Why Do Some Depressive Patients Have Suicidal Ideation but Others Not? Suicidal Ideation From the Perspective of Affective Neuroscience Personality Traits

INTRODUCTION

Although major depression is the disorder most frequently associated with suicidal behavior, it is unclear that major depressive disorder patients may develop suicidal ideation. Basic affective system theory may provide a novel and beneficial viewpoint in this field. The goal of this study was to investigate the basic affective system in relation to suicidal ideation in individuals with depression.

METHOD

The study population comprised 160 participants who had been formally diagnosed with major depressive disorder. Participants were divided into two groups according to whether they had suicide ideation (depression with suicide [DS]) (N = 93) or not (depression with no suicidal ideation [DNS]) (N = 67). The Beck Depression Inventory (BDI), the Suicide Probability Scale (SPS), the Beck Hopelessness Scale (BHS), and the Affective Neuroscience Personality Scale (ANPS) were applied. Statistical Product and Service Solutions (SPSS) 24 and the SPSS macroprocess, which were specifically developed for assessing complex models including serial mediators, were used to analyze the data.

RESULTS

The mean age of all participants was 31.1 ± 11 years, and most of them were female (65%). The DS group had a higher family history of psychiatric medication use and suicidal attempts. In addition, BDI, BHS, and SPS total scores were higher, as well as ANGER subscale scores were higher in the DS group. In mediation analysis, the ANGER subscale significantly predicted the presence of suicide ideation. We observed a direct effect of the ANGER subscale score on suicide ideation as well as an indirect effect of the ANGER subscale score on suicidal ideation via depression severity.

CONCLUSION

Higher scores on ANGER are associated with suicidal ideation. Neurobiological correlates, including the ANGER system, may be promising in understanding suicidal behaviors.

Relationship between rumination, self-compassion, and psychological health among Japanese university students: A cross-sectional study

OBJECTIVES

Rumination is suggested to exacerbate psychological health, but there is room for investigating the potential protecting factors for individuals with high ruminative tendencies against psychological symptoms. The present cross-sectional study aimed to uncover the associations between rumination as a maladaptive dimension of self-focus, self-compassion, and psychological health, and whether and how components of self-compassion may moderate the associations between rumination and psychological health in Japanese undergraduate students.

METHODS

A questionnaire survey was conducted by using both an online platform and a paper-based questionnaire. The survey included established Japanese versions of psychological scales on rumination, self-compassion, perceived stress, trait anxiety, and depression.

RESULTS

The results revealed statistically significant positive correlations between rumination and negative dimensions of self-compassion, and rumination and psychological symptoms. Positive dimensions of self-compassion were significantly negatively correlated with both rumination and psychological symptoms. Reflection as a positive dimension of self-focus did not show significant correlations with most psychological variables. Furthermore, hierarchical multiple regression analyses involving subscales of self-compassion and their interactions with rumination as predictors revealed that the interactions between rumination and components of self-compassion, i.e., over-identification and mindfulness, significantly predicted trait anxiety. Higher rumination predicted higher anxiety when over-identification was high, but not when over-identification was low. Also, lower rumination predicted lower anxiety when mindfulness was high, but not when mindfulness was low.

CONCLUSIONS

The results suggest significant associations between rumination, components of self-compassion, and psychological health in a population of Japanese undergraduate students. The data also suggest that components of self-compassion play moderating roles in the relationship between rumination and psychological health, potentially serving as aggravating/protective factors for psychological health. Longitudinal studies and comparisons between different cultures should be conducted in the future quest.

Mediating Role of Rumination Between Anger and Anxious-Depressive Symptomatology in Family Members of People with Gambling Disorder

Gambling disorder is characterized by a behavioural pattern of dysfunctional gambling that persists despite its negative implications in different areas of people's daily life. One of the most negatively affected areas is the one related to family members. This study aimed, firstly, to study the differences between family members of people with gambling disorder and a general population sample in anger (state, trait, expression-out, expression-in. control-out and control-in), rumination (brooding, reflection and total), and anxiety and depression. The second aim was to analyse the correlation between these variables in the family members of people with gambling disorder, and thirdly, to analyse the mediating role of rumination between anger, anxiety and depression. This study consisted of 170 people, of whom 87 were family members of people with a gambling disorder, and 83 were from the general population. Instruments measuring anger, anxiety, depression, and ruminative responses were administered. Results showed that family members had significantly higher scores in anger (state), depression, anxiety, rumination (total and brooding). Also, results showed that anger correlated positively and significantly with rumination, depression and anxiety, which also correlated positively and significantly with each other. Third, rumination mediated the relationship between the following variables: anger (state) and depression; anger (trait) and anxiety and depression; anger (external expression) and anxiety and depression. A complete mediating effect was found in the latter case and a partial mediating effect in the first two cases. In conclusion, it is found that having a family member with a gambling disorder may increase levels of anger, anxiety, depression and rumination. Furthermore, it is shown that working on rumination may reduce depression and anxiety in family members of gamblers.

Measuring Depression in Young Adults: Preliminary Development of an English Version of the Teate Depression Inventory

Depression is a common and debilitating condition that impacts individuals with various cultural backgrounds, medical conditions, and life circumstances. Thus, assessment tools need to be useful among different cultural groups. The 21-item Teate Depression Inventory (TDI) was developed in Italy, is designed to assess major depression, and focuses on cognitive and affective rather than somatic symptoms. This study aims to examine the factor structure and concurrent validity of the TDI English version among a non-clinical population in the United States. Participants included 398 adults (mean age 19.89 years, SD = 2.72, range: 18 to 46 years old) who completed the TDI and The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R). The results supported a three-factor bifactor structure of the TDI (Positive Affect, Negative Affect, and Daily Functioning), which largely corresponds to the Tripartite Model of affective disorders. These findings support the use of TDI scores as measures of depressive symptoms among U.S. young adults, offering researchers and practitioners a brief and useful tool.

Measuring State and Trait Anxiety: An Application of Multidimensional Item Response Theory

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a widely used measure of state and trait anxiety. Within the Classical Testing Theory model, consistent findings provide support for its multidimensional factor structure, discriminant, convergent, and nomological validity, as well as age and gender invariance, across healthy and clinical samples. Nevertheless, some issues regarding STICSA dimensionality and item-scale composition remain unresolved (e.g., both bifactor and two-factor models were found to fit data equally well). The goal of this study was to investigate the STICSA's dimensionality within the Item Response Theory, and to assess the tenability of the bifactor model as a plausible model over the multidimensional model. The sample consisted of 3338 Italian participants (58.21% females; 41.79% males) with an average age of 35.65 years (range: 18-99; SD = 20.25). Both bifactor and two-correlated dimensions of the STICSA scales were confirmed to fit data by applying the multidimensional Item Response Theory (mIRT). While the bifactor model showed better fit indices, the multidimensional model was more accurate and precise (0.86-0.88) in estimating state and trait latent anxiety. A further comparison between multidimensional item parameters revealed that the multidimensional and bifactor models were equivalent. Findings showed that the STICSA is an accurate and precise instrument for measuring somatic and cognitive symptomatology dimensions within state and trait anxiety. The use of the state/trait total score requires special attention from the clinicians and researchers to avoid bias in the psychodiagnostic assessment.

Acceptance Mindfulness-Trait as a Protective Factor for Post-Natal Depression: A Preliminary Research

(1) Background: the prevalence of postnatal depression (PND) reaches up to 20%. PND could be based on the interaction between a psychological vulnerability and chronic stress that pregnancy would activate. Vulnerability factors reflect a psychological profile mirroring mindfulness-trait (MT). A high level of MT is associated with an efficient regulation of both physiological and psychological stress, especially negative moods. Interestingly, mindfulness level can be improved by program based on mindfulness meditation. We hypothesize that MT is a protective factor for PND. We also postulate that negative moods increase during the pregnancy for women who develop a PND after delivery (2) Methods: we conducted a multicentric prospective longitudinal study including 85 women during their first trimester of their pregnancy and 72 from the childbirth to the baby's first birthday". At the inclusion, presence and acceptance of MT and various variables of personality and of psychological functioning were assessed. Mood evolution was monitored each month during the pregnancy and a delivery trauma risk was evaluated after delivery. PND detection was carried out at 48 h, 2, 6 and 12 months after the delivery with the Edinburgh Postnatal Depression Scale with a screening cut-off >11. (3) Results: high-acceptance MT is a protective factor for PND (OR: 0.79). Women without PND displayed less negative mood during pregnancy (p < 0.05 for Anxiety, Confusion and Anger). (4) Conclusions: these results suggest the value of deploying programs to enhance the level of mindfulness, especially in its acceptance dimension, before, during and after pregnancy, to reduce the risk of PND.

Maladaptive emotion regulation strategies and trait anger as predictors of depression severity

BACKGROUND

According to empirical evidence, trait anger and emotion regulation strategies are associated with depression severity. The objective of this study was to investigate the impact of trait anger and maladaptive emotion regulation strategies in explaining the variance of depressive symptoms severity.

METHODS

Two hundred three participants diagnosed with major depressive disorder completed measures of depression, trait anger, depressive rumination, anger rumination and experiential avoidance. Path analysis using Mplus was employed for data analysis.

RESULTS

Trait anger and depressive rumination were significant predictors of the level of depressive symptomatology, while experiential avoidance and anger rumination did not predict the level of depressive symptoms severity.

CONCLUSION

Maladaptive emotion regulation strategies and trait anger seem to be associated with the level of depressive symptoms, and, as such, should also be investigated when working with depressive symptomatology.

Forgiving Adolescents: Far From Depression, Close to Well-Being

Forgiveness has been proven to be an effective way of regulating negative affect and decreasing depression. This study aimed at examining the relationship among constructs particularly relevant to adolescents' well-being, including forgivingness (dispositional forgiveness) anger, depression and Hedonic Balance (HB). Specifically, using a structural equation modelling approach, the fully mediational role of the different facets of anger in the relationship between forgiveness and depression was tested in 773 adolescents, of which 69% girls. Results showed that forgivingness was positively and negatively related to, respectively, HB and depression, through a general effect of anger, suggesting that more forgiving adolescents had higher HB and lower depression as they reported a lower general tendency to experience anger. Forgivingness was also positively related both to HB and to depression through the mediation of all the facets of Anger. Moreover, only for HB, a specific effect of Anger-control was found, suggesting that more forgiving adolescents had higher HB as they reported higher strategies to control anger in a functional manner. The model invariance was supported across gender. Our results suggest that forgiveness is a significant protective factor against depression for adolescents, helping them to effectively control and manage anger, thus fostering emotional health. An important clinical implication of our study regards the potential of forgiveness as a resource for well-being in therapy: among the various possible protective factors in adolescence, forgiveness has the added advantage that it can be fostered in clinical settings, and working on forgiveness in psychotherapy or in counselling could decrease adolescent depression and improve well-being.

Dimensions of Anxiety, Age, and Gender: Assessing Dimensionality and Measurement Invariance of the State-Trait for Cognitive and Somatic Anxiety (STICSA) in an Italian Sample

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a widely used measure of state and trait anxiety that permits a specific assessment of cognitive and somatic anxiety. Previous research provided inconsistent findings about its factor structure in non-clinical samples (e.g., hierarchical or bi-factor structure). To date, no psychometric validation of the Italian version of the STICSA has been conducted. Our study aimed to determine the psychometric functioning of the Italian version of the STICSA, including its dimensionality, gender and age measurement equivalence, and convergent/divergent validity in a large sample of community-dwelling participants (N = 2,938; 55.9% female). Through confirmatory factor analysis, the multidimensional structure of both State and Trait STICSA scales, with each including Cognitive and Somatic dimensions, was supported. Factor structure invariance was tested and established at configural, metric, and scalar levels for males and females. Additionally, full factorial measurement invariance was supported for the State scale across young, middle age, and old adult groups whereas the Trait scale was partially invariant across age groups. The STICSA also showed good convergent validity with concurrent anxiety measures (State-Trait Anxiety Inventory and Beck Anxiety Inventory), and satisfactory internal discriminant validity with two depression measures (Teate Depression Inventory and Beck Depression Inventory-II). Results provided support for the multidimensionality of the STICSA, as well as the generalizability of the State and Trait scales as independent measures of Cognitive and Somatic symptomatology across gender in the general population. Implications for research and personality and clinical assessment are discussed.

Assessment of late-life depression via self-report measures: a review

Depression in later life is a significant and growing problem. Age-related differences in the type and severity of depressive disorders continue to be questioned and necessarily question differential methods of assessment and treatment strategies. A host of geropsychiatric measures have been developed for diagnostic purposes, for rating severity of depression, and monitoring treatment progress. This literature review includes the self-report depression measures commonly and currently used in geropsychological practice. Each of the included measures is considered according to its psychometric properties. In particular, information about reliability; convergent, divergent, and factorial validity evidence based on data from clinical and nonclinical samples of older adults; and availability of age-appropriate norms was provided along with the strengths and weaknesses of each measure. Results highlighted that in cognitively intact or mildly impaired patients over 65 years, the Geriatric Depression Scale and the Geriatric Depression Scale-15 currently seem to be the preferred instruments. The psychometric functioning of the Beck Depression Inventory-II and the Center for Epidemiological Studies Depression Scale, instead, is mixed in this population. Most importantly, this review may be a valuable resource for practicing clinicians and researchers who wish to develop state-of-the-science assessment strategies for clinical problems and make informed choices about which instruments best suit their purposes in older populations.

Modeling and estimating the feedback mechanisms among depression, rumination, and stressors in adolescents

The systemic interactions among depressive symptoms, rumination, and stress are important to understanding depression but have not yet been quantified. In this article, we present a system dynamics simulation model of depression that captures the reciprocal relationships among stressors, rumination, and depression. Building on the response styles theory, this model formalizes three interdependent mechanisms: 1) Rumination contributes to 'keeping stressors alive'; 2) Rumination has a direct impact on depressive symptoms; and 3) Both 'stressors kept alive' and current depressive symptoms contribute to rumination. The strength of these mechanisms is estimated using data from 661 adolescents (353 girls and 308 boys) from two middle schools (grades 6-8). These estimates indicate that rumination contributes to depression by keeping stressors 'alive'-and the individual activated-even after the stressor has ended. This mechanism is stronger among girls than boys, increasing their vulnerability to a rumination reinforcing loop. Different profiles of depression emerge over time depending on initial levels of depressive symptoms, rumination, and stressors as well as the occurrence rate for stressors; levels of rumination and occurrence of stressors are stronger contributors to long-term depression. Our systems model is a steppingstone towards a more comprehensive understanding of depression in which reinforcing feedback mechanisms play a significant role. Future research is needed to expand this simulation model to incorporate other drivers of depression and provide a more holistic tool for studying depression.

Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt

Background

This study investigated maladaptive cognitive schemas as mediators of the relationship between co-rumination and anxiety.

Methods

Self-report measures of co-rumination, trait cognitive and somatic anxiety, and early maladaptive cognitive schemas were provided to a nonclinical sample of 461 young adults. Mediation of co-rumination and trait somatic and cognitive anxiety by each early maladaptive schema domain was tested using nonparametric, bootstrap-based resampling.

Results

Significant associations between co-rumination and trait and cognitive anxiety were mediated by schema domains related to Rejection and Disconnection, Overvigilance and Inhibition, and Impaired Autonomy. The association between co-rumination and somatic anxiety was mediated by domains related to Rejection and Disconnection and Impaired Autonomy.

Conclusion

The results of this study showed that those who engage in co-rumination, potentially resulting in clinical levels of anxiety, might benefit from treatment that focuses on themes of rejection sensitivity and belonging, beliefs about autonomy, and when the anxiety is more cognitive, treatment that focuses on hypercriticalness and emotional inhibition too.

Assessment of anxiety in older adults: a review of self-report measures

With increasing numbers of older adults in the general population, anxiety will become a widespread problem in late life and one of the major causes of health care access contributing to high societal and individual costs. Unfortunately, the detection of anxiety disorders in late life is complicated by a series of factors that make it different from assessment in younger cohorts, such as differential symptom presentation, high comorbidity with medical and mental disorders, the aging process, and newly emergent changes in life circumstances. This review covers commonly and currently used self-report inventories for assessing anxiety in older adults. For each tool, psychometric data is investigated in depth. In particular, information about reliability, validity evidence based on data from clinical and nonclinical samples of older adults, and availability of age-appropriate norms are provided. Finally, guidance for clinical evaluation and future research are proposed in an effort to highlight the importance of clinical assessment in the promotion of clinically relevant therapeutic choices.

Psychometric Properties of the Italian Version of the Young Schema Questionnaire L-3: Preliminary Results

Schema Therapy (ST) is a well-known approach for the treatment of personality disorders. This therapy integrates different theories and techniques into an original and systematic treatment model. The Young Schema Questionnaire L-3 (YSQ-L3) is a self-report instrument, based on the ST model, designed to assess 18 Early Maladaptive Schemas (EMSs). During the last decade, it has been translated and validated in different countries and languages. This study aims to establish the psychometric properties of the Italian Version of the YSQ-L3. We enrolled two groups: a clinical (n = 148) and a non-clinical one (n = 918). We investigated the factor structure, reliability and convergent validity with anxiety and depression between clinical and non-clinical groups. The results highlighted a few relevant findings. Cronbach's alpha showed significant values for all the schemas. All of the factor models do not seem highly adequate, even if the hierarchical model has proven to be the most significant one. Furthermore, the questionnaire confirms the ability to discriminate between clinical and non-clinical groups and could represent a useful tool in the clinical practice. Limitations and future directions are discussed.

Borderline personality features as a potential moderator of the effect of anger and depressive rumination on shame, self-blame, and self-forgiveness

BACKGROUND AND OBJECTIVES

Recent studies have suggested that types of rumination differ on how they impact psychopathology. Few research studies, however, have compared the two types of rumination. The primary aim of this research was to examine the effects of anger rumination and depressive rumination on factors related to self-conscious experiences (shame, self-blame, self-forgiveness) and negative affect among individuals with varying levels of borderline personality disorder (BPD) features.

METHODS

Participants (N = 120), screened for BPD features, were randomly assigned to an anger or depressive mood induction followed by a rumination induction. Participants then completed self-report measures of emotional state and self-conscious experiences.

RESULTS

In both anger and depressive rumination conditions, participants reported significantly increased negative affect and decreased positive affect relative to their baseline measurements. Participants with elevated levels of BP features reported higher levels of self-blame and shame. In the low-BPD group, self-blame levels were higher following depressive rumination compared to anger rumination.

LIMITATIONS

Due to resource constraints this study lacked a control condition involving no rumination. The range of BPD features was also restricted due to the use of a non-clinical sample thereby limiting the ability to examine BPD features as a moderator.

CONCLUSIONS

Despite the limitations, the current study is one of few investigations comparing the differential effects of induced anger rumination and depressive rumination on affect and self-conscious experiences. This study also addresses an important gap in literature on the mechanisms by which rumination influences negative affect.

Anger in the UK Armed Forces: strong association with mental health, childhood antisocial behavior, and combat role

We assessed the strength of the association of several mental health problems, childhood difficulties, and combat role with anger, as well as the contribution of these factors to explain anger assessed by population attributable fraction (PAF). A total of 9885 UK service personnel, some of them deployed to Iraq and Afghanistan, participated in the study. There was a strong or intermediate association between cases and subthreshold cases of symptoms of posttraumatic stress disorder, psychological distress, multiple physical symptoms and alcohol misuse, having a combat role, childhood adversity, and childhood antisocial behavior with anger. The PAF for any mental health problem and combat role and childhood difficulties was 0.64 (95% confidence interval [CI], 0.56-0.70) and increased to 0.77 (95% CI, 0.69-0.83) if subthreshold cases were included. Anger is a frequent component of mental disorders; health care professionals need to be aware of the interference of anger in the management of mental illness and that anger infrequently presents as an isolated phenomenon.

Predictors of suicidal ideation in a community sample: roles of anger, self-esteem, and depression

The objective of this cross-sectional study was to investigate the relationships of anger, self-esteem, and depression with suicidal ideation. A survey was conducted in a wide range of community areas across Jeollabuk-do Province, Korea. A total of 2964 subjects (mean age=44.4yr) participated in this study. Hierarchical regression was used to investigate predictors of suicidal ideation in terms of their sociodemographic characteristics, depression, self-esteem, and anger. Hierarchical regression analyses revealed that anger and self-esteem were significantly associated with suicidal ideation regardless of age and after controlling for depression. Moderation analysis showed that the impact of anger on suicidal ideation was significantly greater among females than males in adolescents, but not in other age groups. Additionally, there were some differences in sociodemographic predictors of suicidal ideation among age groups. Predictors included gender and family harmony in adolescents, marital status and family harmony in middle-aged individuals, and economic status and family harmony in elderly individuals. Our results revealed that anger and self-esteem play important roles in suicidal ideation beyond the effect of depression. Development and implementation of preventive strategies, including management of anger and self-esteem, could possibly reduce suicidal ideation and subsequent suicide attempts.

Personality and depression: evidence of a possible mediating role for anger trait in the relationship between cooperativeness and depression

BACKGROUND

An increasingly growing area of empirical research has found consistent links between anger, depression, and temperament and character domains of personality, separately. However, precise nature of these relationships remains still unclear, and little is known about its underlying processes.

OBJECTIVES

The aim of our explorative research was to conduct a more detailed investigation into the relationships among depression, anger trait, and personality characteristics based on Cloninger's 7-factor personality theory in healthy individuals.

METHOD

In this preliminary study, 230 Italian undergraduates were investigated by using the Temperament and Character Inventory-Revised, the State-Trait Anger Expression Inventory-2, and the Beck Depression Inventory-II. Depression and cooperativeness were expected to have a negative and significant relationship and separate relationships with the trait-anger. Theoretically, a new hypothesis was that the trait-anger would mediate the relationship between depression and cooperativeness.

RESULTS

Zero-order and partial correlations and a path analysis based on Baron and Kenny's method (J Pers Soc Psychol.1986;51:1173-1182) for calculating multiple regression analyses were calculated. Consistent with the hypotheses, cooperativeness and depression were strongly associated; the trait-anger was significantly associated with both cooperativeness and depression, and the mediation model fit the data.

CONCLUSIONS

Behaviors related to the trait-anger could help to explain how depression and reduced cooperativeness are related each other.

Cognitive Vulnerabilities and Depression in Young Adults: An ROC Curves Analysis

Objectives and Methods. The aim of the present study was to evaluate, by means of receiver operating characteristic (ROC) curves, whether cognitive vulnerabilities (CV), as measured by three well-known instruments (the Beck Hopelessness Scale, BHS; the Life Orientation Test-Revised, LOT-R; and the Attitudes Toward Self-Revised, ATS-R), independently discriminate between subjects with different severities of depression. Participants were 467 young adults (336 females and 131 males), recruited from the general population. The subjects were also administered the Beck Depression Inventory-II (BDI-II). Results. Four first-order (BHS Optimism/Low Standard; BHS Pessimism; Generalized Self-Criticism; and LOT Optimism) and two higher-order factors (Pessimism/Negative Attitudes Toward Self, Optimism) were extracted using Principal Axis Factoring analysis. Although all first-order and second-order factors were able to discriminate individuals with different depression severities, the Pessimism factor had the best performance in discriminating individuals with moderate to severe depression from those with lower depression severity. Conclusion. In the screening of young adults at risk of depression, clinicians have to pay particular attention to the expression of pessimism about the future.