Catharina Elisabeth Arfwedson Wang

Mental habits: Metacognitive reflection on negative self-thinking

In 8 studies, the authors investigated negative self-thinking as a mental habit. Mental content (negative self-thoughts) was distinguished from mental process (negative self-thinking habit). The negative self-thinking habit was assessed with a metacognitive instrument (Habit Index of Negative Thinking; HINT) measuring whether negative self-thoughts occur often, are unintended, are initiated without awareness, are difficult to control, and are self-descriptive. Controlling for negative cognitive content, the authors found that negative self-thinking habit was distinct from rumination and mindfulness, predicted explicit as well as implicit low self-esteem (name letter effect), attenuated a positivity bias in the processing of self-relevant stimuli, and predicted anxiety and depressive symptoms 9 months later. The results support the assumption that metacognitive reflection on negative self-thinking as mental habit may play an important role in self-evaluative processes.

Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial.

AIMS To compare depressive symptoms in participants with low and high serum 25-hydroxyvitamin D (25(OH)D) levels and to examine whether supplementation with vitamin D(3) would improve symptoms in those with low serum 25(OH)D levels. METHOD Participants with low 25(OH)D levels were randomised to either placebo or 40 000 IU vitamin D(3) per week for 6 months. Individuals with high serum 25(OH)D levels were used as nested controls. Depressive symptoms were evaluated with the Beck Depression Inventory, Hospital Anxiety and Depression Scale, Seasonal Pattern Assessment Scale and Montgomery-Åsberg Depression Rating Scale. The study was registered at ClinicalTrials.gov (NCT00960232). RESULTS Participants with low 25(OH)D levels (n = 230) at baseline were more depressed (P<0.05) than participants with high 25(OH)D levels (n = 114). In the intervention study no significant effect of high-dose vitamin D was found on depressive symptom scores when compared with placebo. CONCLUSIONS Low levels of serum 25(OH)D are associated with depressive symptoms, but no effect was found with vitamin D supplementation.

The Structure of Maladaptive Schemas: A Confirmatory Factor Analysis and a Psychometric Evaluation of Factor-Derived Scales

One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. Young (1990). Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a four-factor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test–retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial

The Internet has the potential to increase the capacity and accessibility of mental health services. This study aimed to investigate whether an unguided Internet-based self-help intervention delivered without human support or guidance can reduce symptoms of depression in young people at risk of depression. The study also aimed to explore the usage of such sites in a real-life setting, to estimate the effects of the intervention for those who received a meaningful intervention dose and to evaluate user satisfaction. Young adults were recruited by means of a screening survey sent to all students at the University of Tromsø. Of those responding to the survey, 163 students (mean age 28.2 years) with elevated psychological distress were recruited to the trial and randomized to an Internet intervention condition or the waiting list control group. The Internet condition comprised a depression information website and a self-help Web application delivering automated cognitive behavioural therapy. The participants in the waiting list condition were free to access formal or informal help as usual. Two-thirds of the users who completed the trial initially reported an unmet need for help. The findings demonstrated that an unguided intervention was effective in reducing symptoms of depression and negative thoughts and in increasing depression literacy in young adults. Significant improvements were found at 2-month follow up. Internet-based interventions can be effective without tracking and thus constitute a minimal cost intervention for reaching a large number of people. User satisfaction among participants was high.

Early maladaptive schemas, temperament and character traits in clinically depressed and previously depressed subjects.

UNLABELLED The Young Schema Questionnaire (YSQ) and the Temperament and Character Inventory (TCI) have been suggested as vulnerability markers for depression. One- hundred forty clinically depressed subjects(CD), previously depressed subjects(PD) and never depressed (ND) controls completed the YSQ, the TCI and the Beck Depression Inventory. Results showed that CD and PD differed significantly on early maladaptive schemas, temperament and character traits compared with ND. In accordance with previous research, higher levels of harm avoidance and lower levels of self-directedness were found in CD and in recovered PD. Moreover, CD and PD showed substantial variability in the scores on the YSQ and the TCI when controlling for concurrent depression severity. In multiple regression analyses, YSQ domain scales of disconnection, impaired autonomy, restricted self-expression and impaired limits emerged as significant predictors of depression severity. Likewise, as concerns TCI higher order scales, high harm avoidance, low self-directedness and high persistence emerged as significant predictors of depression severity. Harm avoidance was positively related to several early maladaptive schemas (EMSs), whereas self-directedness was negatively related to a majority of the EMSs. Our findings indicate the presence of maladaptive personality characteristics in CD and PD. Longitudinal studies are needed to establish their causal role in relation to first-onset and recurrent depression. KEY PRACTITIONER MESSAGE *Early maladaptive schemas, high harm [correction made here after initial online publication] avoidance and low self-directedness may be a part of vulnerability to depression. *The finding of these personality characteristics in subjects recovered from depression indicates malfunctioning to some degree. *Addressing such characteristics in therapy should be considered in order to prevent and treat depression from its relapsing and recurring course.

Stability of dysfunctional attitudes and early maladaptive schemas: A 9-year follow-up study of clinically depressed subjects

The Dysfunctional Attitude Scale (DAS) and the Young Schema Questionnaire (YSQ) have been suggested as relatively stable vulnerability markers for depression and entrenched psychological disorders, respectively. One-hundred-and-forty-nine clinically depressed (CDs), previously depressed (PDs) and never-depressed subjects (NDs) completed the DAS, the YSQ and the Beck Depression Inventory in the index study and were followed-up nine years later. Results showed: (1) Elevated scores in CDs and PDs as compared to NDs; (2) Some stability of depressive symptoms; (3) Significant moderate test-retest correlations for DAS scales and YSQ scales Disconnection and Impaired Limits, also after controlling for depression severity; (4) A significant reduction in mean score for DAS total, Approval by Others and YSQ scales Disconnection and Impaired Limits; (5) Significant correlations between DAS and YSQ scales. Our results support a state-trait vulnerability model of depression comprising stable differences in availability of dysfunctional attitudes and early maladaptive schemas, but also fluctuating differences in accessibility of those schemas during the course of depression. The findings point to the significance of the YSQ scales as vulnerability markers for depression in addition to the more established DAS scales.

A study of the psychometric properties of the Beck Depression Inventory-II, the Montgomery and Åsberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale in a sample from a healthy population

The objective of this study is to evaluate internal consistency and psychometric properties of the Hospital Anxiety and Depression Scale (HADS), the Beck Depression inventory-II (BDI-II) and the Montgomery and Åsberg Depression Rating Scale (MADRS) for screening for major depressive episode (MDE) in a selected sample from a healthy population. Participants answered the BDI-II and the HADS questionnaires and were interviewed with MADRS. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Axis I Disorders-Clinician Version (SCID-CV) was used to diagnose MDE. Current MDE was diagnosed in 20 (6%) of the 357 participants. All three scales including the depression sub-scale for HADS had high area under the receiver operating characteristics curve (ROC) (AUC) (0.84-0.87), and internal consistency was also high for all scales (0.75-0.89). Optimal cut-off for MDE was ≥ 12 for BDI-II, MADRS ≥ 8, HADS total ≥ 9, and HADS-D ≥ 4, which all resulted in sensitivities = 85% and specificities > 78%. Diagnostic accuracy was low on all depression scales (Cohens kappa = 0.20-0.40). Reports of the properties of depression scales in a healthy population are limited. We found BDI-II, HADS and MADRS to be acceptable as screening instruments for MDE in a selected sample from healthy population with recommend cut-offs as mentioned above.

Cognitive function in unipolar major depression: a comparison of currently depressed, previously depressed, and never depressed individuals.

There is a lack of consensus upon a conclusive cognitive profile characterizing unipolar major depression. Currently depressed (n = 37), recovered previously depressed (n = 81), and never depressed controls (n = 50) underwent assessment of executive functions, working memory, attention, and psychomotor speed. Currently depressed yielded significantly lower test scores than previously and never depressed subjects on a measure of working memory. Both currently depressed and previously depressed scored significantly lower than never depressed subjects on measures of processing speed. Recurrent depressed performed similarly to subjects with a single depressive episode. These findings indicate a mild and limited cognitive impairment during the course of a mild to moderate major depressive disorder among relatively young adults. Impaired processing speed should be considered in further studies as a potential irreversible marker for recurrent depression.

Verbal learning and memory in depression: A 9-year follow-up study

Memory impairment is often associated with depression. However, the literature is not uniform whether such impairment constitutes state and/or trait characteristics. One-hundred-and-twelve clinically depressed (CDs), previously depressed (PDs), and never depressed (NDs) subjects (T2 diagnostic status),were assessed with the California Verbal Learning Test (CVLT) at T1 and re-assessed 9 years later with the revised version, CVLT-II. At T1 no deficit in verbal memory between CDs and PDs compared to NDs was found, in which the majority of the subjects were younger adults. At follow-up the majority of CDs and PDs had suffered one or several recurrent depressive episodes. Repeated-measures analysis of variance showed, in particular and irrespective of group, a significant decline in recall measures over time. CDs, PDs and NDs showed the same pattern of verbal memory performance over time with the exception of Short Delayed Free Recall, in which CDs and PDs showed a significant decline in performance at follow-up compared to NDs. Likewise, subjects with recurrent depression performed comparable to subjects with a single episode over the course of follow-up. Our results suggest that individuals with mild to moderate unipolar depression may not be significantly affected by verbal memory impairments over the long-term course. The comparability of the versions of the CVLT is addressed.

Depression and Vulnerability As Assessed by the Rorschach Method

We examined clinically depressed (CD; n = 16), previously depressed (PD; n = 19) and never depressed (ND; n = 18) individuals on 13 theoretically selected Rorschach (Exner, 1993; Rorschach, 1942) variables and on the Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979). The group assignment was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). We tested 2 contradictory models for depressive vulnerability, Becks (Clark & Beck, 1999) and Miranda and Personss (1988; Persons & Miranda, 1992), in a planned comparison design with focused contrasts. The CDs significantly contrasted the combined group of NDs and the PDs in a pathological direction on 8 of the 13 Rorschach variables and on the BDI. However, the combined group of CDs and PDs also significantly contrasted the NDs in a pathological direction on 3 of these Rorschach variables and on the BDI. In addition, logistic regression analyses indicated that Rorschach indexes significantly improved the prediction of major depression above and beyond that achieved by the BDI. The findings show that the Rorschach method was able to identify (a) cognitive and aggressive disturbances that are present in individuals who are actively depressed but not in individuals who have been depressed in the past or never been depressed and (b) affective and coping disturbances that are present in depressed individuals and to some degree in PD individuals but not in individuals who have not experienced depression. We discuss the scanty evidence of psychological disturbances in PD individuals, as measured with the Rorschach, in relation to the mood-state dependent hypothesis of Miranda and Persons (1988; Persons & Miranda, 1992).