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Cognitive Vulnerabilities and Depression in Young Adults: an ROC Curves Analysis

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Cognitive Vulnerabilities and Depression in Young Adults: an ROC Curves Analysis Hindawi Publishing Corporation Depression Research and Treatment Volume 2013, Article ID 407602, 8 pages http://dx.doi.org/10.1155/2013/407602 Research Article Cognitive Vulnerabilities and Depression in Young Adults: An ROC Curves Analysis Michela Balsamo,1 Claudio Imperatori,2 MariaRitaSergi,1 Martino Belvederi Murri,3 Massimo Continisio,2,4 Antonino Tamburello,2,4 Marco Innamorati,1,2,4 and Aristide Saggino1 1 DISPUTer, Dipartimento di Scienze Psicologiche, Umanistiche e del Territorio, “G. d’Annunzio” University, 66100 Chieti, Italy 2 UniversitaEuropeadiRoma,00163Rome,Italy` 3 Division of Psychiatry, Department of Neurosciences, University of Parma, 43100 Parma, Italy 4 Istituto Skinner, 00184 Rome, Italy Correspondence should be addressed to Michela Balsamo; [email protected] Received 27 April 2013; Accepted 21 July 2013 Academic Editor: H. Grunze Copyright © 2013 Michela Balsamo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives and Methods. The aim of the present study was to evaluate, by means of receiver operating characteristic (ROC) curves, whether cognitive vulnerabilities (CV), as measured by three well-known instruments (the Beck Hopelessness Scale, BHS; the Life Orientation Test-Revised, LOT-R; and the Attitudes Toward Self-Revised, ATS-R), independently discriminate between subjects with different severities of depression. Participants were 467 young adults (336 females and 131 males), recruited from the general population. The subjects were also administered the Beck Depression Inventory-II (BDI-II). Results. Four first-order (BHS Optimism/Low Standard; BHS Pessimism; Generalized Self-Criticism; and LOT Optimism) and two higher-order factors (Pessimism/Negative Attitudes Toward Self, Optimism) were extracted using Principal Axis Factoring analysis. Although all first- order and second-order factors were able to discriminate individuals with different depression severities, the Pessimism factor had the best performance in discriminating individuals with moderate to severe depression from those with lower depression severity. Conclusion. In the screening of young adults at risk of depression, clinicians have to pay particular attention to the expression of pessimism about the future. 1. Introduction theories involved genetics and biological functioning, other approaches focused on the study of personal characteristics of Major depressive disorder (MDD) is one of the most wide- individuals who are believed to be vulnerable to experiencing spread psychiatric disorder [1–4]andtheleadingcauseof depressive episodes. A large body of research examining disability as measured by years lived with disability (YLDs) cognitive models of vulnerability for depression hypothesized [5–9]. Currently, MDD is estimated to be the fourth leading that the way the individual interprets his/her experiences cause of global disease burden [10, 11], and, by the year 2020, represents a protective or risk factor for the development of it is projected to reach the second place in the ranking of depressive disorders when negative stressful life events occur the major causes of Disability Adjusted Life Years (DALYs). [15].Depressedpeopleengageinprolongedandrepetitive Today, depression is already the second cause of DALYs in thinking about the self, the world, and the future in a negative the age category 15–44 years [11]. The estimated 12-month way with detrimental effects on mood [16–18]. Cognitive prevalence of MDD was 6.6% in the USA [12] and 3.0% in vulnerability (CV) for depression may be defined as a trait- Italy [13]. like tendency to interpret information in a negative and Many approaches have been taken in attempts to explain distorted way when facing a subjectively perceived stressful the origins of depression [14]. Whereas some of these event [19]. The literature indicated that CV may play a crucial 2 Depression Research and Treatment role in the development and maintenance of depressive discriminate independently between subjects with different disorders not only in adulthood but also in childhood and severities of depression. adolescence (for a review see [20]). Despite similarities, currently there are several different 2. Materials and Methods theories which hypothesize the cognitive processes to be a diathesis for the development of depressive disorders. Two 2.1. Participants. Participants were 467 young adults (131 of the most renowned theories are the hopelessness theory males, 28.1%; 336 females, 71.9%). Mean age of the sample [21]andBeck’stheory[22, 23]. According to the hopelessness was 23.58 ± 5.03 years (range 18–39). Subjects were included theory, three kinds of maladaptive inferences that people if they had an age between 18 and 40 years old. Exclusion may make when confronted with negative events contribute criteria were the presence of any condition affecting the to the development of hopelessness and, in turn, depressive ability to complete the assessment, including illiteracy and symptoms: causal attributions, inferred consequences, and denial of informed consent. inferred characteristics about the self. Hopelessness and All participants were nonrandomly recruited in Central depressive symptoms are likely to occur when negative life Italy between February 2012 and June 2012. They accepted to events are (1) attributed to stable (i.e., likely to persist over participate voluntarily and gave their informed consent. time) and global (i.e., likely to affect many areas of life) causes; (2)viewedaslikelytoleadtofurthernegativeconsequences; 2.2. Measures. The Beck Depression Inventory-II (BDI-II) and(3)construedasimplyingthatthepersonisunworthy [38], the BHS, the LOT-R, and the ATS-R were administered or deficient. Similarly, Beck [22, 23]andBecketal.[24] to all subjects. hypothesized depressogenic self-schemata, activated by the The BDI-II is a well-known self-report inventory com- occurrence of negative life events, that take the form of posed of 21 items designed to assess the presence and overlypessimisticviewsoftheself,theworld,andthefuture severity of depressive symptoms, according to DSM-IV [39] (the negative cognitive triad). Also, Carver and Ganellen [25] criteria. Respondents endorse specific statements reflecting considered self-punitiveness as a salient feature of depression, their feelings over the last two weeks, including today. Each associated with the holding of overly high standards, the statement is rated on a 4-point Likert-type scale ranging from tendency to be too critical with the self for failing to attain a 0 to 3, based on the severity of depressive symptoms. Impor- standard, and the tendency to generalize from a single failure tantly, extensive literature has supported the psychometric tothebroadersenseofself-worth.Tomeasurethesethree properties of the scale in clinical and nonclinical samples potential self-regulatory vulnerabilities to depression, Carver [40, 41]. In the current sample, Cronbach alpha was 0.86. and colleagues developed the Attitudes Toward Self (ATS). The BHS [24] is a 20-item scale for measuring the Several researches have provided support for the critical cognitive component of the depression. The scale assesses role of CV in the origin and course of depressive disorders three major aspects of hopelessness: feelings about the future, [26–30]. For example, Beckham et al. [26]reportedthatallthe loss of motivation, and expectations. Responding to the 20 cognitive triad components are significantly associated with true or false items, individuals have to either endorse a pes- the severity of depressive symptoms in depressed patients. simistic statement or deny an optimistic statement. Research Evans et al. [28] indicated that holding a negative self-schema consistently have supported a positive relationship between is an independent risk factor for the onset of depression BHS scores and measures of depression, suicidal intent, and in women. Furthermore, pessimistic views about the future current suicidal ideation [31, 42–44]. The Italian version of have been found to be highly predictive of suicide behaviors the BHS has reported good psychometric properties [45, 46]. [31, 32] and worse health and social functioning [33]in The LOT-R is a 6-item scale measuring optimism: three psychiatric patients. Again, in a longitudinal study, it was items are positively worded (e.g., “I’m always optimistic about reported that undergraduate students with a more general- my future”), and the other three items are negatively worded ized negative cognitive style were 3.5–6.8 times more likely to (e.g., “If something can go wrong for me, it will”). Each item report more depressive episodes compared to students with isratedonafive-pointLikert-typescale(from1—“Iagreea a less generalized negative cognitive style [29]. Some studies lot”—to 5—“I disagree a lot”). Sum scores range between 6 also indicated a partial overlap between the hopelessness and and 30 with higher scores indicating higher optimism. Beck’s theories [34, 35]. The ATS-R is a self-report measure designed to measure Our literature review suggests that investigating the role three potential self-regulatory vulnerabilities to depression. of CV in the development of depression may be beneficial for One of them is the holding of overly high standards, the a better understanding and treatment of depressive disorders. second is the tendency to be self-critical
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