self-schemas Negative and the onset of depression in women.
Thinking sad, feeling sad?
Jonathan Evans, Jon Heron, Glyn Lewis, Ricardo Araya, Dieter Wolke and the Avon Longitudinal Study of Parents and Children (ALSPAC) University of Bristol, UK
What is cognitive theory of depression?
Aaron T Beck a psychoanalyst. Previously - depressed moods arise because of subconscious processes conflict, deficit. Cognitive theory reverses
the feeling thoughts.
Thoughts are not just a symptom of depression they are causal.
Two forms
Automatic negative thoughts Schema
What are schema?
`stable characteristics of personality that cause depression by distorting the selection, encoding, organisation and evaluation of environmental stimuli' (Gotlib & Hammen, 1992)
Are schema latent?
`Even though these attitudes (or concepts) may not be prominent or even discernible at a given time they persist in a latent state like an explosive charge ready to be detonated by an appropriate set of conditions' Beck 1969
Evidence for cognitive theory
Haaga et al (1991)
Causal elements lead to hypotheses:
Stability Events specificity Onset Recurrence
Cognitive therapy for depression effective.
Evidence continued
Evidence for negative schema (dysfunctional attitudes) and onset lacking. Explanation when not depressed subjects need to be primed eg. Teasdale differential activation No large population based longitudinal study looking at onset of depression in relation to negative schema.
Methods
We studied women recruited for ALSPAC Avon Longitudinal Study of Parents and Children 14 000 women recruited in pregnancy Depression measure - EPDS and `personality' IPSM at 18 weeks repeated depression measure at 32 weeks pregnancy We chose from IPSM those items which related to negative self schema:
I avoid saying what I think for fear of being rejected. If others knew the real me they would not like me. If other people knew what I am really like they would think less of me. I always expect criticism. I don't like people to really know me. My value as a person depends enormously on what others think of me.
For the main analyses - those women who were not depressed (EPDS <12) at 18 weeks of pregnancy. Investigated the onset of depression 14 weeks later by EPDS at 32 weeks of pregnancy. Logistic regression with NSS unit score and dividing into tertiles for scale
Women scoring in the highest tertile NSS c.f. lowest two tertiles (combined)
High scorers more likely to have children, a family history of depression, a previous history of severe depression and were older.
Highest tertile Total Clinical variables EPDS Score 0 to 9 Score 10 to 12 Maternal history of depression Missing Yes No Paternal history of depression Missing Yes No Own history of severe depression Yes No Demographi c variables Maternal age at delivery Teen 20-34 35+ Parity 0 1 2 or more N 3066 % 35.9
Lowest two tertiles N 5474
P % 64.1
2291 775
74.7 25.3
4912 562
89.7 10.3
141 625 2300
4.60 20.4 75.0
220 949 4305
4.0 17.3 78.6
0.001
206 247 2613
6.7 8.0 85.2
341 330 4803
6.23 6.03 87.7
0.001
260 2680
8.84 91.2
270 5038
5.09 94.9
< 0.001
68 2621 374 1299 1112 615
2.22 85.6 12.2 42.9 36.7 20.3
166 4758 547 2468 1944 988
3.03 87 10 45.7 36 18.3
0.001
0.020
Onset of depression
Of those with two EPDS measures (i.e. 9083) 8540 (94%) also completed at least the six selected items of comprising the negative self-schema measure and of these 736 (8.6%, 95% c.i. 8.0% to 9.2%) had onset of depression between 18 weeks and 32 weeks of pregnancy
Onset risk by NSS score
The risk of depression onset increased with each unit increase in negative self-schemas score, odds ratio 1.16 (95% c.i. 1.14 to 1.19, p < 0.001). Adjusting EPDS for depression score at baseline attenuated the association, odds ratio 1.07 (95% c.i. 1.05, 1.09 p < 0.001). There was little further change when also adjusting for other potential confounders, odds ratio 1.07 (95% c.i. 1.05, 1.10 p < 0.001, n = 7845).
Odds ratio of becoming depressed by tertiles of negative self-schema score unadjusted and adjusted for depression score at 18 weeks and then adjusted for other confounders.
N Negative self schema score 1st tertile (0-2) 2nd tertile (3-5) 3rd tertile (6-18) 2702 2772 3066 4.8 7.0 13.4 1.00 reference 1.48 [1.18, 1.86] 3.04 [2.48, 3.73] P < 0.001 Sample size 8540 N = 8540 1.00 reference 1.16 [0.91, 1.46] 1.56 [1.26, 1.93] P < 0.001 N = 8540 1.00 reference 1.24 [0.96, 1.60] 1.60 [1.27, 2.02] P < 0.001 N = 7845 Prevalence of depression (%) OR [95% CI] Adj1 OR [CI] Adj2 OR [CI]
1Adjustment for EPDS at baseline 18 weeks of pregnancy. 2 Adjustment for past history of depression, parental history of depression, smoking, housing tenure, crowding in household, marital status, education, age, car ownership, unemployment in partner and parity and also time between measures.
Residual confounding
Additional adjustment for mood using the Crown-Crisp Index no substantial difference.
adjusted odds ratio for onset of depression for those in the highest tertile of the negative selfschemas score 1.42 (95% confidence interval 1.11 to 1.80, p = 0.008, n = 7540).
Differential activation
Is a lowering of mood required to prime women in order to elicit NSS?
Prior (mean +/- 1.4 s.e.)
2 3 4 5 6 7 8
N=
.00
623 653 776 756 811 776 803 729
1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 11.00 12.00
EPDS at 18 wk (a.n.)
682 594 493 467 377
30
EPDS at 32 wk
20
10
Prior (3 groups)
6-18 3-5
0 0 2 4 6 8 10 12 14
0-2
EPDS at 18 wk
30.0
25.0
Odds ratio of becoming depressed and 95% CI
20.0
15.0
EPDS low est tertile EPDS middle tertile EPDS highest tertile
10.0
5.0
0.0 Six item IPSM t1 Six item IPSM t2 Category of negative self-schemas and EPDS at 18 w eeks Six item IPSM t3
Interaction in log regression model
Although the association of negative selfschemas scale score was stronger at higher levels of subthreshold EPDS score this interaction was not statis...