Preoperational Thinking as a Measure of Social Cognition Is Associated With Long-Term Course of Depressive Symptoms. A Longitudinal Study Involving Patients With Depression and Healthy Controls.

BACKGROUND: Deficits in social cognition, referred to as preoperational thinking, are assumed to play a key role in the pathogenesis of persistent depression. The aim of this study was to explore the effect of preoperational thinking on the two-year course of depressive symptoms in a sample of persistently depressed, episodically depressed as well as healthy participants. METHODS: We recruited 43 persistently depressed participants, 26 episodically depressed participants and 16 healthy control participants. Preoperational thinking was assessed at baseline with the Luebeck Questionnaire for Recording Preoperational Thinking. Over the period of two years, the course of depressive symptom severity was measured every three months using the Inventory of Depressive Symptomatology. RESULTS: Using linear mixed model analysis we found a significant effect for the influence of preoperational thinking on the severity of depressive symptoms in the observation period. We found a non-significant statistical trend for an association of preoperational thinking with the change of depressive symptom severity. CONCLUSION: Our analyses suggest that a high degree of preoperational thinking is associated with a higher severity of depressive symptoms and possibly less symptom improvement. These findings support the notion that preoperational thinking is a relevant factor for the further course of depression and might indeed contribute to the maintenance of persistent depression.

Do interpersonal fears mediate the association between childhood maltreatment and interpersonal skills deficits? A matched cross-sectional analysis.

Objective: Childhood maltreatment, interpersonal fear and a specific kind of interpersonal skills deficit (preoperational thinking) have all been associated with persistent depressive disorder (PDD). We hypothesize that interpersonal fears mediate the association between childhood maltreatment and preoperational thinking.Method: A total of 108 matched participants have been examined cross-sectionally (31 healthy controls, 30 patients with episodic depression and 47 patients with PDD) with the following instruments: the Childhood Trauma Questionnaire (CTQ-SF), a measure of interpersonal fear (CBASP Interpersonal Questionnaire) and the Lübeck Questionnaire of Preoperational Thinking.Results: Patients with PDD reported significantly more childhood maltreatment than patients with episodic depression (d = 0.65) and healthy controls (d = 1.29). They also had more interpersonal fears (d = 0.71 and d = 2.11 respectively) and higher levels of preoperational thinking (d = 0.90 and d = 2.78 respectively). The association between childhood maltreatment and preoperational thinking was mediated through interpersonal fears.Conclusions: Our findings might have important implications for psychotherapy of PDD because they demonstrate how specific problems in social interactions can be associated with interpersonal fears that arise secondary to childhood maltreatment.

Development and psychometric evaluation of the Interactive Test of Interpersonal Behavior (ITIB): a pilot study examining interpersonal deficits in chronic depression.

Chronic depression is assumed to be caused and maintained by interpersonal deficits. We describe the development and psychometric evaluation of the Interactive Test of Interpersonal Behavior (ITIB) that we developed for self-assessment of these deficits. Participants with chronic depression (CD, N = 15), episodic depression (ED, N = 15) and healthy controls (HC, N = 15) participated in this pilot study. They completed the ITIB and a number of pen and paper questionnaires including the Lübeck Questionnaire of Preoperational Thinking (LQPT) and the inventory of interpersonal problems (IIP). The ITIB was highly acceptable for use in these participants. Internal consistency for the ITIB was adequate for group comparisons (Cronbach's alpha = 0.649). Item-total correlations indicated adequate discriminatory power of five of the six items. The ITIB correlated moderately with the LQPT (r = 0.524) and the IIP (r = -0.568). The ITIB score differed significantly between the diagnostic groups (ANOVA F(2,42) = 6.22, p = 0.004). It was the only measure that - albeit at a trend level - was associated with diagnostic group (CD vs. ED) on multinomial logistic regression analysis (B = 0.049 ± 0.029; OR 1.051; p = 0.088). We found preliminary evidence that the ITIB is an acceptable and psychometrically adequate measure of interpersonal behavior that distinguishes between patients with CD and patients with ED. If replicated with an improved version of the test, our results could support the hypothesis that having interpersonal problems is a core deficit in patients with CD.