Abstract
This article reports on a longitudinal study in which we examined, across multiple waves of participants, the rumination vulnerability-stress model for the differential prediction of the dimensions of anxiety and depression. Baseline and 6-month follow-up data were obtained from 371 adolescents with subthreshold depression. According to analyses based on hierarchical linear modeling, increased rumination showed association with increased total score for depressive symptoms. The greater increases were only associated with the dimension of depressed mood, not with other symptoms of depression. Furthermore, increased rumination was associated with increases in the total score and all symptomatic dimensions of anxiety following stressful events. These findings support rumination’s potential for a transdiagnostic role as symptoms of depression and anxiety develop. While rumination may have general application concerning how symptoms of anxiety develop on each dimension, its application for diagnoses of depression is limited to assessing depressed mood, not other dimensions.
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References
Abela, J. R., & Hankin, B. L. (2011). Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. Journal of Abnormal Psychology, 120(2), 259–271. https://doi.org/10.1037/a0022796
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.
Barker, M. M., Beresford, B., Bland, M., & Fraser, L. K. (2019). Prevalence and incidence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions: A systematic review and meta-analysis. JAMA Pediatrics, 173(9), 835–844. https://doi.org/10.1001/jamapediatrics.2019.1712
Buch, A. M., & Liston, C. (2021). Dissecting diagnostic heterogeneity in depression by integrating neuroimaging and genetics. Neuropsychopharmacology, 46(1), 156–175. https://doi.org/10.1038/s41386-020-00789-3
Choi, S., & In, H. (2020). Paths from core belief disruption to post-traumatic stress symptoms and post-traumatic growth among Korean undergraduates: The mediating role of rumination. International Journal of Psychology: Journal International de Psychologie, 55(2), 215–223. https://doi.org/10.1002/ijop.12578
Claudia, B., Ebert, D. D., Lehr, D., et al. (2016). Effect of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: A randomized clinical trial. JAMA, 315(17), 1854–1863.
Cuijpers, W. J. M. J., & Smit, F. (2004). Subthreshold depression as a risk indicator for major depressive disorder: A systematic review of prospective studies. Acta Psychiatrica Scandinavica, 109, 325–331. https://doi.org/10.1111/j.1600-0447.2004.00301.x
Daly, M. (2022). Prevalence of depression among adolescents in the U.S. from 2009 to 2019: Analysis of trends by sex, race/ethnicity, and income. The Journal of adolescent health : official publication of the Society for. Adolescent Medicine, 70(3), 496–499. https://doi.org/10.1016/j.jadohealth.2021.08.026
Diggle, P. (2002). Analysis of longitudinal data. Oxford University Press.
Elsayed, N. M., Fields, K. M., Olvera, R. L., & Williamson, D. E. (2019). The role of familial risk, parental psychopathology, and stress for first-onset depression during adolescence. Journal of Affective Disorders, 253, 232–239. https://doi.org/10.1016/j.jad.2019.04.084
First, M., Spitzer, R. L., Gibbon, M., & Williams, J. (2001). Structured clinical interview for DSM-IV-TR axis I disorders. Biometrics Research Department, New York State Psychiatric Institute.
Hankin, B. L., & Abramson, L. Y. (2002). Measuring cognitive vulnerability to depression in adolescence: Reliability, validity, and gender differences. Journal of Clinical Child and Adolescent Psychology, 31(4), 491–504. https://doi.org/10.1207/S15374424JCCP3104_8
Hoff, E. R., & Muehlenkamp, J. J. (2009). Nonsuicidal self-injury in college students: The role of perfectionism and rumination. Suicide and Life-threatening Behavior, 39(6), 576–587.
Horwath, E., Johnson, J., Klerman, G. L., & Weissman, M. M. (1992). Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry, 49(10), 817–823. https://doi.org/10.1001/archpsyc.1992.01820100061011
Hsu, K. J., Beard, C., Rifkin, L., Dillon, D. G., Pizzagalli, D. A., & Björgvinsson, T. (2015). Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control. Journal of Affective Disorders, 188, 22–27.
Hwang, J. W., Egorova, N., Yang, X. Q., Zhang, W. Y., Chen, J., Yang, X. Y., Hu, L. J., Sun, S., Tu, Y., & Kong, J. (2015). Subthreshold depression is associated with impaired resting-state functional connectivity of the cognitive control network. Translational Psychiatry, 5(11), e683. https://doi.org/10.1038/tp.2015.174
Ingram, R. E., & Luxton, D. D. (2005). Vulnerability-stress models. In B. L. Hankin & J. R. Z. Abela (Eds.), Development of psychopathology: A vulnerability-stress perspective (pp. 32–46). Sage Publications Inc.. https://doi.org/10.4135/9781452231655.n2
Ingram, R. E., Miranda, J., & Segal, Z. V. (1998). Cognitive vulnerability to depression. Guilford Press.
Klein, D. N., Shankman, S. A., Lewinsohn, P. M., & Seeley, J. R. (2009). Subthreshold depressive disorder in adolescents: Predictors of escalation to full-syndrome depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 48(7), 703–710. https://doi.org/10.1097/CHI.0b013e3181a56606
Lee, F. K., & Zelman, D. C. (2019). Boredom proneness as a predictor of depression, anxiety and stress: The moderating effects of dispositional mindfulness. Personality and Individual Differences, 146, 68–75.
Levin, R. Y., & Liu, R. T. (2021). Life stress, early maltreatment, and prospective associations with depression and anxiety in preadolescent children: A six-year, multi-wave study. Journal of Affective Disorders, 278, 276–279. https://doi.org/10.1016/j.jad.2020.09.072
Liao, K. Y., & Wei, M. (2011). Intolerance of uncertainty, depression, and anxiety: The moderating and mediating roles of rumination. Journal of Clinical Psychology, 67(12), 1220–1239. https://doi.org/10.1002/jclp.20846
Mann, R. E., Paglia-Boak, A., Adlaf, E. M., et al. (2011). Estimating the prevalence of anxiety and mood disorders in an adolescent general population: An evaluation of the GHQ12. International Journal of Mental Health and Addiction, 9, 410–420. https://doi.org/10.1007/s11469-011-9334-5
March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 554–565. https://doi.org/10.1097/00004583-199704000-00019
McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193. https://doi.org/10.1016/j.brat.2010.12.006
Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339–352. https://doi.org/10.1037/a0031994
Monroe, S. M., & Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin, 110(3), 406–425. https://doi.org/10.1037/0033-2909.110.3.406
Nandi, A., Beard, J. R., & Galea, S. (2009). Epidemiologic heterogeneity of common mood and anxiety disorders over the lifecourse in the general population: a systematic review. BMC Psychiatry, 9, 31. https://doi.org/10.1186/1471-244X-9-31
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504–511.
Nolen-Hoeksema, S., & Harrell, Z. A. (2002). Rumination, depression, and alcohol use: Tests of gender differences. Journal of Cognitive Psychotherapy, 16(4), 391–403.
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. https://doi.org/10.1037//0022-3514.61.1.115
Nolen-Hoeksema, S., Morrow, J., & Fredrickson, B. L. (1993). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102(1), 20–28. https://doi.org/10.1037//0021-843x.102.1.20
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x
Ouimet, A. J., Gawronski, B., & Dozois, D. J. (2009). Cognitive vulnerability to anxiety: A review and an integrative model. Clinical Psychology Review, 29(6), 459–470. https://doi.org/10.1016/j.cpr.2009.05.004
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Roberts, J. E., Gilboa, E., & Gotlib, I. H. (2018). Ruminative response style and vulnerability to episodes of dysphoria: Gender, neuroticism, and episode duration. Cognitive Therapy and Research, 22, 401–423. https://doi.org/10.1023/A:1018713313894
Roberts, N., Stuart, H., & Lam, M. (2008). High school mental health survey: Assessment of a mental health screen. Canadian Journal of Psychiatry, 53, 314–322.
Romano, E., Tremblay, R. E., Vitaro, F., Zoccolillo, M., & Pagani, L. (2001). Prevalence of psychiatric diagnoses and the role of perceived impairment: Findings from an adolescent community sample. Journal of Child Psychology and Psychiatry, 42, 451–461.
Struijs, S. Y., Groenewold, N. A., Oude Voshaar, R. C., & de Jonge, P. (2013). Cognitive vulnerability differentially predicts symptom dimensions of depression. Journal of Affective Disorders, 151(1), 92–99. https://doi.org/10.1016/j.jad.2013.05.057
Thomsen, D. K., Mehlsen, M. Y., Christensen, S. B., & Zachariae, R. (2003). Rumination—Relationship with negative mood and sleep quality. Personality and Individual Differences, 34, 1293–1301.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259. https://doi.org/10.1023/A:1023910315561
Vélez, C. E., Krause, E. D., McKinnon, A., Brunwasser, S. M., Freres, D. R., Abenavoli, R. M., & Gillham, J. E. (2016). Social support seeking and early adolescent depression and anxiety symptoms: The moderating role of rumination. The Journal of Early Adolescence, 36(8), 1118–1143. https://doi.org/10.1177/0272431615594460
Verstraeten, K., Bijttebier, P., Vasey, M. W., & Raes, F. (2011). Specificity of worry and rumination in the development of anxiety and depressive symptoms in children. British Journal of Clinical Psychology, 50(4), 364–378.
Wakefield, J. C. (2016). Diagnostic issues and controversies in DSM-5: Return of the false positives problem. Annual Review of Clinical Psychology, 12, 105–132. https://doi.org/10.1146/annurev-clinpsy-032814-112800
Wang, D., Zhao, J., Ross, B., Ma, Z., Zhang, J., Fan, F., & Liu, X. (2022). Longitudinal trajectories of depression and anxiety among adolescents during COVID-19 lockdown in China. Journal of Affective Disorders, 299, 628–635. https://doi.org/10.1016/j.jad.2021.12.086
Wang, J., Wang, D., Cui, L., McWhinnie, C. M., Wang, L., & Xiao, J. (2017). The “weakest link” as an indicator of cognitive vulnerability differentially predicts symptom dimensions of anxiety in adolescents in China. Journal of Anxiety Disorders, 50, 69–75.
Wesselhoeft, R., Sørensen, M. J., Heiervang, E. R., & Bilenberg, N. (2013). Subthreshold depression in children and adolescents - A systematic review. Journal of Affective Disorders, 151(1), 7–22. https://doi.org/10.1016/j.jad.2013.06.010
Wolkenstein, L., Zwick, J. C., Hautzinger, M., & Joormann, J. (2014). Cognitive emotion regulation in euthymic bipolar disorder. Journal of Affective Disorders, 160, 92–97. https://doi.org/10.1016/j.jad.2013.12.022
Xiao, J., Qiu, Y., He, Y., Cui, L., Auerbach, R. P., McWhinnie, C. M., & Yao, S. (2016). ‘Weakest Link’ as a cognitive vulnerability within the hopelessness theory of depression in Chinese university students. Stress and Health, 32(1), 20–27. https://doi.org/10.1002/smi.2571
Yang, H. J., Soong, W. T., Kuo, P. H., Chang, H. L., & Chen, W. J. (2004). Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: A stratum-specific likelihood ratio analysis. Journal of Affective Disorders, 82(3), 419–430. https://doi.org/10.1016/j.jad.2004.04.008
Yang, J., Yao, S., Zhu, X., Zhang, C., Ling, Y., Abela, J. R., Esseling, P. G., & Mcwhinnie, C. M. (2010). The impact of stress on depressive symptoms is moderated by social support in Chinese adolescents with subthreshold depression: A multi-wave longitudinal study. Journal of Affective Disorders, 127(1-3), 113–121.
Yao, S., Zou, T., Zhu, X., Abela, J. R., Auerbach, R. P., & Tong, X. (2007). Reliability and validity of the Chinese version of the multidimensional anxiety scale for children among Chinese secondary school students. Child Psychiatry and Human Development, 38(1), 1–16. https://doi.org/10.1007/s10578-006-0039-0
Zhang, X., Gao, F., Kang, Z., Zhou, H., Zhang, J., Li, J., Yan, J., Wang, J., Liu, H., Wu, Q., & Liu, B. (2022). Perceived academic stress and depression: The mediation role of mobile phone addiction and sleep quality. Frontiers in Public Health, 10, 760387. https://doi.org/10.3389/fpubh.2022.760387
Zhou, K., Chen, J., Huang, C., & Tang, S. (2023). Prevalence of and factors influencing depression and anxiety among Chinese adolescents: A protocol for a systematic review. BMJ Open, 13(3), e068119. https://doi.org/10.1136/bmjopen-2022-068119
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The study was designed by Jing Xiao, Yini He. Data were collected by Jing Xiao. Results were analyzed by Yini He, Jing Xiao, and Weiqi Li. The draft manuscript was written by Weiqi Li and Jing Xiao. Later versions of the manuscript were seen and commented upon by all authors.
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• Rumination may have transdiagnostic application concerning depressive and anxiety symptoms’ development following negative stress events.
• Rumination may have application concerning each dimension’s development in symptoms of anxiety.
• Rumination may only have particular application concerning depressed mood dimension of symptoms related to depression.
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Li, W., He, Y. & Xiao, J. Rumination as a Moderating Factor for Different Dimensions of Depressive and Anxiety Symptoms in Adolescents with Subthreshold Depression: a Multi-Wave Longitudinal Study. Int J Ment Health Addiction (2023). https://doi.org/10.1007/s11469-023-01194-9
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DOI: https://doi.org/10.1007/s11469-023-01194-9