Jennifer L. Hames

Interpersonal Processes in Depression

Humans have an intrinsic need for social connection; thus, it is crucial to understand depression in an interpersonal context. Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases their risk for future depression. In this review, we summarize the interpersonal characteristics, risk factors, and consequences of depression in the context of the relevant theories that address the role of interpersonal processes in the onset, maintenance, and chronicity of depression. Topics reviewed include social skills, behavioral features, communication behaviors, interpersonal feedback seeking, and interpersonal styles as they relate to depression. Treatment implications are discussed in light of the current research on interpersonal processes in depression, and the following future directions are discussed: developing integrative models of depression, improving measurement of interpersonal constructs, examining the association between interpersonal processes in depression and suicide, and tailoring interventions to target interpersonal processes in depression.

Status update: maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms.

BACKGROUND The current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms. METHODS We tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks. RESULTS Results provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly. LIMITATIONS Limitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample. CONCLUSIONS The results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology.

Development and Validation of a Brief Self-Report Measure of Agitation: The Brief Agitation Measure

Emerging evidence indicates that agitation is an ominous precursor to imminent death by suicide, yet measures of it are few, and to our knowledge, no self-report measure of agitation exists. To fill this gap, we have developed the Brief Agitation Measure (BAM), which is designed as a brief measure to assess agitation. In this article, we provide preliminary evidence from 2 studies examining the reliability and validity of the BAM in an undergraduate sample as well as a clinical sample. We close with a discussion of the limitations of the studies and implications of our findings.

A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning.

Objectives: Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. Method: At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery–Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. Results: Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. Conclusions: EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery–Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Cognitive Vulnerability to Depression Can Be Contagious

Cognitive vulnerability is a potent risk factor for depression. Individual differences in cognitive vulnerability solidify in early adolescence and remain stable throughout the life span. However, stability does not mean immutability. We hypothesized that cognitive vulnerability would be susceptible to change during major life transitions when social milieus undergo significant changes (e.g., moving to college). Specifically, we tested the hypothesis that cognitive vulnerability could change via a contagion effect. We tested this hypothesis using a prospective longitudinal design with a sample of randomly assigned college freshmen roommate pairs (103 pairs). Results supported the hypotheses. Participants who were randomly assigned to a roommate with high levels of cognitive vulnerability were likely to “catch” their roommate’s cognitive style and develop higher levels of cognitive vulnerability. Moreover, those who experienced an increase in cognitive vulnerability had significantly greater levels of depressive symptoms over the prospective interval than those who did not.

Too Much of a Good Thing: Testing the Efficacy of a Cognitive Bias Modification Task for Cognitively Vulnerable Individuals

A growing body of research indicates that cognitive bias modification (CBM) may be an effective intervention for individuals with anxiety. However, few studies have tested whether CBM works for other disorders characterized by negative cognitive biases such as depression. This experiment tested the efficacy of CBM for altering depressogenic self-worth biases. Consistent with hypotheses, results showed that CBM was more effective than a control condition in teaching participants a more adaptive cognitive style (i.e., increased attention for adaptive self-worth stimuli). Those who successfully learned a more adaptive style reported fewer depressive symptoms and exhibited greater persistence (i.e., less helplessness) on a difficult laboratory task. However, the task proved difficult for cognitively vulnerable participants; they were not able to maintain their new learning over the entire course of the CBM training. Rather, their negative cognitive bias began to re-emerge after only 20 learning trials. These results indicate that CBM attention training might be most effective in reducing cognitive vulnerability when initially used in small doses.

The interpersonal effects of Facebook reassurance seeking.

BACKGROUND Social networking sites like Facebook represent a potentially valuable means for individuals with low self-esteem or interpersonal difficulties to connect with others; however, recent research indicates that individuals who are most in need of social benefits from Facebook may be ineffective in their communication strategies, and thereby sabotage their potential to benefit interpersonally. The current study tested whether reassurance seeking via Facebook negatively influenced self-esteem, and whether this change in self-esteem mediated the relationship between Facebook reassurance seeking and greater thwarted belongingness and perceived burdensomeness. METHOD Participants completed measures online at two time-points approximately 24 days apart. RESULTS Results provided evidence that Facebook reassurance seeking predicted lower levels of self-esteem, which in turn predicted increased feelings that one does not belong and that one is a burden. LIMITATIONS Key limitations to this study include our use of a predominantly young, female, Caucasian sample, a novel reassurance seeking measure, and only evaluating two time points. CONCLUSIONS These results suggest that Facebook usage has the potential for negative and far-reaching influences on ones interpersonal functioning.

Acute suicidal affective disturbance: factorial structure and initial validation across psychiatric outpatient and inpatient samples

BACKGROUND A new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients. METHODS Two samples of psychiatric outpatients (N=343, aged 18-71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15-99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning. RESULTS Across both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders. LIMITATIONS This study utilized cross-sectional data and did not use a standardized measure of ASAD. CONCLUSIONS ASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk.

Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students

STUDY OBJECTIVES Suicide is a serious public health problem, and suicide rates are particularly high in South Korea. Insomnia has been identified as a risk factor for suicidal ideation; however, little is known about the mechanisms accounting for this relationship in this population. Based on the premise that insomnia can be lonely (e.g., being awake when everyone else is asleep), the purpose of this study was to examine whether greater insomnia severity would be associated with higher levels of thwarted belongingness and suicidal ideation, and whether thwarted belongingness would mediate the relationship between insomnia and suicidal ideation. METHODS Predictions were tested in a sample of 552 South Korean young adults who completed self-report measures of insomnia severity, suicidal ideation, and thwarted belongingness. RESULTS Greater insomnia symptom severity was significantly and positively associated with thwarted belongingness and suicidal ideation. Mediation analyses revealed that thwarted belongingness significantly accounted for the relationship between insomnia severity and suicidal ideation. CONCLUSIONS These findings highlight the potential importance of monitoring and therapeutically impacting insomnia and thwarted belongingness to help reduce suicide risk.