Attributional Style, Self-Esteem, and Human Immunodeficiency Virus: A Test of the Hopelessness and Self-Esteem Theories of Depression

  • Jeffrey G. Johnson
  • Gerald I. Metalsky
  • Judith G. Rabkin
  • Janet B. W. Williams
  • Robert H. Remien
Article

Abstract

Research on the hopelessness and self-esteem theories of depression (Abramson, Metalsky, & Alloy, 1989; Metalsky, Joiner, Hardin, & Abramson, 1993) suggests that HIV-infected persons with depressotypic attributional style (AS) and low self-esteem (SE) may be at risk for onset of a syndrome referred to as “hopelessness depression” (HD). In a prospective study conducted to test these theories, measures of anxiety and depression, AS, and SE were administered to 85 HIV+ and 43 HIV− men; symptoms were reassessed 6 months later. Results indicated that: (1) The interaction of AS, SE, and HIV status predicted change in HD symptoms, but not overall depression or anxiety symptoms; (2) HIV+ men with depressotypic AS and high SE had increased HD symptom levels while other men with high SE had decreased HD symptom levels; (3) HD symptoms remained stable over the 6-month interval among men with low SE; and (4) High SE predicted decreases in anxiety symptoms among HIV− men, but not among HIV+ men. Contrary to the study hypothesis, these findings suggest that among individuals with life-threatening illnesses such as HIV infection, those with depressotypic AS and high SE may be at highest risk for onset of HD.

HIV self-esteem hopelessness depression 

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REFERENCES

  1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.Google Scholar
  2. Abramson, L. Y., Metalsky, G. I., and Alloy, L. B. (1989). Hopelessness depression: A theorybased subtype of depression. Psychological Review, 96, 358–372.CrossRefGoogle Scholar
  3. Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87, 49–74.PubMedGoogle Scholar
  4. Ahrens, A. H., & Haaga, D. A. F. (1993). The specificity of attributional style and expectations to positive and negative affectivity, depression, and anxiety. Cognitive Therapy and Research, 17, 83–98.Google Scholar
  5. Andrews, B., & Brown, G. W. (1993). Self-esteem and vulnerability to depression: The concurrent validity of interview and questionnaire measures. Journal of Abnormal Psychology, 102, 565–572.PubMedGoogle Scholar
  6. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefPubMedGoogle Scholar
  7. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.Google Scholar
  8. Beck, A. T., Brown, G., Steer, R. A., Eidelson, J. I., & Riskind, J. H. (1987). Differentiating anxiety and depression: A test of the cognitive content-specificity hypothesis. Journal of Abnormal Psychology, 96, 179–183.PubMedGoogle Scholar
  9. Brown, G. W., & Harris, T. (1978). Social origins of depression. New York: Free Press.Google Scholar
  10. Bruch, M. A., Mattia, J. I., Heimberg, R. G., & Holt, C. S. (1993). Cognitive specificity in social anxiety and depression: Supporting evidence and qualifications due to affective confounding. Cognitive Therapy and Research, 17, 1–21.Google Scholar
  11. Butler, A. C., Hokanson, J. E., & Flynn, H. A. (1994). A comparison of self-esteem lability and low trait self-esteem as vulnerability factors for depression. Journal of Personality and Social Psychology, 66, 166–177.PubMedGoogle Scholar
  12. Carroll, B. J., Fielding, J. M., & Blashki, T. G.: Depression rating scales: a critical review. Archives of General Psychiatry, 45, 742–747.Google Scholar
  13. Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.PubMedGoogle Scholar
  14. Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  15. Colvin, C. R., Block, J., & Funder, D. C. (1995). Overly positive self-evaluations and personality: Negative implications for mental health. Journal of Personality and Social Psychology, 68, 1152–1162.PubMedGoogle Scholar
  16. Davis, R. F., Metzger, D. S., Meyers, K., McLellan, A. T., Mulvaney, F. D., Navaline, H. A., & Woody, G. E. (1995). Long-term changes in psychological symptomatology associated with HIV serostatus among male injecting drug users. AIDS, 9, 73–79.PubMedGoogle Scholar
  17. Dew, M. A., Ragni, M. V., & Nimorwicz, P. (1990). Infection with Human Immunodeficiency Virus and vulnerability to psychiatric distress: a study of men with hemophilia. Archives of General Psychiatry, 47, 737–744.PubMedGoogle Scholar
  18. Dohrenwend, B. P., Shrout, P. E., Egri, G., & Mendelsohn, F. S. (1980). Nonspecific psychological distress and other dimensions of psychopathology: Measures for use in the general population. Archives of General Psychiatry, 37, 1229–1236.PubMedGoogle Scholar
  19. Gorman, J. M., Kertzner, R., Todak, G., Goetz, R. R., Williams, J. B. W., Rabkin, J., Meyer-Bahlburg, H. F. L., Mayeux, R., Stern, Y., Lange, M., Dobkin, J., Spitzer, R. L., & Ehrhardt, A. A. (1991). Multidisciplinary baseline assessment of homosexual men with and without Human Immunodeficiency Virus infection: I. overview of study design. Archives of General Psychiatry, 48, 120–123.PubMedGoogle Scholar
  20. Ganellen, R. J. (1988). Specificity of attributions and overgeneralization in depression and anxiety. Journal of Abnormal Psychology, 97, 83–86.PubMedGoogle Scholar
  21. Hamilton, E., & Abramson, L. (1983). Cognitive patterns and major depressive disorder: A longitudinal study in a hospital setting. Journal of Abnormal Psychology, 92, 173–184.PubMedGoogle Scholar
  22. Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychiatry, 32, 50–55.Google Scholar
  23. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.Google Scholar
  24. Hedlund, J. L., & Vieweg, B. W. (1979). The Hamilton rating scale for depression: A comprehensive review. Journal of Oper Psychiatry, 10, 149–165.Google Scholar
  25. Heimberg, R. G., Klosko, J. S., Dodge, C. S., Shadick, R., Becker, R. E., & Barlow, D.H. (1989). Anxiety disorders, depression, and attributional style: A further test of the specificity of depressive attributions. Cognitive Therapy and Research, 13, 21–36.Google Scholar
  26. Heimberg, R. G., Vermilyea, J. A., Dodge, C. S., Becker, R. E., & Barlow, D. H. (1987). Attributional style, depression, and anxiety: An evaluation of the specificity of depressive attributions. Cognitive Therapy and Research, 11, 537–550.Google Scholar
  27. Hilsman, R., & Garber, J. (1995). A test of the cognitive diathesis-stress model of depression in children: Academic stressors, attributional style, perceived competence, and control. Journal of Personality and Social Psychology, 69, 370–380.PubMedGoogle Scholar
  28. Johnson, J. E., Petzel, T. P., & Munic, D. (1986). An examination of the relative contribution of depression versus global psychopathology to depressive attributional style in a clinical population. Journal of Social and Clinical Psychology, 4, 107–113.Google Scholar
  29. Johnson, J. G., & Miller, S. M. (1990). Attributional, life-event, and affective predictors of onset of depression, anxiety, and negative attributional style. Cognitive Therapy and Research, 14, 417–430.Google Scholar
  30. Johnson, J. G., Rabkin, J. G., Lipsitz, J. D., Williams, J. B. W., & Remien, R. H. (1999). Recurrent major depressive disorder among HIV+ and HIV-intravenous drug users: Findings of a three-year longitudinal study. Comprehensive Psychiatry, 40, 31–34.PubMedGoogle Scholar
  31. Johnson, J. G., Williams, J. B. W., Goetz, R. R., Rabkin, J. G., Remien, R. H., Lipsitz, J. D., & Gorman, J. M. (1996). Personality disorders predict onset of axis I disorders and impaired functioning among homosexual men with and at risk for HIV infection. Archives of General Psychiatry, 53, 350–357.PubMedGoogle Scholar
  32. Johnson, J. G., Williams, J. B. W., Rabkin, J. G., Goetz, R. R., & Remien, R. H. (1995). Axis I psychiatric symptomatology associated with HIV infection and personality disorder. American Journal of Psychiatry, 152, 551–554.PubMedGoogle Scholar
  33. Josephs, R. A., Markus, H. R., & Tafarodi, R. W. (1992). Gender and self-esteem. Journal of Personality and Social Psychology, 63, 391–402.PubMedGoogle Scholar
  34. Kernis, M. H., Cornell, D. P., Sun, C. R., Berry, A., & Harlow, T. (1993). There's more to self-esteem than whether it is high or low: The importance of stability of self-esteem. Journal of Personality and Social Psychology, 65, 1190–1204.Google Scholar
  35. Kernis, M. H., Grannemann, B. D., & Mathis, L. C. (1991). Stability of self-esteem as a moderator of the relation between level of self-esteem and depression. Journal of Personality and Social Psychology, 61, 80–84.PubMedGoogle Scholar
  36. Lewinsohn, P. M., Hoberman, H. M., & Rosenbaum, M. (1988). A prospective study of risk factors for unipolar depression. Journal of Abnormal Psychology, 97, 251–264.PubMedGoogle Scholar
  37. Lipsitz, J. D., Williams, J. B. W., Rabkin, J. G., Remien, R. H., Bradbury, M., Sadr, W., Goetz, R., Sorrell, S., & Gorman, J. M. (1994). Psychopathology in male and female intravenous drug users with and without HIV infection. American Journal of Psychiatry, 151, 1662–1668.PubMedGoogle Scholar
  38. Metalsky, G. I., Halberstadt, L. J., and Abramson, L. Y. (1987). Vulnerability to depressive mood reactions: Toward a more powerful test of the diathesis-stress and causal mediation components of the reformulated theory of depression. Journal of Personality and Social Psychology, 52, 386–393.CrossRefPubMedGoogle Scholar
  39. Metalsky, G. I., & Joiner, T. E. (1991). Development of a questionaire for measuring the symptoms of hopelessness depression. Unpublished data.Google Scholar
  40. Metalsky, G. I., & Joiner, T. E. (1992). Vulnerability to depressive symptomatology: Aprospective test of the diathesis-stress and causal mediation components of the hopelessness theory of depression. Journal of Personality and Social Psychology, 63, 667–675.CrossRefPubMedGoogle Scholar
  41. Metalsky, G. I., & Joiner, T. E. (1997). The Hopelessness Depression Symptom Questionnaire. Cognitive Therapy and Research, 21, 359–384.Google Scholar
  42. Metalsky, G. I., Joiner, T. E., Hardin, T. S., & Abramson, L. Y. (1993). Depressive reactions to failure in a naturalistic setting: A test of the hopelessness and self-esteem theories of depression. Journal of Abnormal Psychology, 102, 101–109.CrossRefPubMedGoogle Scholar
  43. Miller, I. W., III, Klee, S. H., & Norman, W. H. (1982). Depressed and nondepressed inpatients' cognitions of hypothetical events, experimental tasks, and stressful life events. Journal of Abnormal Psychology, 91, 78–81.PubMedGoogle Scholar
  44. Ostrow, D. G., DiFranceisco, W., & Halman, L. J. (1996). International Review of Psychiatry, 8, 185–199.Google Scholar
  45. Perkins, D. O. Stern, R. A., Golden, R. N., Murphy, C., Naftolowitz, D., & Evans, D. L. (1994). Mood disorders in HIV infection: prevalence and risk factors in a nonepicenter of the AIDS epidemic. American Journal of Psychiatry, 151, 233–236.PubMedGoogle Scholar
  46. Perry, S. W. (1994). HIV-related depression. In: R. W. Price and S. W. Perry (Eds.), HIV, AIDS, and the brain. New York: Raven.Google Scholar
  47. Peterson, C., Semmel, A., von Baeyer, C., Abramson, L. Y., Metalsky, G. I., & Seligman, M. E. P. (1982). The Attributional Style Questionnaire. Cognitive Therapy and Research, 6, 287–300.Google Scholar
  48. Rabkin, J. (1996). Prevalence of psychiatric disorders in HIV illness. International Review of Psychiatry, 8, 157–166.Google Scholar
  49. Rabkin, J. G., & Klein, D. F. (1987). The clinical measurement of depressive disorders. In: A. Marsella, R. Hirschfeld, & M. Katz (Ed.), The measurement of depression. New York: Guilford.Google Scholar
  50. Raps, C. W., Peterson, C., Reinhard, K. E., Abramson, L. Y., & Seligman, M. E. P. (1982). Attributional style among depressed patients. Journal of Abnormal Psychology, 91, 102–108.PubMedGoogle Scholar
  51. Roberts, J. E., & Kassel, J. D. (1997). Labile self-esteem, life stress, and depressive symptoms: prospective data testing a model of vulnerability. Cognitive Therapy and Research, 21, 569–589.Google Scholar
  52. Roberts, J. E., & Monroe, S. M. (1992). Vulnerable self-esteem and depressive symptoms: Prospective findings comparing three alternative conceptualizations. Journal of Personality and Social Psychology, 62, 804–812.PubMedGoogle Scholar
  53. Roberts, J. E., & Monroe, S. M. (1994). A multidimensional model of self-esteem in depression. Clinical Psychology Review, 14, 161–181.Google Scholar
  54. Robinson, N. S., Garber, J., & Hilsman, R. (1995). Cognitions and stress: Direct and moderating effects on depressive versus externalizing symptoms during the junior high school transition. Journal of Abnormal Psychology, 104, 453–463.PubMedGoogle Scholar
  55. Rouse, S. V., & Perkins, T. S. (1991). Positive and negative attributional style: The comparative and combined influences of depression, anxiety, and social maladjustment. Paper presented at the 25th annual meeting of the Association for Advancement of Behavior Therapy.Google Scholar
  56. Rundell, J. R., Kyle, K. M., Brown, G. R., & Thomason, J. L. (1992). Risk factors for suicide attempts in a human immunodeficiency virus screening program. Psychosomatics, 33, 24–27.PubMedGoogle Scholar
  57. Schneider, S. G., Taylor, S. E., Kemeny, M. E., & Hammen, C. (1991). AIDS-related factors predictive of suicidal ideation of low and high intent among gay and bisexual men. Suicide and Life-Threatening Behavior, 21, 313–328.PubMedGoogle Scholar
  58. Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. San Francisco: Freeman.Google Scholar
  59. Seligman, M. E. P., Abramson, L. Y., Semmel., A., & von Baeyer, C. (1979). Depressive attributional style. Journal of Abnormal Psychology, 88, 242–247.PubMedGoogle Scholar
  60. Showers, C. J., & Kling, K. C. (1996). Organization of self-knowledge: Implications for recovery from sad mood. Journal of Personality and Social Psychology, 70, 578–590.PubMedGoogle Scholar
  61. Spangler, D. L., Simons, A. D., Monroe, S. M., & Thase, M. (1993). Evaluating the hopelessness model of depression: Diathesis-stress and symptom components. Journal of Abnormal Psychology, 102, 592–600.PubMedGoogle Scholar
  62. Strauman, T. J. (1989). Self-discrepancies in clinical depression and social phobia: Cognitive structures that underlie emotional disorders? Journal of Abnormal Psychology, 98, 14–22.CrossRefPubMedGoogle Scholar
  63. Swann, W. B., Stein-Seroussi, A., & Giesler, R. B. (1992). Why people self-verify. Journal of Personality and Social Psychology, 62, 392–401.PubMedGoogle Scholar
  64. Tennen, H., Hall, J. A., & Affleck, G. (1995). Depression research methodologies in the Journal of Personality and Social Psychology: Areview and critique. Journal of Personality and Social Psychology, 68, 870–884.PubMedGoogle Scholar
  65. Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346–353.PubMedGoogle Scholar
  66. Whisman, M. A., Miller, I. W., Norman, W. H., & Keitner, G. I. (1995). Hopelessness depression in depressed inpatients: Symptomatology, patient characteristics, and outcome. Cognitive Therapy and Research, 19, 377–398.Google Scholar
  67. Williams, J. B. W. (1988a). The Structured Interview Guide for the Hamilton Anxiety and Depression Rating Scales (SIGH-AD). New York, NY: Biometrics Research Unit, New York State Psychiatric Institute.Google Scholar
  68. Williams, J. B. W. (1988b). A Structured Interview Guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742–747.PubMedGoogle Scholar
  69. Williams, J. B. W., Rabkin, J. G., Remien, R. H., Gorman, J. M., & Ehrhardt, A. A. (1991). Multidisciplinary baseline assessment of homosexual menwith and without Human Immunodeficiency Virus infection: II. standardized clinical assessment of current and lifetime psychopathology. Archives of General Psychiatry, 48, 124–130.PubMedGoogle Scholar
  70. Wolk, S. I., & Weissman, M. M. (1996). Suicidal behavior in depressed children grown up: Preliminary results of a longitudinal study. Psychiatric Annals, 26, 331–335.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Jeffrey G. Johnson
    • 1
  • Gerald I. Metalsky
    • 2
  • Judith G. Rabkin
    • 1
  • Janet B. W. Williams
    • 1
  • Robert H. Remien
    • 1
  1. 1.Columbia University and the New York State Psychiatric InstituteUSA
  2. 2.Lawrence UniversityUSA

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