Cognitive patterns and depression: study of a Japanese university student population

Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder

OBJECTIVES

Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD.

METHODS

Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts.

RESULTS

Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group.

CONCLUSION

Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.

Why is my world so dark? Effects of child physical and emotional abuse on child depression: The mediating role of self-compassion and negative automatic thoughts

BACKGROUND

The adverse effects of childhood maltreatment on the mental health of individuals have received increasing attention. However, it is unclear whether the effects of invisible emotional abuse and visible physical abuse differ on child depression and the mediating processes under this relationship.

OBJECTIVE

This study aimed to investigate whether self-compassion and negative automatic thoughts mediated the effects of physical abuse and emotional abuse on child depression and the underlying mechanistic differences.

PARTICIPANTS AND SETTING

Using a two-wave longitudinal design, a total of 946 elementary school students completed the self-report questionnaires at two-time points, including child abuse, self-compassion, negative automatic thoughts, and depression.

METHODS

This study constructed structural equation models (SEM) to examine the mediating role of self-compassion and negative automatic thoughts between emotional/physical abuse and child depression.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that only physical abuse significantly and positively predicted child depression directly (β = 0.16, p < 0.01). Emotional abuse was positively associated with child depression through self-compassion (β = 0.02, p < 0.05) and negative automatic thoughts (β = 0.02, p < 0.05), while physical abuse influenced child depression only via negative automatic thoughts (β = 0.07, p < 0.001).

CONCLUSIONS

The findings showed a strong association between emotional/physical abuse and child depression, but there were mechanistic differences under these relationships. Therefore, we also need to pay equal attention to the adverse effects of emotional abuse on children.

Resiliency and mental health of school teachers in Okinawa

Purpose

The purpose of this paper is to describe the mental health issues among teachers globally and to investigate the significant factors that specifically impact the mental health of school teachers in Okinawa, Japan.

Design/methodology/approach

This cross-sectional study examined depression, anxiety, stress, self-esteem and resiliency among 174 teachers from seven schools in Okinawa, Japan. The study questionnaire consisted of four parts, including demographic data, Depression, Anxiety, and Stress scale (DASS-42), Rosenberg Self-Esteem Scale (RSE), and Connor-Davidson Resiliency Scale (CD-RISC). Multiple regression analyses were performed to identify predictors of mental health variables.

Findings

Of the 174 teachers, 111 were females (64%) and 60 were males (35%). Average age of participants was 41.65 (SD = 10.07). Average number of years being a teacher was 15.50 (SD = 9.88). There was a significant gender difference in the level of self-esteem. Significant differences in anxiety were found among varying grade levels taught. Regression analyses indicated that resiliency and self-esteem significantly predicted depression, anxiety and stress among school teachers in Okinawa.

Originality/value

This is the first study among school teachers in Okinawa that examined the impact of resiliency and self-esteem on their mental health. To reduce psychological distress common within the teaching profession, social and environmental support should be provided within the school to better foster the successful promotion of teacher resiliency and self-esteem.

Influence of parental competence on postpartum depression mediated via negative thoughts: moderating role of type of delivery

The present study intended to explore and compare the mediating role of negative thoughts between the sense of parental competence and postpartum depression in postpartum mothers who gave birth to their baby either through vaginal or cesarean delivery. A purposive sample of 170 women suffering from postpartum depression was recruited from different hospitals in Gujrat, Pakistan. Urdu versions of the Parenting Sense of Competency Scale, Automatic Thoughts Questionnaire, and Edinburgh Postnatal Depression Scale were used to measure the focal constructs of the study. Data were collected from May 2018 to October 2018. Path analysis revealed that parental competence had negative direct effects on postpartum depression (β = -.17, p < .05) and negative thoughts (β = -.27, p < .05) and both of these effects were stronger for women with cesarean delivery (Δβ = .04, p < .001; Δβ = .36, p < .001, respectively). Negative thoughts had a positive direct effect on postpartum depression (β = .43, p < .05) and this direct effect was also stronger among women with cesarean delivery (Δβ = -.12, p < .001). Furthermore, parental competence reduced the negative thoughts, which in turn, lowered the postpartum depression (β = -.12, p < .05), however, this indirect effect was true only for the group of women with cesarean delivery (Δβ = .20, p < .05). Our findings indicate the powerful role of parental competence in reducing the likelihood of postpartum depression through the regulation of negative thoughts and highlight that cesarean delivery may increase mothers' vulnerability to negative thoughts and postpartum depression.

Childhood maltreatment on young adult depression: A moderated mediation model of negative automatic thoughts and self-compassion

This study examines the mediating role of negative automatic thoughts on the link between childhood maltreatment and young adult depression, and the moderating role of self-compassion in this indirect link. College students ( N = 578) completed self-report questionnaires assessing the mentioned study variables. The results showed that childhood maltreatment was positively associated with young adult depression via negative automatic thoughts. Moreover, self-compassion moderated this indirect link such that participants with low self-compassion demonstrated a stronger indirect link than those with high self-compassion. These findings highlight the important role of self-compassion in countering the adverse outcomes of childhood maltreatment.

Associations of negative cognitions, emotional regulation, and depression symptoms across four continents: International support for the cognitive model of depression

BACKGROUND

Cognitive-behavioral therapy (CBT) is one of the most widely tested and empirically supported psychological treatments for depression. Beck and other scholars established the theoretical foundations of CBT among North American populations, yet surprisingly few studies have examined central hypotheses of the cognitive model of depression among people living in non-Western regions.

METHODS

In the present study, we used the alignment method to minimize measurement bias to examine several central hypotheses of the cognitive model among adults living on four continents (n = 752): North America (n = 103; female = 29.1%), Europe (n = 404; female = 36.4%), South America (n = 108; female = 18.5%), and Asia (n = 136; female = 19.9%).

RESULTS

Depressive symptoms were positively and strongly correlated with negative automatic thoughts about self (ATQ-N), and moderately associated with dysfunctional attitudes (DAS) among people living on the four continents. Further, use of emotional suppression strategies to regulate emotion (ERQ-Suppression) was moderately and positively associated with depressive symptoms among people on all four continents, while use of cognitive-reappraisal (ERQ-Reappraisal) was not systematically associated with depressive symptoms.

CONCLUSIONS

Results of this study offer preliminary cross-continental support for foundational hypotheses of the cognitive model of depression. Negative thoughts appear to be associated with depression in all regions of the world, cementing this construct as a hallmark feature of the disorder.

A Dataset of Students’ Mental Health and Help-Seeking Behaviors in a Multicultural Environment

University students, especially international students, possess a higher risk of mental health problems than the general population. However, the literature regarding the prevalence and determinants of mental health problems as well as help-seeking behaviors of international and domestic students in Japan seems to be limited. This dataset contains 268 records of depression, acculturative stress, social connectedness, and help-seeking behaviors reported by international and domestic students at an international university in Japan. One of the main findings that can be drawn from this dataset is how the level of social connectedness and acculturative stress are predictive of the reported depression among international as well as domestic students. The dataset is expected to provide reliable materials for further study of cross-cultural public health studies and policy-making in higher education.

Depression, Acculturative Stress, and Social Connectedness among International University Students in Japan: A Statistical Investigation

(1) This study aims to examine the prevalence of depression and its correlation with Acculturative Stress and Social Connectedness among domestic and international students in an international university in Japan. (2) Methods: A Web-based survey was distributed among several classes of students of the university, which yielded 268 responses. On the survey, a nine-item tool from the Patient Health Questionnaire (PHQ-9), the Social Connectedness Scale (SCS) and Acculturative Stress Scale for International Students (ASSIS) were used together with socio-demographic data. (3) Results: The prevalence of depression was higher among international than domestic students (37.81% and 29.85%, respectively). English language proficiency and student age (20 years old) showed a significant correlation with depression among domestic students (β = −1.63, p = 0.038 and β = 2.24, p = 0.048). Stay length (third year) also displayed a significant correlation with depression among international students (β = 1.08, p = 0.032). Among international and domestic students, a statistically significant positive correlation between depression and acculturative stress, and negative associations of social connectedness with depression and acculturative stress were also found. (4) Conclusions: The high prevalence of depression, and its association with Acculturation stress and Social Connectedness, among the students in this study highlight the importance of implementing support programs which consider the role of Acculturation and Social Connectedness.

The relationships between dysfunctional attitudes, rumination, and non-somatic depressive symptomatology in newly diagnosed Asian cancer patients

BACKGROUND

Given the high prevalence of cancer patients with comorbid depression, the present study sought to elucidate the relationships between two vulnerability factors, dysfunctional attitudes and rumination, and their influence on non-somatic depressive symptomatology in an Asian cohort of cancer patients. It was hypothesized that all variables of interest would be inter-correlated, and that both dysfunctional attitudes and rumination would mediate one another in influencing non-somatic depressive symptoms.

METHODS

A total of 194 recently diagnosed mixed-cancer patients in Singapore (Mage=49.2±9.2years; 68% women; 61% ethnically Chinese), without any comorbid psychiatric diagnosis, completed the Dysfunctional Attitudes Scale Form A, Rumination Responses Scale (comprising brooding and reflective rumination), and Hospital Anxiety and Depression Scale.

RESULTS

Correlational analyses revealed that all variables were inter-correlated (rhos[194]=.35-.52). Bootstrapping mediation analyses controlling for gender and treatment received revealed that both brooding and reflective rumination mediated the relationship between dysfunctional attitudes and non-somatic depressive symptoms, and that dysfunctional attitudes also mediated the relationship between both brooding and reflective rumination and non-somatic depressive symptoms.

CONCLUSIONS

Findings suggest that, in cancer patients, both dysfunctional attitudes and rumination seem to act upon one other, in a feedback loop, to influence non-somatic depressive symptomatology. Clinicians may therefore have a wider range of treatments to choose from in managing cancer patients with depressive symptomatology.

Validation of the Automatic Thoughts Questionnaire (ATQ) Among Mainland Chinese Students in Hong Kong

OBJECTIVE

The present study validated the combined version of the 8-item Automatic Thought Questionnaire (ATQ) and 10 positive items from the ATQ-revised among Chinese university students.

METHOD

A total of 412 Mainland Chinese university students were recruited in Hong Kong by an online survey.

RESULTS

A 14-item Chinese ATQ was derived via item analysis. Satisfactory internal consistency reliability and good split-half reliability were obtained. Exploratory and confirmatory factor analysis revealed a 3-correlated-factor solution for the Chinese ATQ: negative thought, positive thought (emotional), and positive thought (cognitive). The negative ATQ subscale score was positively correlated with negative affect, and negatively correlated with positive affect and life satisfaction. The two positive ATQ subscale scores were negatively correlated with negative affect, and positively correlated with positive affect and life satisfaction.

CONCLUSION

The 14-item ATQ is a valid and reliable instrument for measuring automatic thoughts in the Chinese context of Hong Kong.

Association between depression, examination-related stressors, and sense of coherence: the Ronin-Sei study

AIMS

In the Japanese education system, students who fail university entrance exam often go to special preparatory schools to prepare for the following year's exam. These students are called ronin-sei. The purpose of this study was to clarify: (i) depression and somatic complaints in ronin-sei; and (ii) the association between depression, examination-related stressors, and sense of coherence (SOC).

METHODS

A total of 914 ronin-sei from two preparatory schools were asked to answer a self-rating questionnaire. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and SOC was measured using the SOC-13 Scale.

RESULTS

Overall, 57.9% of subjects were considered to have depression (CES-D ≥ 16) and 19.8% had severe depression (CES-D ≥ 26). Higher CES-D scores were associated with a higher rate of somatic complaints. In hierarchical logistic regression analysis, having no one to talk to about his/her worries and having parents who disagree about the first-choice of university and faculty were independent risk factors for depression and severe depression, respectively, even after controlling for SOC.

CONCLUSIONS

Preparatory school students have various somatic complaints, and their depression is in part related to examination-related stressors. To maintain mental health, it is important to enhance SOC, to understand their examination-related stressors and to provide adequate support for these students.

A study of cognitive vulnerability-stress model of depressive symptoms among Chinese adolescents

The objective of the present study is to test the validity of the integrated cognitive model of depression proposed by Kwon and Oei (1994) with a Chinese adolescent sample. A two-wave panel design was used. We hypothesized that the interaction between dysfunctional attitudes measured at time 1 and adolescents' negative life events experienced between times 1 and 2 would predict changes in the frequency of automatic thoughts between times 1 and 2. We further hypothesized that changes in the frequency of automatic thoughts would, in turn, predict changes in the severity of depressive symptoms. Participants were 329 Chinese adolescents. As a comparison, we tested three other competing models: linear mediation, alternative aetiologies and symptom models. All participants completed the Adolescent Self-Rating Life Events Checklist, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire and Center for Epidemiological Studies Depression Scale on two occasions-5 months apart. Path analysis was used to test all models. Results of the path analysis indicated that the integrated cognitive model showed an adequate fit for the Chinese adolescent data. During phases of increased depression, dysfunctional attitudes were common cognitive moderators of depression, whereas automatic thoughts were specific cognitive mediators of depression.

Comparative efficacy and durability of continuation phase cognitive therapy for preventing recurrent depression: design of a double-blinded, fluoxetine- and pill placebo-controlled, randomized trial with 2-year follow-up

BACKGROUND

Major Depressive Disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences.

PURPOSE

This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower vs. higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24 months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX).

METHODS

Outpatients, aged 18 to 70 years, with recurrent MDD received 12-14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression

RESULTS

The trial began in 2000. Enrollment is complete (n=523). The follow-up continues.

CONCLUSIONS

The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide.

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Key Words

• relapse prevention
• recurrent depression
• cognitive therapy
• fluoxetine
• longitudinal follow-up

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MESH Headings

• Adolescent
• Adult
• Aged
• Antidepressive Agents, Second-Generation/therapeutic use
• Cognitive Behavioral Therapy
• Depressive Disorder, Major/prevention & control
• Depressive Disorder, Major/therapy
• Double-Blind Method
• Female
• Fluoxetine/therapeutic use
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Research Design
• Secondary Prevention
• Young Adult

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Grants

• K24 MH001571 NIMH NIH HHS
• K24-MH001571 NIMH NIH HHS
• R01 MH-58356 NIMH NIH HHS
• R01 MH058397 NIMH NIH HHS
• R01 MH069618 NIMH NIH HHS
• R01 MH058397-11 NIMH NIH HHS
• R01 MH-69219 NIMH NIH HHS
• R01 MH-58397 NIMH NIH HHS
• R01 MH069619-05 NIMH NIH HHS
• R01 MH-69618 NIMH NIH HHS
• L40 MH069219 NIMH NIH HHS
• R01 MH069619 NIMH NIH HHS
• R01 MH058356 NIMH NIH HHS
• K24 MH001571-10 NIMH NIH HHS

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Affiliation(s)

Robin B. Jarrett Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9149, United States of America; 214-648-5345; fax 214-648-5340
Michael E. Thase The University of Pennsylvania School of Medicine, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, United States of America. Philadelphia, Veterans Affairs Medical Center and University of Pittsburgh Medical Center

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Prospective study on suicidal ideation among Japanese undergraduate students: correlation with stressful life events, depression, and depressogenic cognitive patterns

The present study examines the effects of stressful life events, depression, and depressogenic cognitive patterns on suicidal ideation in 500 Japanese undergraduate students. The above factors were assessed at baseline (T1) and two weeks later (T3). At T1, structural equation modeling confirmed that (1) cognitive patterns and depression, but not stressful life events, influence suicidal ideation, and (2) cognitive patterns also influence suicidal ideation through depression. These findings were confirmed in a longitudinal analysis. The results suggest that the effects of stressful life events on suicidal ideation are indirect and are mediated by depressogenic cognitive styles and depressed mood.

Reliability and validity of the Japanese version of the 24-item Dysfunctional Attitude Scale

BACKGROUND

The 24-item Dysfunctional Attitude Scale (DAS-24) is a short version of the Dysfunctional Attitude Scale, which is a self-report inventory for depressogenic schemata.

OBJECTIVE

The object of this study was to examine the reliability and validity of the Japanese version of the DAS-24 (DAS-24-J).

METHODS

Subjects consisted of non-clinical sample 1 (248 university students), non-clinical sample 2 (872 Japanese company employees) and a clinical sample (59 depressed out-patients).

RESULTS

Internal consistency was satisfactory in all three samples, Cronbach's α coefficient being higher than 0.85. Test-retest reliability was satisfactory in non-clinical sample 1. The interclass correlation coefficient was 0.79 and there was no significant difference in the average score of DAS-24-J between the two points. The DAS-24-J showed satisfactory concurrent validity with the Japanese Irrational Belief Test-20 (r= 0.76); Automatic Thoughts Questionnaire - Revised total (r= 0.46), negative (r= 0.53) and positive (r=-0.41); and the Beck Depression Inventory-II (r= 0.44 for non-clinical sample, r= 0.63 for clinical sample). The clinical sample showed a significantly higher DAS-24-J score than non-clinical sample 2. According to a factor analysis combining all three samples, three factors were extracted: factor 1 (11 items) corresponded with 'achievement' in the original version, factor 2 (6 items) with 'self-control' and factor 3 (5 items) with 'dependency'.

CONCLUSION

The DAS-24-J is a reliable and valid instrument to measure depressogenic schemata in Japanese.