Format

Send to

Choose Destination
Br J Clin Psychol. 2018 Sep;57(3):313-327. doi: 10.1111/bjc.12175. Epub 2018 Feb 27.

The measurement of cognitive reactivity to sad mood in patients remitted from major depressive disorder.

Author information

1
Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, The Netherlands.
2
Department of Psychiatry, Warneford Hospital, University of Oxford, UK.
3
Department of Psychology, University of Utrecht, The Netherlands.
4
Department of Psychology, Leiden University, The Netherlands.
5
Department of Psychiatry, Leiden University Medical Center, The Netherlands.
6
Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
7
Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, The Netherlands.

Abstract

OBJECTIVES:

Cognitive reactivity (CR) to sad mood is a risk factor for major depressive disorder (MDD). CR is usually measured by assessing change on the Dysfunctional Attitudes Scale (DAS-change) after sad mood-induction. It has, however, been suggested that the versions of the DAS (A/B) are not interchangeable, impacting the reliability and validity of the change score. The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) is an alternative self-report measure of CR. Studies examining the relationship between LEIDS-R and DAS-change have shown mixed results. We examined whether scores of these CR measures differed between remitted MDD and controls, the relationship between these CR measures, and the effect of order of DAS administration on DAS-change.

DESIGN:

Cross-sectional design with two groups (remitted MDD and controls).

METHODS:

Sixty-eight MDD patients remitted from ≥2 previous episodes, not taking antidepressants, and 43 never-depressed controls participated in a mood-induction and filled in the DAS-A/B in randomized order before and after mood-induction, and LEIDS-R separately.

RESULTS:

LEIDS-R scores and pre-mood-induction DAS scores were significantly higher in remitted MDD than controls (p < .001, Cohen's d = 1.48; p = .001, Cohen's d = 0.66, respectively). DAS-change did not differ between these groups (p = .67, Cohen's d = 0.08). LEIDS-R correlated with DAS-change (r = .30, p = .042), but only in the group that filled in DAS-B before DAS-A. In remitted MDD, DAS-change was dependent on the order of DAS versions before and after mood-induction (10.6 ± 19.0 vs. -1.2 ± 10.5, for order B-A and A-B, respectively), with a significant group × order interaction (p = .012).

CONCLUSIONS:

Existing DAS versions are not interchangeable, which compromises the usefulness of mood-inductions in clinical practice. The LEIDS-R seems a valid measure of cognitive vulnerability to depression.

PRACTITIONER POINTS:

Clinical implications: Cognitive reactivity (CR) is a risk factor of depressive recurrence. The current measurement of CR, by assessing change on the Dysfunctional Attitudes Scale (DAS) after mood-induction, is not reliable. The Leiden Index Depression Sensitivity-Revised (LEIDS-R) is an alternative CR measure. In contrast to mood-induction, it reliably assesses depression vulnerability. The use of mood-inductions for clinical/research purposes is unnecessary.

LIMITATIONS OF THE STUDY:

We were not able to examine the effect of previous treatment, which could have affected results as psychological treatments probably have differential effects on CR. Examining un-medicated patients may have led to selection of a sample not completely representative for the general MDD population. We did not administer both parallel versions of the DAS (A/B) before and after mood-induction. This might have provided better understanding of their differential sensitivity to change.

KEYWORDS:

cognition; cognitive reactivity; depression; stress; vulnerability

PMID:
29488231
PMCID:
PMC6099317
DOI:
10.1111/bjc.12175
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center