Mental health during the COVID-19 pandemic: Effects of stay-at-home policies, social distancing behavior, and social resources.

Social distancing is the most visible public health response to the COVID-19 pandemic, but its implications for mental health are unknown. In a nationwide online sample of 435 U.S. adults, conducted in March 2020 as the pandemic accelerated and states implemented stay-at-home orders, we examined whether stay-at-home orders and individuals' personal distancing behavior were associated with symptoms of depression, generalized anxiety disorder (GAD), intrusive thoughts, insomnia, and acute stress. Stay-at-home order status and personal distancing were independently associated with higher symptoms, beyond protective effects of available social resources (social support and social network size). A subsample of 118 participants who had completed symptom measures earlier in the outbreak (February 2020) showed increases in depression and GAD between February and March, and personal distancing behavior was associated with these increases. Findings suggest that there are negative mental health correlates of social distancing, which should be addressed in research, policy, and clinical approaches to the COVID-19 pandemic.

Socially oriented thinking and the biological stress response: Thinking of friends and family predicts trajectories of salivary cortisol decline.

The cortisol stress response has been related to perceived social support, but previous studies rely on self-reported social support variables. The cortisol recovery phase in particular has been theorized to serve a social coping function, but individual differences in recovery slope have not yet been examined in relation to social coping-relevant indices. This study addressed these gaps by examining the relationship of cortisol trajectories after a socioevaluative task to individual differences in covertly assessed cognitions related to close social relationships. We examined trajectories of cortisol change related to socially oriented thinking, the semi-implicit activation of cognitive representations of friends or family. Young adults (N = 64) gave salivary cortisol samples before and for 45 min after a speech task. Participants' thoughts were sampled repeatedly; the frequency of words related to friends or family was assessed to index socially oriented thinking. A free curve slope intercept latent growth curve model showed excellent fit with the cortisol data. Socially oriented thinking was unrelated to overall magnitude of cortisol response to the task (latent intercept) but predicted the latent cortisol trajectory, independently of cortisol intercept and baseline cortisol levels. Socially oriented thinkers showed more gradual cortisol declines, whereas nonsocially oriented thinkers showed a steeper downslope driven primarily by cortisol changes 45 min after the task. Individual differences in socially oriented thinking may manifest in different rates of biological changes following a performance task.

Social influences on cognitive processing in enacted social support: effects on receivers' cognitive appraisals, emotion, and affiliation.

Background and objectives. Social support is linked with psychological health, but its mechanisms are unclear. We examined supporters' influence on recipients' cognitive processing as a mechanism of effects of support on outcomes associated with depression. Design/methods. 2 × 2 between-subjects experiment. 147 participants (1) experienced a negative event (false feedback); (2) received social support modeling one of two contrasting cognitive processing modes (abstract/evaluative or concrete/experiential); (3) generated explanations for the event, later coded for processing mode and internal/external causal attribution; and (4) reported on emotion, perceptions of self and future, and social affiliation. To examine relational effects, half of participants were led to perceive the supporter as similar to themselves via a shared birthday manipulation. Results. Support condition influenced participants' processing mode and causal attributions as predicted. Abstract/evaluative support led to more positive emotion and self-perceptions, and less pessimistic expectancies for the future than concrete/experiential support. Perceived similarity moderated effects on beliefs about an upcoming social interaction, magnifying positive affiliation outcomes of abstract/evaluative versus concrete/experiential support. Conclusions. Processing modes that are generally maladaptive at the intrapersonal level may be adaptive (and vice versa) when they are interpersonally influenced, and perceived similarity may facilitate interpersonal effects of processing mode on affiliation.

Affect Intensity Moderates the Association of Emotional Clarity with Emotion Regulation and Depressive Symptoms in Unselected and Treatment-Seeking Samples.

Depression is associated with subjective difficulties identifying one's emotions, known as low emotional clarity, but the mediators and moderators of this relationship are not well understood. We hypothesized that the role of emotional clarity in emotion regulation and, in turn, depression depends on individual differences in negative affect intensity. In Study 1, conducted in an unselected sample (N=119), low emotional clarity more strongly predicted depression symptoms among individuals higher in affect intensity. In Study 2, conducted in a clinically diagnosed, treatment-seeking sample (N=245), we examined whether affect intensity moderated an indirect path of clarity through emotion regulation strategy use that has emerged in previous work. When affect intensity was very low, emotional clarity did not predict reappraisal, and when affect intensity was very high, emotional clarity did not predict non-acceptance or experiential avoidance. By contrast, rumination mediated associations of emotional clarity with depressive symptoms regardless of affect intensity. Findings support a process model of low emotional clarity in depression that integrates (1) emotion regulatory mediators and (2) moderation by negative affect intensity. Trait differences in affect intensity may determine whether and how emotional clarity and regulation processes factor into mood psychopathology.

The future-oriented repetitive thought (FoRT) scale: A measure of repetitive thinking about the future.

BACKGROUND AND OBJECTIVES: Repetitive thinking about the future has been suggested as one way in which individuals may become hopeless about the future. We report on a new scale assessing future-oriented repetitive thinking, termed the Future-Oriented Repetitive Thought (FoRT) Scale. METHODS: In Study 1, an exploratory factor analysis was conducted with data from 1071 individuals who completed the scale. Study 2 describes a confirmatory factor analysis with a revised version of the scale on a sample of 612 individuals, a subsample of whom (N=99) also completed measures of repetitive thought (rumination, worry), hopelessness-related cognitions, and symptoms of depression and generalized anxiety disorder in order to examine evidence for the measure's convergent, discriminant, and concurrent validity. Study 3 examined the scale's concurrent validity in distinguishing between individuals with and without a history of suicidal ideation and attempts. RESULTS: A three-factor solution emerged in Study 1, and this solution was confirmed in Study 2. In addition, the FoRT scale demonstrated moderate associations with other measures of repetitive thought (rumination, worry), with hopelessness-related cognitions, and with symptoms of depression and generalized anxiety. Finally, the FoRT scale distinguished between individuals with and without a history of suicidal ideation and attempts. LIMITATIONS: Cross-sectional data limit conclusions that can be drawn about directionality. CONCLUSIONS: These findings suggest that the newly developed FoRT scale is a reliable and valid measure of future-oriented repetitive thought.

Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors.

Among individuals coping with cancer, emotional approach coping-expressing and processing emotions following negative events-has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.

Using Emotion as Information in Future-Oriented Cognition: Individual Differences in the Context of State Negative Affect.

Predictions about the future are susceptible to mood-congruent influences of emotional state. However, recent work suggests individuals also differ in the degree to which they incorporate emotion into cognition. This study examined the role of such individual differences in the context of state negative emotion. We examined whether trait tendencies to use negative or positive emotion as information affect individuals' predictions of what will happen in the future (likelihood estimation) and how events will feel (affective forecasting), and whether trait influences depend on emotional state. Participants (N=119) reported on tendencies to use emotion as information ("following feelings"), underwent an emotion induction (negative versus neutral), and made likelihood estimates and affective forecasts for future events. Views of the future were predicted by both emotional state and individual differences in following feelings. Whereas following negative feelings affected most future-oriented cognition across emotional states, following positive feelings specifically buffered individuals' views of the future in the negative emotion condition, and specifically for positive future events, a category of future-event prediction especially important in psychological health. Individual differences may confer predisposition toward optimistic or pessimistic expectations of the future in the context of acute negative emotion, with implications for adaptive and maladaptive functioning.

Emotion regulation and depressive symptoms: Close relationships as social context and influence.

Depression is associated with social dysfunction and maladaptive social environments, but mechanisms through which social relationships affect depressive psychopathology are unclear. We hypothesized that emotion regulation (ER) is such a mechanism, with outcomes of individuals' ER efforts sensitive to the social context, and individuals' ER strategy repertoire and use sensitive to social influence. In Study 1, a longitudinal study of community adults (N = 1,319), associations of individuals' ER strategies with depressive symptoms depended on social connectedness and romantic relationship status (social context hypothesis). Moreover, associations of social connectedness and relationship status with symptoms were accounted for by maladaptive ER concurrently and, for social connectedness, prospectively over 1 year (social influence hypothesis). Study 2a, using a national sample (N = 772), replicated and extended these findings with a broader array of ER strategies, and ruled out alternative explanations regarding social skills and psychological wellbeing. Among participants in romantic relationships (Study 2b; N = 558), intimacy and trust buffered associations of maladaptive ER strategies with symptoms (context), and maladaptive and adaptive ER mediated links between relationship variables and symptoms (influence). Findings suggest that close relationships-and variation in underlying relational processes within relationships-influence the ER strategies people use, and also affect whether individuals' own ER repertoires contribute to depression when deployed. Results elucidate core social mechanisms of ER in terms of both basic processes and depressive psychopathology, suggest ER is a channel through which social factors affect internal functioning and mental health, and inform relationship pathways for clinical intervention.

EVENT PREDICTION AND AFFECTIVE FORECASTING IN DEPRESSIVE COGNITION: USING EMOTION AS INFORMATION ABOUT THE FUTURE.

Depression is characterized by a bleak view of the future, but the mechanisms through which depressed mood is integrated into basic processes of future-oriented cognition are unclear. We hypothesized that dysphoric individuals' predictions of what will happen in the future (likelihood estimation) and how the future will feel (affective forecasting) are attributable to individual differences in incorporating present emotion as judgment-relevant information. Dysphoric individuals (n = 77) made pessimistic likelihood estimates and blunted positive affective forecasts relative to controls (n = 84). These differences were mediated by dysphoric individuals' tendencies to rely on negative emotion as information more than controls-and on positive emotion less-independent of anhedonia. These findings suggest that (1) blunted positive affective forecasting is a distinctive component of depressive future-oriented cognition, and (2) future-oriented cognitive processes are linked not just to current emotional state, but also to individual variation in using that emotion as information. This role of individual differences elucidates basic mechanisms in future-oriented cognition, and suggests routes for intervention on interrelated cognitive and affective processes in depression.

Maladaptive Processing of Maladaptive Content: Rumination as a Mechanism Linking Cognitive Biases to Depressive Symptoms.

Cognitive theories propose that negatively biased thinking is an important factor in the development and maintenance of depression. The mechanisms by which cognitive biases lead to depression, however, have not been thoroughly researched. One potential mechanism is that negatively biased thoughts trigger rumination, or the process of focusing passively and repetitively on the causes and consequences of one's mood, a well-established risk factor for depression. In a series of three studies, we examined rumination and other cognitive emotion regulatory strategies as mechanisms of the relationship between cognitive biases and depressive symptoms. We found consistent evidence that rumination mediates the relationship between interpretation and memory biases and depressive symptoms. The indirect effects through rumination were stronger than indirect effects through other cognitive emotion regulation strategies (dampening and worry). These findings indicate that negatively biased thinking may increase risk for depression by increasing rumination, supporting the notion that rumination is a useful target for intervention with depressed clients.

Active and passive problem solving as moderators of the relation between negative life event stress and suicidal ideation among suicide attempters and non-attempters.

This study examined whether active problem solving would buffer against, whereas passive problem solving would exacerbate, the association of negative life stress with suicidal ideation. Young adult college students (73 females, M(age) = 19.0) from a diverse urban public university, with (n = 37) and without (n = 59) a suicide attempt history completed measures of life stress, problem solving, hopelessness, depression, and suicidal ideation. Hierarchical linear regressions were conducted to test moderating roles of active and passive problem solving, along with suicide attempt history, on the relation between negative life event stress and suicidal ideation. There was a weaker relation between life stress and suicidal ideation at high and average levels of relevant problem solving than at low levels, and this was the case primarily for suicide attempters but not for non-attempters. Individuals with a past attempt produced more passive solutions than non-attempters, but among attempters, even passive problem solving buffered the association of life stress with suicidal ideation. Relevant problem solving in the face of life stress may be especially important for individuals vulnerable to suicidal ideation due to an attempt history. Among such at-risk individuals, generating even passive solutions in the face of life stress may be more adaptive than generating few solutions. Thus, clinical interventions with suicide attempters that focus on generating solutions to problems, even if these are initially passive, may help mitigate the effect of life stress on suicidal ideation.

Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history.

BACKGROUND: Previous studies suggest that people attempt suicide because they are cognitively inflexible, but past research suggesting a link between cognitive inflexibility and suicidal thoughts and behavior has been limited by cross-sectional designs. This study examined whether cognitive inflexibility differentially and prospectively predicted suicidal ideation among young adults with and without a history of a suicide attempt. METHODS: A sample of 45 young adults with (n = 13) or without (n = 32) a suicide attempt history completed the Wisconsin Card Sorting Test (WCST), a diagnostic interview, and self-report measures of hopelessness, depressive symptoms, and suicidal ideation, and were followed up 6 months later to reassess suicidal ideation. RESULTS: Cognitive inflexibility, as measured by perseverative errors on the WCST, predicted suicidal ideation at 6-month follow-up, among suicide attempters, but not among nonattempters, adjusting for the presence of a baseline mood or anxiety diagnosis, hopelessness, and baseline suicidal ideation. CONCLUSIONS: Cognitive inflexibility may increase vulnerability to suicidal ideation over time among individuals with a previous suicide attempt history. Implications for interventions with suicide attempters are discussed.

Interpersonal emotion regulation as a mechanism of social support in depression.

Although social support is widely considered to be protective against depression, the mechanisms through which it acts on depressive psychopathology are not well known. This integrative review argues that emotion regulation serves as such a mechanism. First, the literature on the effects of social support on depression is reviewed, with an emphasis on open empirical questions regarding mechanisms linking support and depression. Then, the literature on emotion regulation is reviewed, highlighting its importance as a mechanism in the psychopathology of depression. Finally, potential interpersonal influences on depressive emotion regulation and dysregulation are suggested, drawing from theory and research on psychotherapy and on close relationships. The review suggests that emotion regulation is responsive to interpersonal influences, and that this responsiveness may account for the effects of social support on depression. Implications of an interpersonal perspective for basic and clinical research on depression, close relationships, and emotion regulation are discussed.

Brooding and reflective rumination among suicide attempters: cognitive vulnerability to suicidal ideation.

Previous research suggests that the brooding subtype of rumination is associated with increased suicidal ideation, but findings are inconsistent with respect to reflection, considered to be the more adaptive form of rumination. This study investigated the circumstances under which reflective rumination might be associated with increased suicidal ideation by examining whether a suicide attempt history moderated the relationship between the ruminative subtypes and current suicidal ideation. Thirty-seven young adults who reported a past suicide attempt and fifty-nine young adults without a suicide attempt history completed measures of rumination and depression symptoms in an initial study session. They then completed a measure of suicidal ideation and hopelessness during a second study session. Overall, brooding was associated with higher self-reported suicidal ideation, whereas reflection was not significantly associated with ideation. However, reflection - but not brooding - interacted with suicide attempt history to statistically predict suicidal ideation, even after adjusting for symptoms of depression and hopelessness, whereas brooding no longer predicted ideation after adjusting for these symptoms. These findings qualify earlier suggestions that reflection is a more adaptive form of rumination by indicating that among vulnerable individuals - in particular those with a history of a suicide attempt - a higher degree of reflective rumination is associated with increased suicidal ideation.

Cognitive content-specificity in future expectancies: role of hopelessness and intolerance of uncertainty in depression and GAD symptoms.

The present study examined cognitive content-specificity in future-event predictions associated with symptoms of depression and generalized anxiety disorder (GAD). College undergraduates (N=284) completed measures of depression, GAD, and rated their certainty that a given set of positive and negative outcomes were or were not likely to happen in their future. Participants also completed measures of hopelessness and intolerance of uncertainty (IU). Individuals (N=263) completed the same measures again 6 weeks later. Certainty in an absence of positive future outcomes was associated with symptoms of depression but not GAD, and hopelessness mediated this relationship - concurrently and when examining change scores over 6 weeks. Certainty in negative outcomes was concurrently associated with both symptoms of depression and GAD, and hopelessness partially mediated these relationships. IU predicted concurrent increases in depression and GAD symptoms, and negative-outcome certainty partially mediated the IU-depression but not the IU-GAD symptom relationship. Change in certainty did not mediate the relationship between changes in IU and GAD symptoms but partially mediated the relationship between change in IU and depression symptoms over time. Hopelessness appears to play a unique role in the relationship between reduced anticipation of positive future outcomes and depression. Although less clearly suggested by the data, IU may contribute to both depression and GAD symptoms but may do so through different pathways.