Hostname: page-component-6766d58669-wvcvf Total loading time: 0 Render date: 2026-05-23T21:55:03.281Z Has data issue: false hasContentIssue false
  • English
  • Français

Response style and severity and chronicity of depressive disorders in primary health care

Published online by Cambridge University Press:  23 March 2020

K. Riihimäki ,
M. Vuorilehto ,
P. Jylhä  and
E. Isometsä
K. Riihimäki
Affiliation:
Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland Health Care and Social Services, City of Järvenpää, PL 41, 04401Järvenpää, Finland
M. Vuorilehto
Affiliation:
Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland
P. Jylhä
Affiliation:
Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland
E. Isometsä*
Affiliation:
Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland
*
⁎ Corresponding author at:Department of Psychiatry, Faculty of Medicine, University of Helsinki, P.O. Box 22, 00014 Helsinki, Finland. Tel.: +358 9 471 63728; fax: +358 9 471 63735. E-mail address:erkki.isometsa@hus.fi (E. Isometsä).
Get access

Abstract

Background

Response styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.

Methods

In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).

Results

At five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.

Conclusions

Among primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

Keywords

DepressionResponse styleRuminationNeuroticismComorbidityPrimary care

Information

Type
Original article
Information
European Psychiatry , Volume 33 , Issue 1 , March 2016 , pp. 1 - 8
Copyright
Copyright © European Psychiatric Association 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Nolen-Hoeksema, S.Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol 1991; 100: 569–582CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S.Morrow, J.Fredrickson, B.L.Response styles and the duration of episodes of depressed mood. J Abnorm Psychol 1993; 102: 20–28CrossRefGoogle Scholar
Nolen-Hoeksema, S.Wisco, B.E.Lyubomirsky, S.Rethinking rumination. Perspect Psychol Sci 2008; 3: 400–424CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S.Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol 2012; 8: 161–187CrossRefGoogle ScholarPubMed
Wilkinson, P.O.Croudace, T.J.Goodyer, I.M.Rumination, anxiety, depressive symptoms and subsequent depression in adolescents at risk for psychopathology: a longitudinal cohort study. BMC Psychiatry 2013; 13: [250-244X-13-250]CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S.The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol 2000; 109: 504–511CrossRefGoogle ScholarPubMed
McLaughlin, K.A.Nolen-Hoeksema, S.Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther 2011; 49: 186–193CrossRefGoogle ScholarPubMed
Roelofs, J.Huibers, M.Peeters, F., et al.Rumination and worrying as possible mediators in the relation between neuroticism and symptoms of depression and anxiety in clinically depressed individuals Behav Res Ther 2008; 46: 1283–1289CrossRefGoogle ScholarPubMed
Armey, M.F.Fresco, D.M.Moore, M.T., et al.Brooding and pondering: isolating the active ingredients of depressive rumination with exploratory factor analysis and structural equation modeling Assessment 2009; 16: 315–327CrossRefGoogle ScholarPubMed
Watkins, E.R.Depressive rumination and co-morbidity: evidence for brooding as a transdiagnostic process. J Ration Emot Cogn Behav Ther 2009; 27: 160–175CrossRefGoogle ScholarPubMed
Treynor, WGonzales, RNolen-Hoeksema, S.Rumination reconsidered: a psychometric analysis. Cogn Ther Res 2003;27:247–59.CrossRefGoogle Scholar
Whitmer, A.J.Gotlib, I.H.Brooding and reflection reconsidered: a factor analytic examination of rumination in currently depressed, previously depressed, and never depressed individuals. Cogn Ther Res 2011; 35: 99–107CrossRefGoogle Scholar
Pervin, L.A.Cervone, D.John, O.P.Personality: theory and research 9th ed. 2005; Wiley; Hoboken, NJ:Google Scholar
Ormel, J.Jeronimus, B.F.Kotov, R., et al.Neuroticism and common mental disorders: meaning and utility of a complex relationship Clin Psychol Rev 2013; 33: 686–697CrossRefGoogle ScholarPubMed
Ormel, J.Bastiaansen, A.Riese, H., et al.The biological and psychological basis of neuroticism: current status and future directions Neurosci Biobehav Rev 2013; 37: 59–72CrossRefGoogle ScholarPubMed
Kendler, K.S.Neale, M.C.Kessler, R.C., et al.A longitudinal twin study of personality and major depression in women Arch Gen Psychiatry 1993; 50: 853–862CrossRefGoogle ScholarPubMed
Kendler, K.S.Gatz, M.Gardner, C.O.Pedersen, N.L.Personality and major depression: a Swedish longitudinal, population-based twin study. Arch Gen Psychiatry 2006; 63: 1113–1120CrossRefGoogle ScholarPubMed
Ormel, J.Oldehinkel, A.J.Vollebergh, W.Vulnerability before, during, and after a major depressive episode: a 3-wave population-based study. Arch Gen Psychiatry 2004; 61: 990–996CrossRefGoogle Scholar
Boyce, P.Parker, G.Barnett, B., et al.Personality as a vulnerability factor to depression Br J Psychiatry 1991; 159: 106–114CrossRefGoogle ScholarPubMed
Clayton, P.J.Ernst, C.Angst, J.Premorbid personality traits of men who develop unipolar or bipolar disorders. Eur Arch Psychiatry Clin Neurosci 1994; 243: 340–346CrossRefGoogle ScholarPubMed
Hirschfeld, R.M.Klerman, G.L.Lavori, P., et al.Premorbid personality assessments of first onset of major depression Arch Gen Psychiatry 1989; 46: 345–350CrossRefGoogle ScholarPubMed
Jylha, P.Melartin, T.Rytsala, H.Isometsa, E.Neuroticism, introversion, and major depressive disorder–traits, states, or scars?. Depress Anxiety 2009; 26: 325–334CrossRefGoogle ScholarPubMed
Kendell, R.E.DiScipio, W.J.Eysenck personality inventory scores of patients with depressive illnesses. Br J Psychiatry 1968; 114: 767–770CrossRefGoogle ScholarPubMed
Bagby, R.M.Parker, J.D.A.Relation of rumination and distraction with neuroticism and extraversion in a sample of patients with major depression. Cogn Ther Res 2001; 25: 91–102CrossRefGoogle Scholar
Shull, A.M.Rumination mediates impact of personality on depression [Honors Thesis] 2014 University of MichiganGoogle Scholar
Spasojevic, J.Alloy, L.B.Rumination as a common mechanism relating depressive risk factors to depression. Emotion 2001; 1: 25–37CrossRefGoogle ScholarPubMed
Aldao, A.Nolen-Hoeksema, S.Schweizer, S.Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev 2010; 30: 217–237CrossRefGoogle ScholarPubMed
Knowles, R.Tai, S.Christensen, I.Bentall, R.Coping with depression and vulnerability to mania: a factor analytic study of the Nolen-Hoeksema (1991) Response Styles Questionnaire. Br J Clin Psychol 2005; 44: 99–112CrossRefGoogle ScholarPubMed
Just, N.Alloy, L.B.The response styles theory of depression: tests and an extension of the theory. J Abnorm Psychol 1997; 106: 221–229CrossRefGoogle Scholar
Nolen-Hoeksema, S.Parker, L.E.Larson, J.Ruminative coping with depressed mood following loss. J Pers Soc Psychol 1994; 67: 92–104CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S.McBride, A.Larson, J.Rumination and psychological distress among bereaved partners. J Pers Soc Psychol 1997; 72: 855–862CrossRefGoogle ScholarPubMed
McEvoy, P.M.Watson, H.Watkins, E.R.Nathan, P.The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct. J Affect Disord 2013; 151: 313–320CrossRefGoogle ScholarPubMed
Lam, D.Smith, N.Checkley, S., et al.Effect of neuroticism, response style and information processing on depression severity in a clinically depressed sample Psychol Med 2003; 33: 469–479CrossRefGoogle Scholar
Bagby, R.M.Rector, N.A.Segal, Z.V., et al.Rumination and distraction in major depression: assessing response to pharmacological treatment J Affect Disord 1999; 55: 225–229CrossRefGoogle ScholarPubMed
Donaldson, C.Lam, D.Rumination, mood and social problem-solving in major depression. Psychol Med 2004; 34: 1309–1318CrossRefGoogle ScholarPubMed
Kasch, K.L.Klein, D.N.Lara, M.E.A construct validation study of the Response Styles Questionnaire Rumination Scale in participants with a recent-onset major depressive episode. Psychol Assess 2001; 13: 375–383CrossRefGoogle ScholarPubMed
Kuehner, C.Huffziger, S.Response styles to depressed mood affect the long-term course of psychosocial functioning in depressed patients. J Affect Disord 2012; 136: 627–633CrossRefGoogle ScholarPubMed
Kuehner, C.Huffziger, S.Factors predicting the long-term illness course in a cohort of depressed inpatients. Eur Arch Psychiatry Clin Neurosci 2013; 263: 413–423CrossRefGoogle Scholar
Schmaling, K.B.Dimidjian, S.Katon, W.Sullivan, M.Response styles among patients with minor depression and dysthymia in primary care. J Abnorm Psychol 2002; 111: 350–356CrossRefGoogle ScholarPubMed
Teismann, T.Steinfeld, B.Willutzki, U.Michalak, J.Rumination and distraction: selected findings related to the response styles theory. Psychother Psychosom Med Psychol 2011; 61: 126–132CrossRefGoogle ScholarPubMed
Vuorilehto, M.Melartin, T.Isometsa, E.Depressive disorders in primary care: recurrent, chronic, and co-morbid. Psychol Med 2005; 35: 673–682CrossRefGoogle ScholarPubMed
Riihimaki, K.A.Vuorilehto, M.S.Melartin, T.K.Isometsa, E.T.Five-year outcome of major depressive disorder in primary health care Psychol Med 2011 1–11Google ScholarPubMed
Nolen-Hoeksema, S.Morrow, J.A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. J Pers Soc Psychol 1991; 61: 115–121CrossRefGoogle ScholarPubMed
Eysenck, H.Eysenck, S.Manual of the Eysenck Personality Inventory London: University of London Press Ltd; 1964Google Scholar
Floderus, B.Psychosocial factors in relation to coronary heart disease and associated risk factors. Nordisk Hygienisk Tidskrift 1974; Suppl. 6:1–148Google Scholar
Roberts, J.E.Gilboa, E.Gotlib, I.H.Ruminative response style and vulnerability to episodes of dysphoria: gender, neuroticism, and episode duration. Cogn Ther Res 1998; 22: 401–423CrossRefGoogle Scholar
Miranda, R.Nolen-Hoeksema, S.Brooding and reflection: rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behav Res Ther 2007; 45: 3088–3095CrossRefGoogle Scholar
Surrence, K.Miranda, R.Marroquin, B.M.Chan, S.Brooding and reflective rumination among suicide attempters: cognitive vulnerability to suicidal ideation. Behav Res Ther 2009; 47: 803–808CrossRefGoogle ScholarPubMed
Johnson, D.P.Whisman, M.A.Gender differences in rumination: a meta-analysis. Pers Individ Dif 2013; 55: 367–374CrossRefGoogle ScholarPubMed
Muris, P.Roelofs, J.Rassin, E., et al.Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Pers Individ Dif 2005; 39: 1105–1111CrossRefGoogle Scholar
Van Loey, N.E.Oggel, A.Goemanne, A.S., et al.Cognitive emotion regulation strategies and neuroticism in relation to depressive symptoms following burn injury: a longitudinal study with a 2-year follow-up. J Behav Med 2014; 37: 839–848CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S.Sex differences in unipolar depression: evidence and theory. Psychol Bull 1987; 101: 259–282CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.