Samantha L. Connolly

Rumination prospectively predicts executive functioning impairments in adolescents

BACKGROUND AND OBJECTIVES The current study tested the resource allocation hypothesis, examining whether baseline rumination or depressive symptom levels prospectively predicted deficits in executive functioning in an adolescent sample. The alternative to this hypothesis was also evaluated by testing whether lower initial levels of executive functioning predicted increases in rumination or depressive symptoms at follow-up. METHODS A community sample of 200 adolescents (ages 12-13) completed measures of depressive symptoms, rumination, and executive functioning at baseline and at a follow-up session approximately 15 months later. RESULTS Adolescents with higher levels of baseline rumination displayed decreases in selective attention and attentional switching at follow-up. Rumination did not predict changes in working memory or sustained and divided attention. Depressive symptoms were not found to predict significant changes in executive functioning scores at follow-up. Baseline executive functioning was not associated with change in rumination or depression over time. CONCLUSIONS Findings partially support the resource allocation hypothesis that engaging in ruminative thoughts consumes cognitive resources that would otherwise be allocated towards difficult tests of executive functioning. Support was not found for the alternative hypothesis that lower levels of initial executive functioning would predict increased rumination or depressive symptoms at follow-up. Our study is the first to find support for the resource allocation hypothesis using a longitudinal design and an adolescent sample. Findings highlight the potentially detrimental effects of rumination on executive functioning during early adolescence.

Information Processing Biases Concurrently and Prospectively Predict Depressive Symptoms in Adolescents: Evidence from a Self-Referent Encoding Task

Negative information processing biases have been hypothesised to serve as precursors for the development of depression. The current study examined negative self-referent information processing and depressive symptoms in a community sample of adolescents (N = 291, Mage at baseline = 12.34 ± 0.61, 53% female, 47.4% African-American, 49.5% Caucasian and 3.1% Biracial). Participants completed a computerised self-referent encoding task (SRET) and a measure of depressive symptoms at baseline and completed an additional measure of depressive symptoms nine months later. Several negative information processing biases on the SRET were associated with concurrent depressive symptoms and predicted increases in depressive symptoms at follow-up. Findings partially support the hypothesis that negative information processing biases are associated with depressive symptoms in a nonclinical sample of adolescents, and provide preliminary evidence that these biases prospectively predict increases in depressive symptoms.

Associations between sleep disturbance, cognitive functioning and work disability in Bipolar Disorder

Bipolar Disorder (BD) is associated with impairment in a number of areas including poor work functioning, often despite the remission of mood symptoms. The present study aimed to examine the role of sleep disturbance and cognitive functioning in occupational impairment in BD. Twenty-four euthymic BD participants and 24 healthy control participants completed a week of prospective assessment of sleep disruption via self-report and actigraphy, a battery of neuropsychological tests of executive functioning, working memory, and verbal learning, and assessments of work functioning. BD participants experienced significantly poorer cognitive functioning as well as greater months of unemployment and greater incidence of being fired than controls. Moderation analyses revealed that both poor sleep and cognitive functioning were associated with poor work performance in BD participants, but not control participants. Sleep and cognitive functioning may be impaired in euthymic BD and are associated with poor work functioning in this population. More research should be conducted to better understand how sleep and cognitive functioning may interact in BD.

Negative cognitive style interacts with negative life events to predict first onset of a major depressive episode in adolescence via hopelessness.

The hopelessness theory of depression is a prominent account of depression that posits that individuals with a negative inferential style are more likely to become hopeless when they experience negative life events (NLEs) and that hopelessness is a proximal cause of depression. There is strong evidence supporting the role of a negative inferential style in the pathogenesis of major depression; however, substantially less is known about the proposed role played by hopelessness. The cornerstone hypothesis of hopelessness theory, that hopelessness is a proximal cause of major depression, is largely untested. A small number of studies have generated inconclusive evidence that hopelessness mediates the relationship between a negative inferential style, NLEs, and depressive symptoms. The current study tested whether hopelessness mediates the relationship between a Negative Inferential Style × NLEs interaction and (a) 1st onset of a major depressive episode (MDE) and (b) depressive symptoms in a fully prospective design. A diverse sample of 249 adolescents, ages 12–13 years, were assessed at baseline and at 2 or more follow-ups over approximately 2.5 years. Self-report as well as life event and diagnostic interviews assessed inferential style, NLEs, hopelessness, depressive symptoms, and depression diagnosis. Moderated mediation analyses indicated that hopelessness mediated the relationship between a Negative Inferential Style × NLEs interaction and (a) 1st onset of an MDE as well as (b) depressive symptoms at higher levels of multiple types of NLEs. The current study demonstrates the validity of the hopelessness theory of depression and its continued clinical relevance in predicting depression in adolescence.

Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Background Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology.

Negative Event Recall as a Vulnerability for Depression: Relationship Between Momentary Stress-Reactive Rumination and Memory for Daily Life Stress:

The current research utilized ecological momentary assessment (EMA) methodology to test the hypotheses that (a) engaging in greater rumination following stress (stress-reactive rumination, SRR) would lead to improved stressor recall and (b) this improved memory for stress would predict increases in depressive symptoms. One hundred and twenty-one participants received smartphone alerts in which they reported on their experience of negative life events (NLEs) as well as SRR and depressed mood after event occurrence. NLEs followed by increased SRR were more likely to be recalled 2 weeks later. Furthermore, individuals who endorsed and recalled more stressors displayed increased depressive symptoms. Contrary to hypotheses, no evidence was found for a mediational effect in which SRR predicted depressive symptoms and was mediated by memory for NLEs. Current findings demonstrate a relationship between rumination following stress and the subsequent recall of those stressors and support the role of negative event recall as a vulnerability factor for depression.