increases in depressive symptoms following stressful life events. Additionally, retrieving more specific autobiographical memories appeared to buffer against the impact of negative life events on depressive symptoms among both boys and girls. Memory specificity may play a protective role in depression risk, suggesting that memory specificity training interventions may prove beneficial for adolescents.

A Prospective Examination of Emotional Clarity, Stress Responses, and Depressive Symptoms During Early Adolescence

This study examined the proposal that difficulty understanding one's emotional experiences (i.e., deficits in emotional clarity) would interfere with the formulation of adaptive responses to interpersonal stress, which would then predict depressive symptoms. This process was examined across 3 years (fourth to sixth grade) during early adolescence. Participants included 636 youth (338 girls, 298 boys; X̅ age in fourth grade = 9.95, SD = .37) who completed measures assessing emotional clarity, stress responses, and depressive symptoms. Consistent with the hypothesized model, path analyses revealed that maladaptive interpersonal stress responses partially mediated the prospective contribution of deficits in emotional clarity to depressive symptoms. These findings implicate impairment in emotional understanding as a precursor to emerging interpersonal and psychological difficulties during a developmental stage of heightened vulnerability to depression, the transition to adolescence.

Pubertal timing and vulnerabilities to depression in early adolescence: differential pathways to depressive symptoms by sex

Although research implicates pubertal processes in the emergence of the sex difference in depression during adolescence, few studies have examined how cognitive and affective vulnerabilities influence the effect of pubertal timing on depressive symptoms. The current study prospectively examined whether early pubertal timing predicted increases in depressive symptoms among adolescents with more negative cognitive styles and lower emotional clarity, and whether this risk was specific to adolescent girls. In a diverse sample of 318 adolescents, early pubertal timing predicted increases in depressive symptoms among adolescent boys and girls with more negative cognitive styles and adolescent girls with poor emotional clarity. These findings suggest that earlier pubertal maturation may heighten the risk of depression for adolescents with pre-existing vulnerabilities to depression, and that early maturing adolescent girls with lower levels of emotional clarity may be particularly vulnerable to depressive symptoms, representing one pathway through which the sex difference in depression may emerge.

Negative inferential style, emotional clarity, and life stress: integrating vulnerabilities to depression in adolescence

Negative inferential style and deficits in emotional clarity have been identified as vulnerability factors for depression in adolescence, particularly when individuals experience high levels of life stress. However, previous research has not integrated these characteristics when evaluating vulnerability to depression. In the present study, a racially diverse community sample of 256 early adolescents (ages 12 and 13) completed a baseline visit and a follow-up visit 9 months later. Inferential style, emotional clarity, and depressive symptoms were assessed at baseline, and intervening life events and depressive symptoms were assessed at follow-up. Hierarchical linear regressions indicated that there was a significant three-way interaction between adolescents' weakest-link negative inferential style, emotional clarity, and intervening life stress predicting depressive symptoms at follow-up, controlling for initial depressive symptoms. Adolescents with low emotional clarity and high negative inferential styles experienced the greatest increases in depressive symptoms following life stress. Emotional clarity buffered against the impact of life stress on depressive symptoms among adolescents with negative inferential styles. Similarly, negative inferential styles exacerbated the impact of life stress on depressive symptoms among adolescents with low emotional clarity. These results provide evidence of the utility of integrating inferential style and emotional clarity as constructs of vulnerability in combination with life stress in the identification of adolescents at risk for depression. They also suggest the enhancement of emotional clarity as a potential intervention technique to protect against the effects of negative inferential styles and life stress on depression in early adolescence.