Negative selfschemas and the onset of depression in women.

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Negative self-schemas 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

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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.

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Two forms

• Automatic negative thoughts
• Schema

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What are schema?

• stable characteristics of personality that
  cause depression by distorting the selection,
  encoding, organisation and evaluation of
  environmental stimuli (Gotlib Hammen, 1992)

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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

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Evidence for cognitive theory

• Haaga et al (1991)
• Causal elements lead to hypotheses
• Stability
• Events specificity
• Onset
• Recurrence
• Cognitive therapy for depression effective.

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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.

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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

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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 dont like people to
really know me. My value as a person depends
enormously on what others think of me.
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• For the main analyses - those women who were not
  depressed (EPDS
• 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

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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.

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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

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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 for EPDS depression score at baseline
  attenuated the association, odds ratio 1.07 (95
  c.i. 1.05, 1.09 p
• There was little further change when also
  adjusting for other potential confounders, odds
  ratio 1.07 (95 c.i. 1.05, 1.10 p 7845).

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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.
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.
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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
  self-schemas score 1.42 (95 confidence interval
  1.11 to 1.80, p 0.008, n 7540).

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Differential activation

• Is a lowering of mood required to prime women in
  order to elicit NSS?

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Interaction in log regression model

• Although the association of negative
  self-schemas scale score was stronger at higher
  levels of subthreshold EPDS score this
  interaction was not statistically significant
  within the logistic regression model, Likelihood
  Ratio test, chi squared 0.053, p0.819.

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• Are these just early symptoms?

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Conclusion

• Findings support the hypothesis that individuals
  who have negative self schema are vulnerable to
  the onset of depression.
• These negative self schema are not latent and do
  not require low mood to prime them ie their
  effect is the same at all levels of depression.
• It is worth studying origins of NSS as
  understanding these may help inform primary
  preventive programme for depression.