Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study.

Background: Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days. Method: Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms. Results: When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms. Discussion: The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.

When talking goes awry: association between co-rumination and trait anxiety, test anxiety, and anxiety sensitivity in early and late adolescents.

BACKGROUND AND OBJECTIVES: Friends are major sources of social support for adolescents. This support may sometimes lead to co-rumination when the problem is discussed exhaustively with a focus on negative feelings. Co-rumination has been associated with some forms of anxiety, including clinical symptoms. Further studies are needed to investigate whether this association extends to additional and non-clinical forms of anxiety in youth. This study aimed to explore the relationship between co-rumination and trait anxiety, test anxiety, and anxiety sensitivity using secondary data. DESIGN AND METHODS: In this 2019 cross-sectional study, 1204 (59% girls) Canadian 6th-grade early adolescents (ages 11-12) and 11th-grade late adolescents (ages 16-17) completed self-report questionnaires measuring co-rumination, trait anxiety, test anxiety, and anxiety sensitivity. RESULTS: Co-rumination was associated with anxiety sensitivity in early adolescents and with trait anxiety, test anxiety, and anxiety sensitivity in late adolescents. CONCLUSIONS: Developmental factors may play a role in the association between co-rumination and different forms of anxiety. Anxiety sensitivity may appear alongside co-rumination in early adolescence and may broaden to trait and test anxiety in late adolescence. These results extend our understanding of the relationship between co-rumination and anxiety, as well as generate hypotheses for future longitudinal studies.

Childhood Trauma and Non-Suicidal Self-Injury Among Chinese Adolescents: The Chain-Mediated Role of Alexithymia and Rumination.

OBJECTIVE: To explore the associations between childhood trauma, alexithymia, rumination, and non-suicidal self-injury (NSSI) among adolescents and to provide theoretical and empirical evidence for effective prevention, identification, and intervention of NSSI in the future. METHODS: Questionnaires, including the Childhood Trauma Questionnaire, the twenty-item Toronto Alexithymia scale, the Ruminative Responses Scale, and the Adolescents Self-Harm Scale, were given to 1,270 Chinese teenagers. The mediating role was simulated utilizing Amos 24.0. RESULTS: The Pearson's product-difference correlation analyses indicated the two-by-two significant correlations between childhood trauma, alexithymia, rumination, and NSSI. The structural equation modeling suggests that alexithymia and rumination partially mediate between childhood trauma and NSSI in teenagers, respectively. Additionally, it reveals that alexithymia and rumination chain mediate between childhood trauma and NSSI. CONCLUSION: The study confirms the impact of childhood trauma on adolescents' NSSI and also highlights the mediating role of alexithymia and rumination between the two. This study enriches the findings of NSSI and provides a theoretical basis for preventing and intervening in dysfunctional behaviors among adolescents.

The chain mediating role of rumination and social withdrawal in the relationship between smartphone distraction and depression among Chinese nursing students.

Smartphone distraction (SD) is closely related to depression, and the prevalence of SD among nursing students is gradually increasing. However, the potential mechanism of the effect of SD on nursing students' depression is unclear. A total of 574 nursing students were assessed using Smartphone Distraction Scale, Ruminative Response Scale, Hikikomori Questionnaire, and Patient Health Questionnaire-9. The results indicated that SD among nursing students had an impact on depression through four pathways: (1) SD was positively associated with depression (ß = 0.353, P < 0.001); (2) Rumination (ß = 0.199, 95% CI: 0.081 to 0.162) and social withdrawal (ß = 0.061, 95% CI: 0.034 to 0.091) mediated the effects of SD on depression, respectively; and (3) Rumination and social withdrawal played a chain mediating role in the effect of SD on nursing students' depression (ß = 0.027, 95% CI: 0.015 to 0.042). The negative impact of SD on nursing students' mental health should not be taken lightly. Schools and hospitals should guide nursing students to use smartphones correctly, including providing mental health education and professional psychological counselling; families could play a supervisory role and communicate regularly to understand the psychological state and learning of nursing students. These measures can help nursing students cope with stress and reduce the risk of depression.

Ruminative Variability Predicts Increases in Depression and Social Anxiety.

Background: Rumination is a well-established contributor to the severity of depression and anxiety. It is unknown, however, whether individual differences in the temporal dynamics of rumination over time predict longitudinal increases in depression or anxiety. Methods: The current study examined whether the dynamic indices of ruminative inertia and variability assessed over 14 days via ecological momentary assessment predicted change in symptoms of depression, general anxiety, and social anxiety at a 90-day follow-up (n = 115). Results: Controlling for ruminative variability, baseline levels of the dependent variable, sex, and mean levels of momentary rumination, ruminative inertia did not predict change in symptoms of depression, general anxiety, or social anxiety at the 90-day follow-up. In contrast, greater ruminative variability predicted increases in symptoms of both depression and social anxiety but not general anxiety at follow-up. Individuals endorsing higher baseline levels of depressive symptoms demonstrated greater amounts of inertia and variability in their momentary rumination. Greater ruminative variability but not inertia was also associated with higher baseline levels of general anxiety and social anxiety. Conclusions: These results suggest that ruminative variability may be a risk factor for increases in symptoms of depression and social anxiety over time and a potentially useful target for clinical intervention.

Neural correlates of treatment response to ketamine for treatment-resistant depression: A systematic review of MRI-based studies.

Treatment-resistant depression (TRD) is defined as patients diagnosed with depression having a history of failure with different antidepressants with an adequate dosage and treatment duration. The NMDA receptor antagonist ketamine rapidly reduces depressive symptoms in TRD. We examined neural correlates of treatment response to ketamine in TRD through a systematic review of brain magnetic resonance imaging (MRI) studies. A comprehensive search in PubMed was performed using "ketamine AND depression AND magnetic resonance." The time span for the database queries was "Start date: 2018/01/01; End date: 2024/05/31." Total 41 original articles comprising 1,396 TRD and 587 healthy controls (HC) were included. Diagnosis of depression was made using the Structured Clinical Interview for DSM Disorders (SCID), the Mini-International Neuropsychiatric Interview (MINI), and/or the clinical assessment by psychiatrists. Patients with affective psychotic disorders were excluded. Most studies applied ketamine [0.5mg/kg racemic ketamine and/or 0.25mg/kg S-ketamine] diluted in 60cc of normal saline via intravenous infusion over 40 min one time, four times, or six times spaced 2-3 days apart over 2 weeks. Clinical outcome was defined as either remission, response, and/or percentage changes of depressive symptoms. Brain MRI of the T2*-weighted imaging (resting-state or task performance), arterial spin labeling, diffusion weighted imaging, and T1-weighted imaging were acquired at baseline and mainly 1-3days after the ketamine administration. Only the study results replicated by ≥ 2 studies and were included in the default-mode, salience, fronto-parietal, subcortical, and limbic networks were regarded as meaningful. Putative brain-based markers of treatment response to ketamine in TRD were found in the structural/functional features of limbic (subgenual ACC, hippocampus, cingulum bundle-hippocampal portion; anhedonia/suicidal ideation), salience (dorsal ACC, insula, cingulum bundle-cingulate gyrus portion; thought rumination/suicidal ideation), fronto-parietal (dorsolateral prefrontal cortex, superior longitudinal fasciculus; anhedonia/suicidal ideation), default-mode (posterior cingulate cortex; thought rumination), and subcortical (striatum; anhedonia/thought rumination) networks. Brain features of limbic, salience, and fronto-parietal networks could be useful in predicting the TRD with better response to ketamine in relief of anhedonia, thought rumination, and suicidal ideation.

Reduce negative life events to Increase satisfaction: A daily diary study on the relationship between negative life events and life satisfaction.

Life satisfaction refers to an individual' s cognitive evaluation of the overall quality of their life considering the various aspects therein. Although the existing research has demonstrated the between-person relationship between negative life events and life satisfaction based on retrospective measures, less is known about this relationship at the within-person level. A daily diary method could examine this within-person relationship and decrease systematic recall biases. Therefore, this study investigated the link between daily negative life events and daily life satisfaction, as well as the mediating role of perceived stress and the moderating role of trait rumination in 146 young adults (Mage = 20.75, SD = 1.35) using a 14-day daily diary design. Multilevel regression analysis showed that daily negative life events had negative predictive effects on daily life satisfaction. In addition, the multilevel 1-1-1 mediation analysis indicated that daily perceived stress mediated the association between daily negative life events and daily life satisfaction. More importantly, the mediating effect of perceived stress was moderated by trait rumination, with the within-person mediating effect being stronger for individuals with higher than those with lower trait rumination tendencies. These findings contribute to the understanding of the underlying pathways in the relationship between daily negative life events and daily life satisfaction and provide a new perspective for improving individuals' life satisfaction.

Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial.

BACKGROUND: Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT). OBJECTIVE: This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being. METHODS: A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks. RESULTS: Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference -2.92, 95% CI -5.57 to -0.28; P=.03; ηp2=0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; ηp2=0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point. CONCLUSIONS: The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated. TRIAL REGISTRATION: ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-021-03536-0.

Delay in diagnosis is associated with decreased treatment effectiveness in children with rumination syndrome.

OBJECTIVES: Rumination syndrome (RS) is challenging to diagnose, which can lead to diagnostic delays. Our objective was to evaluate the length of time from RS symptom onset to diagnosis in patients referred to our institution and to examine whether this duration predicts treatment outcomes. METHODS: We conducted a review of patients with RS evaluated at our institution. Data were collected from chart review and patient/family reported questionnaires. We evaluated the time from symptom onset to diagnosis over time and whether it was associated with symptom resolution. RESULTS: We included 247 patients with RS (60% female, median age of 14 years, interquartile range [IQR]: 9-16 years). The median age at symptom onset was 11 years (IQR: 5-14 years) and median age at diagnosis was 13 years (IQR: 9-15 years) for a median duration of 1 year (IQR: 0-3 years) between symptom onset and diagnosis. Length of time between symptom onset and diagnosis did not change significantly at our institution from 2016 to 2022. Among the 164 children with outcome data, 47 (29%) met criteria for symptom resolution after treatment. A longer time to diagnosis was associated with a lower likelihood of symptom resolution after treatment (p = 0.01). CONCLUSION: In our experience, the time to RS diagnosis after symptom onset is shorter than previously described. A longer delay in diagnosis is associated with lower likelihood of symptom resolution after treatment, emphasizing the importance of a prompt recognition of rumination symptoms and a timely diagnosis.

Neuroticism affects nightmare distress through rumination.

BACKGROUND/AIMS: The role of neuroticism in predicting nightmare distress have been highlighted, and negative coping style may contribute to this relationship, but how these variables interact is limited. The present study aimed to explore how neuroticism and ruminative response contribute to producing nightmare distress, and to explore whether sex influences this relationship. METHODS: We recruited 758 university students, aged an average of 19.07. A moderated mediation model was built to examine the relationships among neuroticism, rumination, and nightmare distress (measured by dream anxiety scale), and explore whether sex could affect this relationship, using the SPSS PROCESS 3.5 macro. RESULTS: The moderated mediation analyses results showed that ruminative response-depression related can significantly partially mediate the relationship between neuroticism and dream anxiety (ß = 0.32), dream anxiety-sleep-related disturbances (ß = 0.11) and dream anxiety-daytime dysfunctions (ß = 0.21). However, the moderating effects of sex were not significant in all path from neuroticism to dream anxiety. CONCLUSION: The study provides a novel architecture on the underlying psychological mechanisms of neuroticism and nightmare distress. This interplay is assumed to be facilitated by ruminations, suggesting that interventions for individuals who suffer from nightmares may focus on their repetitive negative response strategies, especially in people with high neuroticism, irrespective of sex differences.

Predictors of psychosocial impairment in a transdiagnostic sample: Unique effects of repetitive negative thinking.

BACKGROUND: Repetitive negative thinking (RNT) is a transdiagnostic process involving perseverative, unproductive, and uncontrollable thoughts. Although RNT may impede adaptive psychosocial functioning by prolonging negative mood states, strengthening cognitive biases, and preventing effective problem-solving, the extent to which RNT is associated with risk for poor psychosocial outcomes is unclear. Given that this has clear transdiagnostic treatment implications, the present study aimed to isolate the unique relationship of RNT with social functioning and life satisfaction in a mixed clinical and non-clinical sample. METHODS: In 201 mid-to-later life adult participants (27 with primary diagnoses of bipolar disorder, 84 with major depressive disorder, and 90 healthy volunteers), we measured RNT, social functioning, life satisfaction, trait rumination, DSM-5 diagnoses, depressive symptoms, manic symptoms, cognitive control performance, and global cognitive functioning. RESULTS: Linear regression models revealed that RNT, but not rumination, was significantly associated with poorer social functioning (ß = 0.42 p < .001) and reduced life satisfaction (ß = -0.42, p < .001) after controlling for clinical and cognitive covariates. LIMITATIONS: Limited demographic diversity, cross-sectional design, self-reporting of outcomes. CONCLUSIONS: Results suggest that RNT may confer risk for key psychosocial outcomes during middle to later adulthood, over and above the effects of clinical and cognitive variables and independent of diagnostic status. Findings lend support to the notion of RNT as a transdiagnostic process and suggest that RNT may be an important therapeutic target for adults with poor social functioning and/or reduced life satisfaction.

From Tripping and Falling to Ruminating and Worrying: A Meta-Control Account of Repetitive Negative Thinking.

Repetitive negative thinking (RNT) is a transdiagnostic construct that encompasses rumination and worry, yet what precisely is shared between rumination and worry is unclear. To clarify this, we develop a meta-control account of RNT. Meta-control refers to the reinforcement and control of mental behavior via similar computations as reinforce and control motor behavior. We propose rumination and worry are coarse terms for failure in meta-control, just as tripping and falling are coarse terms for failure in motor control. We delineate four meta-control stages and risk factors increasing the chance of failure at each, including open-ended thoughts (stage 1), individual differences influencing subgoal execution (stage 2) and switching (stage 3), and challenges inherent to learning adaptive mental behavior (stage 4). Distinguishing these stages therefore elucidates diverse processes that lead to the same behavior of excessive RNT. Our account also subsumes prominent clinical accounts of RNT into a computational cognitive neuroscience framework.

A comparison of functionality, rumination, and distraction tasks on women's state body image and mood after idealised media exposure.

Writing tasks that encourage an appreciation of body functionality can improve women's body image and may buffer against negative effects of idealised media exposure. However, no research has examined whether these tasks can serve as a coping strategy after idealised exposure. To this end, young adult women (N = 217, Mage = 21.63) recruited from an Australian university and general community completed a writing task after idealised media exposure, with state body image measures taken at baseline, post-exposure, and post-task. Women were randomly allocated to one of three writing tasks and asked to appreciate their body functionality, to focus on the previously viewed images (rumination), or to describe a frequently travelled route (distraction). Improvements on outcome measures were equally found across both the functionality and distraction condition. Only body appreciation uniquely improved in the functionality condition. The functionality task was rated more helpful but also more challenging. These findings add to the evidence base regarding the usefulness of functionality-based writing tasks for improving women's body image. They can offer immediate benefits when experiencing body image distress, as can distraction, and future research should explore their utility in driving more sustained and deeper ways of engaging with one's body long-term.

When high work engagement is negative for family tasks: mechanisms and boundary conditions.

Background: Typically, work engagement is positively related to beneficial job outcomes. Earlier studies, however, revealed a "dark side" of work engagement showing negative effects such as more work-family conflict. Using a resource perspective, our study seeks to better understand why and when these negative effects of work engagement occur. Specifically, we test a new model in which the relationship of work engagement with work-family conflict is mediated by organizational citizenship behavior (OCB) and work rumination. Moreover, we argue that employees' resource-building strategies (i.e., job crafting) and resource levels (i.e., psychological capital) buffer resource depletion due to high work engagement. Methods: We tested our assumptions in a field study that involved data collected on three measurement points with 523 employees from Nigeria. The measures consist of Utrecht Work Engagement Scale, Organizational Citizenship Behavior Scale, Work Rumination Scale, Psychological Capital Scale, Job Crafting Measure, Work-family Conflict Scale, and demographic variables. Structural Equation Modeling (SEM) was used to test the hypotheses. Results and discussion: Results from latent structure equation modelling confirm that work rumination mediates the positive relationship between work engagement and work-family conflict. Additionally, our findings suggest that behavioral engagement (i.e.,OCB) and work rumination mediate the relationship between work engagement and work-family conflict. Moreover, psychological capital mitigated the relationships of work engagement with work rumination, but not job crafting. Our study helps to better understand the "dark side" of work engagement and offers implications on how to mitigate its detrimental relationship with work-family conflict.

Relationships Between Function, Pain Severity and Psychological and Cognitive Levels in People With Chronic Neck Pain: Cross-Sectional Study.

OBJECTIVE: This study aimed to investigate the relationship between pain and functional levels with pain catastrophizing, rumination, decision-making, and critical thinking in people with chronic neck pain. METHODS: The study included 62 patients with chronic neck pain who had presented to a physiotherapy center with pain complaints for at least 3 months. The visual analog scale for pain severity, the Neck Disability Index for functional level, the Pain Catastrophizing Scale, the Ruminative Thinking Scale, the Melbourne Decision-Making Scale I-II, and the Marmara Critical Thinking Inventory were used for assessments. RESULTS: Activity pain, night pain, and disability were positively correlated with rumination (rho: 0.368, p = .003; rho: 0.423, p = <.001; rho = 0.334, p = .008). There was a positive correlation between night pain, disability, and pain catastrophizing (rho = 0.298, p = .019; rho = .434 p < .001). A negative correlation was observed between patients' pain severity and disability with critical thinking scores (rho = -0.393, p = .002; rho = -0.377 p = .003, rho = -0.428 p < .001, rho = -0.441 p < .001). CONCLUSIONS: The study suggested that there were positive correlations between pain severity and disability with rumination and pain catastrophizing. Additionally, chronic neck pain was found to have negative correlations with critical thinking scores, indicating potential impacts on cognitive processes. These findings may provide insights into the complex interplay between chronic pain and psychological factors, which can inform the development of interventions to enhance chronic pain management.

Sleep-specific repetitive negative thinking processes and prenatal insomnia symptoms: A naturalistic follow-up study from mid- to late-pregnancy.

Insomnia symptoms are highly prevalent during pregnancy; therefore, identifying modifiable risk markers is important for risk prediction and early intervention. This study aimed to examine the role of sleep-specific rumination and sleep-specific worry in prenatal insomnia symptoms. A total of 859 married pregnant women without history of psychiatric illnesses (mean [standard deviation] age, 30.15 [3.86] years; 593 [69.0%] with a bachelor's degree or above) were enrolled from the obstetrical outpatient departments of two tertiary comprehensive hospitals in Shandong, China, who completed assessments of sleep-specific rumination, sleep-specific worry, and insomnia symptoms at baseline (mid-pregnancy) and follow-up (late-pregnancy). Measures included Daytime Insomnia Symptom Response Scale, Anxiety and Preoccupation about Sleep Questionnaire, and Insomnia Severity Index. Our results showed that after controlling for covariates, both sleep-specific rumination and sleep-specific worry showed significant concurrent and prospective associations with insomnia symptoms, and the increases in scores of sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of insomnia symptoms at follow-up. Moreover, the increases in sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of reporting newly developed insomnia symptoms rather than persistent normal sleep. However, the changes in sleep-specific rumination and sleep-specific worry were not significantly associated with the likelihood of reporting persistent or remitted insomnia symptoms rather than persistent normal sleep. In conclusion, sleep-specific rumination and sleep-specific worry were significantly associated with concurrent or subsequent insomnia symptoms; thus, they may be promising cognitive risk markers and intervention targets.

Worry and ruminative brooding: associations with cognitive and physical health in older adults.

Introduction: Mental health conditions are associated with cognition and physical function in older adults. We examined whether worry and ruminative brooding, key symptoms of certain mental health conditions, are related to subjective and/or objective measures of cognitive and physical (cardiovascular) health. Methods: We used baseline data from 282 participants from the SCD-Well and Age-Well trials (178 female; agemean = 71.1 years). We measured worry and ruminative brooding using the Penn State Worry Questionnaire and the Ruminative Response Scale-brooding subscale. We assessed subjective physical health using the WHOQOL-Bref physical subscale, and objective physical health via blood pressure and modified versions of the Framingham Risk Score and Charlson Comorbidity Index. With subjective and objective cognition, we utilized the Cognitive Difficulties Scale and a global composite (modified Preclinical Alzheimer's Cognitive Composite, PACC5, with the Wechsler Adult Intelligence Scale-IV, category fluency, Mattis Dementia Rating Scale-2, and either the California Verbal Learning Test or the Rey Auditory Verbal Learning Test). We conducted linear regressions, adjusted for education, age, sex and cohort. Results: Worry and ruminative brooding were negatively associated with subjective physical health (worry: ß = -0.245, 95%CI -0.357 to -0.133, p < 0.001; ruminative brooding: ß = -0.224, 95%CI -0.334 to -0.113, p < 0.001) and subjective cognitive difficulties (worry: ß = 0.196, 95%CI 0.091 to 0.302, p < 0.001; ruminative brooding: ß = 0.239, 95%CI 0.133 to 0.346, p < 0.001). We did not observe associations between worry or ruminative brooding and any measure of objective health. Discussion: Worry and ruminative brooding may be common mechanisms associated with subjective but not objective health. Alternatively, cognitively unimpaired older adults may become aware of subtle changes not captured by objective measures used in this study. Interventions reducing worry and ruminative brooding may promote subjective physical and cognitive health; however, more research is needed to determine causality of the relationships.

Golden steps: A nursing approach for vitality, agility, and rumination in geriatric clients with depressive disorders through mindful walking.

BACKGROUND: Depression is a prevalent issue among older adults and can significantly impact their overall quality of life. While traditional treatments may not always be sufficient or suitable for all individuals, the potential of alternative interventions, such as mindful walking, offers a ray of hope. This study aimed to evaluate the impact of mindful walking on rumination, agility, vitality, and mindfulness in geriatric patients with depressive disorders. METHOD: A prospective quasi-experimental design was employed with a purposive sample of 35 clients in the intervention group and 33 in the control group. This study utilized the Ruminative Responses Scale - Short Form (RRS-SF) and Five Facet Mindfulness Questionnaire (FFMQ) to measure the primary outcome. The Timed Up and Go Test (TUG) and State-Level Version of the Subjective Vitality Scale (SVS) were used to measure the secondary outcomes. RESULTS: Mindful walking significantly affected vitality, mindfulness, and rumination, with effect sizes (Õ²2 = 0.168, 0.137, and 0.127), respectively. On the other hand, the intervention had a less significant effect on agility, with an effect size (Õ²2 = 0.047). CONCLUSION: This study revealed that geriatric clients with depressive disorders showed more significant improvements in vitality, followed by improvement in rumination and agility. Integrating mindful walking as a part of care plans for those clients would promote their physical activity and mental well-being.

The Quality of Interpersonal Relationships, Intrusive and Deliberate Rumination and Adjustment to the Death of a Spouse.

The aim of the presented study was to gain a better understanding of relationships between the pre-loss quality of marriage, global attachment style, rumination, the severity of complicated grief and the level of posttraumatic growth among widowed individuals. After the researchers obtained the consent of the ethics board to conduct the study, they examined widowed individuals (n = 152) using the Experiences in Close Relationships - Revised, the Dyadic Adjustment Scale, the Event Related Rumination Inventory, the Inventory of Complicated Grief, and the Posttraumatic Growth Inventory. Results show a positive relationship between attachment anxiety and complicated grief via intrusive rumination, as well as a positive relationship between attachment anxiety and posttraumatic growth via intrusive and deliberate rumination. Results also show that the greater the attachment avoidance the higher the severity of complicated grief, but only in the case of perceived low quality of the marriage. The presented research provides insight into the complex associations between the quality of interpersonal relationships, rumination and adjustment to loss among individuals who experienced the death of a spouse.

Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial.

BACKGROUND: Behavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD). METHODS: In this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS). RESULTS: The results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up. DISCUSSION: BAGT was more effective than SBA in MDD patients. Participants' engagement with self-help treatment is discussed. TRIAL REGISTRATION: The present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/ ) (Registration Date: 04/03/2019).