Interpersonal Factors, Peer Relationship Stressors, and Gender Differences in Adolescent Depression.

PURPOSE OF REVIEW: Compared to boys, girls value close relationships more. Thus, heightened affiliative proclivities may serve as a particularly salient psychosocial risk factor for depression in adolescent girls. The purpose of this review is to examine whether the preponderance of depression in girls is because of gender differences in interpersonal vulnerabilities and peer relationship stressors and/or in the associations between these factors and depression. RECENT FINDINGS: Girls (vs. boys) exhibit higher levels of co-rumination and affective empathy, but not excessive reassurance-seeking. The prevalence of different forms of peer relationship stressors (e.g., peer victimization) varies by gender depending on the specific type. Evidence is mixed regarding gender differences in the association between peer victimization and depression. Gender differences in the association between peer victimization and depression not only depend on peer victimization subtype but also on the country. Most studies were conducted in non-clinical samples, highlighting the need for future research to assess major depressive disorder (not just depressive symptoms). Future research should also assess interpersonal factors (e.g., co-rumination) and peer relationship stressors together.

Growth mindset and responses to acute stress.

Individuals with high levels of growth mindsets believe that attributes are malleable. Although links between acute stress responses and growth mindsets of thought, emotion, and behaviour are central to the conceptualisation of psychological disorders and their treatment, such links have yet to be examined. Undergraduate participants (N = 135) completed a modified Trier Social Stress Test (TSST), and their salivary cortisol and anxiety were assessed throughout the session. Hierarchical linear models revealed that higher growth mindset of behaviour was associated with lower cortisol levels at 25-min after the TSST onset (i.e. peak cortisol stress reactivity) in men, but not in women. Considering one's gender may be critical in understanding the relationship between growth mindset and stress responses.

Gender differences in aggression: A multiplicative function of outward anger expression.

Individuals with a higher (vs. lower) tendency to outwardly express anger (i.e., greater anger-out) generally exhibit greater aggression; men (vs. women) also tend to be more aggressive. Although the general aggression model posits that multiple person variables trigger aggression, the combined effects of multiple person variables are poorly understood. Thus, the aim of this study was to examine the nature of the relation between gender, anger-out, and reactive aggression. In particular, we were interested in whether the effects of anger-out and gender are additive or multiplicative. Specifically, we tested whether men exhibit higher levels of aggression than women at a consistent ratio across all levels of anger-out (i.e., the multiplicative model) or at a fixed amount depending on the level of anger-out (i.e., the additive interaction model). To this end, undergraduate participants (N = 203) completed a task in which they were falsely instructed that their objective was to respond more quickly than a same-sex opponent. They were told that whoever responded more quickly would administer a white noise burst to the opponent and choose its intensity, which served as our measure of aggression. Compared to an additive interaction model, the multiplicative model exhibited a better fit. Specifically, men displayed proportionately more aggression than women with the same level of anger-out. Research on and treatment for aggression should consider the multiplicative effects of factors related to aggression.

Cognitive control and cortisol response to stress in generalised anxiety disorder: a study of working memory capacity with negative and neutral distractors.

We investigated the association between cognitive control and individual differences in cortisol response to stress in participants with generalised anxiety disorder (GAD) and in never-disordered controls (CTL). To assess cognitive control, participants completed an affective version of the reading span task, which measures working memory capacity (WMC) in the presence of negative and neutral distractors. Participants then completed a standard psychosocial stressor and provided salivary cortisol samples throughout. The relation between WMC and cortisol response to stress was dependent on diagnostic group and distractor valence. Within the GAD group, greater WMC in the presence of neutral distractors was associated with attenuated cortisol response to stress, and greater WMC in the presence of negative distractors was associated with faster cortisol recovery from stress. In contrast, within the CTL group, WMC was unrelated to cortisol stress reactivity or recovery.

Emotional response to autobiographical memories in depression: less happiness to positive and more sadness to negative memories.

Retrieving positive autobiographical memories effectively repairs mood in healthy individuals. This is not the case in individuals with Major Depressive Disorder (MDD) possibly due to lower levels of positive emotions elicited by the positive memories. We examined whether the intensity of emotions experienced from recalling the happiest, saddest, and most anxious autobiographical memories differed between individuals with MDD (n = 30) and healthy controls (n = 46). Participants retrieved their happiest, saddest, and most anxious autobiographical memories and rated the emotional intensity experienced at the time of the event and at the time of recall. For all memory types, emotional intensity at the time of the event did not differ between MDD and CTL groups. However, the MDD (vs. CTL) group experienced less happiness recalling their happiest memories, more sadness recalling their saddest memories, and marginally more nervousness recalling their most anxious memories. The CTL group experienced more intense emotions when retrieving happiest (vs. saddest or most anxious) memories. Greater sadness when recalling their saddest memories and less happiness when recalling their happiest memories in the MDD (vs. CTL) group may hinder effective mood regulation and perpetuate negative mood.

Mindfulness and negative affectivity in real time: a within-person process model.

To extend our understanding of the proximal etiology of personality pathology, this study examined the dynamic, in-the-moment relations between mindfulness and negative affectivity (NA; emotional lability, anxiousness, separation insecurity) as defined by the alternative model for personality disorders. We tested predictions based upon the Monitor and Acceptance Theory that when people monitored their attention judgmentally, their state NA would be higher than usual; by contrast, when they monitored their attention nonjudgmentally, their state NA would be lower than usual. Sixty-five undergraduates participated in an experience sampling study wherein they completed five reports per day for eight days about their states of mindfulness and NA. Multi-level models revealed an interaction wherein participants exhibited more state NA when they monitored their attention judgmentally than when they monitored their attention nonjudgmentally. Analyses of simple slopes revealed that participants exhibited more state NA than usual when they monitored their attention judgmentally. These findings emerged for only one of two attention monitoring processes, however: monitoring relations between thoughts, emotions, and behaviours, but not monitoring sensory stimuli. Analyses including non-reactivity instead of nonjudgment replicated these findings. Implications for theory, research, and treatment are discussed.

Working memory capacity and spontaneous emotion regulation in generalised anxiety disorder.

Researchers have postulated that deficits in cognitive control are associated with, and thus may underlie, the perseverative thinking that characterises generalised anxiety disorder (GAD). We examined associations between cognitive control and levels of spontaneous state rumination following a stressor in a sample of healthy control participants (CTL; n = 27) and participants with GAD (n = 21). We assessed cognitive control by measuring working memory capacity (WMC), defined as the ability to maintain task-relevant information by ignoring task-irrelevant information. To this end, we used an affective version of the reading span task with valenced (negative or neutral) distractors. Lower WMC in the presence of negative distractors was associated with greater state rumination in the GAD group, but not in the CTL group. These findings suggest that difficulty maintaining task-relevant information due to interference from negative distractors contributes to perseverative thinking in GAD.

Emotion regulation and biological stress responding: associations with worry, rumination, and reappraisal.

Individual differences in the habitual use of emotion regulation strategies may play a critical role in understanding psychological and biological stress reactivity and recovery in depression and anxiety. This study investigated the relation between the habitual use of different emotion regulation strategies and cortisol reactivity and recovery in healthy control individuals (CTL; n = 33) and in individuals diagnosed with social anxiety disorder (SAD; n = 41). The tendency to worry was associated with increased cortisol reactivity to a stressor across the full sample. Rumination was not associated with cortisol reactivity, despite its oft-reported similarities to worry. Worry and rumination, however, were associated with increased cortisol during recovery from the stressor. The only difference between CTL and SAD participants was observed for reappraisal. In the CTL but not in the SAD group, reappraisal predicted recovery, such that an increased tendency to reappraise was associated with greater cortisol recovery. These results suggest an important role of the habitual use of emotion regulation strategies in understanding biological stress reactivity and recovery.

Working memory in social anxiety disorder: better manipulation of emotional versus neutral material in working memory.

Individuals with social anxiety disorder (SAD) engage in post-event processing, a form of perseverative thinking. Given that deficits in working memory might underlie perseverative thinking, we examined working memory in SAD with a particular focus on the effects of stimulus valence. SAD (n = 31) and healthy control (n = 20) participants either maintained (forward trials) or reversed (backward trials) in working memory the order of four emotional or four neutral pictures, and we examined sorting costs, which reflect the extent to which performance deteriorated on the backward trials compared to the forward trials. Emotionality of stimuli affected performance of the two groups differently. Whereas control participants exhibited higher sorting costs for emotional stimuli compared to neutral stimuli, SAD participants exhibited the opposite pattern. Greater attention to emotional stimuli in SAD might facilitate the processing of emotional (vs. neutral) stimuli in working memory.

Diversity in emotion regulation strategy use: Resilience against posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is associated with impaired emotion regulation (ER). ER diversity, the variety, prevalence, and relative abundance of ER strategy use, may provide resilience against PTSD. This study examined the prospective relation between ER diversity and PTSD, while accounting for negative and positive life events, in interpersonal violence (IPV) survivors. IPV-exposed women with PTSD onset (PTSD; n = 22), without PTSD onset (IPV; n = 37), and non-traumatized control participants (NTC; n = 41) rated their ER strategy use and experience of negative and positive life events. The ER diversity index differentiated the participant groups. Importantly, group differences in ER diversity depended on the experience of life events. When experiencing fewer positive life events and more negative life events, the IPV and NTC groups, but not the PTSD group, demonstrated higher ER diversity. Thus, greater ER diversity during periods with more negative life events and fewer positive life events may play a protective role against PTSD onset for IPV survivors.

Gauging the stress of long-term care nursing assistants using ecological momentary assessment, wearable sensors and end of day reconstruction.

BACKGROUND: Nursing assistants working in long-term care (LTC) often report that their job is stressful. To reduce their work stress, a better understanding of their stress profile is needed. OBJECTIVE: We aimed to pilot test methods to identify and understand stressors that LTC nursing assistants experience. METHODS: We asked each participant to provide wearable sensor/watch data, ecological momentary assessment (EMA) surveys and end of day review data over two eight-hour working shifts. RESULTS: Eight nursing assistants participated. All participants worked in a common continuing care retirement community in Maryland, United States of America. Our stress assessment method revealed 83 stressful events that were classified under 10 categories. Most of the reported events were rated as having a mild to low-moderate intensity. The three most common causes of stress were work demands and pressure (28.35%), heavy workload and staffing (19.69%), and safety issues and COVID-19 concerns (17.32%). We also explored the difference between stress events and intensity among different shifts. Disrespect from residents (22.73%) was the most commonly reported stressor during day shifts. Feeling rushed was the most commonly reported stressor during the evening (22.47%) and the night (38.46%) shifts. CONCLUSIONS: We found stress was commonly reported. Stress intensity conflicted with prior literature, and we explored possible explanations. IMPLICATIONS FOR PRACTICE: We discuss potential implications for these findings, modification of our methods to increase feasibility, the utility of these data collection methods for future work and suggest next steps.

Cultural and gender differences in emotion regulation: relation to depression.

In the last decade, studies have shown that the use of specific emotion regulation strategies contributes to an increased risk for depression. Past research, however, has overlooked potential cultural and gender differences in emotion regulation. The present study examined the relation between the use of emotion regulation strategies and depressive symptoms among college students in two different cultures (n=380 in Seoul, Korea; n=384 in Miami, USA). Koreans, compared with American students, reported more frequent use of brooding, whereas Americans reported more anger suppression than Koreans. Women were more likely than men to use both types of rumination (i.e., reflective pondering and brooding) and anger suppression in both countries, but these gender differences disappeared once levels of depressive symptoms were controlled for. In addition, the association between the use of reappraisal and depressive symptoms was significantly stronger in the Korean compared to the US sample. In contrast, the association between anger suppression and depressive symptoms was significantly stronger in the American compared to the Korean sample. These findings highlight the importance of considering the role of culture in emotion regulation.

Biased cognitive control of emotional information in remitted depression: A meta-analytic review.

Cognitive theories of depression posit that maladaptive information processing increases the risk for depression recurrence. There is increasing theoretical and empirical support for the cognitive control of emotional information as a vulnerability factor for depression recurrence. In this investigation, findings from behavioral studies that compared the cognitive control of emotional information between participants with remitted major depressive disorder (rMDD) and healthy control (HC) participants were examined. Response times (RTs) and error rates were used as outcome variables, and aspects of clinical features, sample characteristics, and methodology and design were examined as moderating variables. The final review included 44 articles with a total of 2,081 rMDD participants and 2,285 HC participants. The two groups significantly differed in the difference score between RTs for negative and positive stimuli. Specifically, the difference in RTs between negative and positive stimuli was larger in participants with rMDD than in HC participants, indicating greater difficulty controlling irrelevant negative (vs. positive) stimuli in rMDD. Such cognitive control bias may be associated with preferential processing of negative over positive information in working memory. This imbalance may then be linked to other emotional information processing biases and emotion dysregulation, thereby increasing the risk for depression recurrence. Implications, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Physiological sensation word usage in social anxiety disorder with and without comorbid depression.

BACKGROUND & OBJECTIVES: Social anxiety disorder (SAD) is characterized by a fear of showing anxiety symptoms, which may manifest in greater physiological sensation (PS) word usage, especially when describing their anxious experiences. However, the role of comorbid major depressive disorder (MDD) is unknown. Given blunted physiological arousal in MDD, the SAD only group (SAD) may use more PS words than the comorbid (COM) group with SAD and MDD when discussing anxious memories. Due to more severe symptomology, however, the COM group may use more PS words than the SAD group. We examined these competing hypotheses. METHODS: The SAD (n = 30), COM (n = 19), and control (CTL; n = 30) groups recalled their happiest, saddest, and most anxious events. The proportion of PS words was examined. RESULTS: The SAD group used significantly more PS words than the CTL group, whose PS words did not differ significantly from the COM group; the SAD group used marginally more PS words than the COM group. Anxious memories contained significantly more PS words than happiest and saddest memories. Happiest and saddest memories did not significantly differ in PS words. LIMITATIONS: The PS words list was created by the authors, and a LIWC dictionary was not used. CONCLUSIONS: Blunted physiological arousal in MDD may have contributed to lower PS word usage in the COM group than the SAD group. Understanding linguistic differences between these groups may provide clinicians with insight into these individuals' preoccupations with bodily sensations that may maintain or exacerbate symptoms of anxiety.

Anger suppression predicts pain, emotional, and cardiovascular responses to the cold pressor.

BACKGROUND: Manipulated anger suppression has been shown to heighten pain and anger responses to pain. PURPOSE: We examined whether individual differences in self-reported anger suppression predicted pain, anger, and blood pressure responses to acute pain. METHODS: Healthy participants (N = 47) underwent an anger-provoking speech task followed by a cold pressor pain task. Participants reported their degree of suppression of thoughts and feelings related to the speech. Pain intensity ratings were obtained throughout the cold pressor. Self-reported anger, anxiety and positive emotion, as well as ratings of sensory, general distress, and anger-specific elements of pain were obtained following the cold pressor. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded throughout. RESULTS: Self-reported suppression predicted greater pain intensity ratings, perception of sensory and anger-specific elements of pain, and self-reported anger in response to the cold pressor. Associations between self-reported suppression and pain intensity and ratings of anger-specific elements of pain were statistically mediated by pain-induced changes in self-reported anger, whereas the effect of suppression on sensory pain ratings was not. Self-reported suppression was also correlated inversely with SBP responses to the cold pressor. CONCLUSIONS: Consistent with an ironic process model and prior studies involving experimental manipulation of suppression, self-reported suppression of anger predicted greater pain intensity and perception of the anger-specific element of pain. Findings also suggest that suppression might attenuate homeostatic pressor responses to acute pain.

Behavioral inhibition system sensitivity moderates audio-visual neutral information processing.

BACKGROUND AND OBJECTIVES: Misperception of other people's intention and emotions could cause and worsen interpersonal problems, thereby increasing the likelihood of developing depression and anxiety disorders among individuals who are already at risk for those conditions. Although multisensory emotional information is ubiquitous in the real world, most previous research focused exclusively on processing facial expressions. Addressing this gap, the current study examined the association between behavioral inhibition system (BIS) sensitivity and audio-visual emotional information processing. Sensitive BIS suggests heightened sensitivity to anxiety provoking stimuli and is a known risk factor for developing emotional disorders. We hypothesized that higher BIS levels would be associated with inefficient multisensory emotional processing, which might be pronounced for neutral stimuli. METHODS: Seventy-six undergraduates (40 women) completed a task while target faces (disgusted, happy, and neutral) were rendered invisible, and a voice (disgusted, happy, and neutral) or no voice was presented simultaneously. Participants' reaction times to indicate the location of the interocularly suppressed faces were measured. RESULTS: Individuals with lower BIS levels detected neutral faces faster when accompanied by neutral voices than by no voice; individuals with higher BIS levels, however, did not benefit from congruent auditory information when processing neutral faces. LIMITATIONS: The current study cannot address whether the finding is due to attentional biases, interpretation biases, or both in individuals who are prone to become anxious. CONCLUSION: Multisensory processing of neutral information is modulated by individuals' propensity to become anxious.

Treatment of double depression: A meta-analysis.

BACKGROUND: Double depression (DD), the co-existence of DSM-IV major depressive disorder (MDD) and dysthymia, is a poorly known and sparsely studied phenomenon. Nevertheless, it is prevalent in clinical samples of patients with depression. Thus, it is important to understand the efficacy of its treatment. METHODS: We conducted a meta-analysis of studies in which antidepressant medication was used to treat depression. Systematic searches in bibliographical databases resulted in 11 samples, including 775 patients that met inclusion criteria. RESULTS: The overall effect size indicating the differences in depressive symptoms before and after pharmacotherapy was 1.81 (95% CI: 1.47, 2.16), suggesting that individuals with depression exhibited a significant reduction in their depressive symptoms following treatment. Importantly, a moderation analysis indicated that a higher proportion of individuals with DD within a sample was associated with lower effect sizes. Publication bias did not pose a major threat to the stability of the findings. LIMITATIONS: High observed heterogeneity indicated substantial variability in effect sizes and elucidation of the potential moderators of treatment outcome was limited due to a paucity of relevant data. CONCLUSIONS: Pharmacotherapy seems to be effective in treating DD, but DD may be more difficult to treat than either MDD or dysthymia alone. More research specifically focusing on the treatment of DD with larger sample sizes using randomized control trials is needed to make a firm conclusion.

Perception of facial expressions of emotion during binocular rivalry.

Binocular rivalry is the perceptual alternation between two incompatible stimuli presented simultaneously but to each eye separately. The observer's perception switches back and forth between the two stimuli that are competing for perceptual dominance. In two studies, pictures of emotional faces (disgust and happy) were pitted against each other or against pictures of faces with neutral expressions. Study 1 demonstrated that (a) emotional facial expressions predominate over neutral expressions, and (b) positive facial expressions predominate over negative facial expression (i.e., positivity bias). Study 2 examined individual differences in emotional predominance and positivity bias during binocular rivalry. Although the positivity bias was not affected by the levels of depressive symptoms, results demonstrated that emotional predominance diminished as the level of depressive symptoms increased. These results indicate that individuals who report more depressive symptoms compared to their less depressed counterparts tend to assign more meaning to neutral faces.

Depression and affective flexibility: A valence-specific bias.

Depression might be associated with poor affective flexibility, defined as the ability to switch between emotional and non-emotional aspects of a stimulus. However, it is unclear whether affective inflexibility in depression is valence-specific, whether it predicts future depressive symptoms, and whether affective flexibility following a stressor, compared to before a stressor, better predicts depressive symptoms. Before and after a stressor, participants (N = 300) completed an affective switching task during which they categorized pictures either by the valence or by the number of humans present in the pictures. Slower shifting from emotional aspects of negative material before stress was uniquely associated with higher levels of prospective depressive symptoms. This negative bias in affective flexibility may hinder disengagement from negative information, thereby exacerbating depressive symptoms.

Affective flexibility and generalized anxiety disorder: valence-specific shifting difficulties.

Background: Growing evidence suggests that generalized anxiety disorder (GAD) is associated with poor affective flexibility, defined as the ability to switch between emotional aspects and non-emotional aspects of a situation. However, it is unclear whether affective inflexibility is valence-specific in GAD. Methods: Participants with GAD (n = 21) and non-clinical control participants (n = 28) were tested on an Affective Switching Task during which participants were asked to categorize pictures either by the valence or by the number of humans present in the pictures. Results: Individuals with GAD, but not healthy controls, exhibited greater difficulty shifting from emotional aspects of negative material compared to emotional aspects of positive material and shifting to the emotional aspects of positive material compared to emotional aspects of negative material. Conclusions: These findings suggest that GAD is associated with valence-specific affective flexibility biases. The relevance of the findings and directions for future research are discussed.