title: Perseverative negative cognitive processes are associated with depression in people with long-term conditions.
abstract: BACKGROUND
  Perseverative negative cognitive processes, such as worry, suppression and avoidance of undesirable thoughts, have been linked to persistence and relapse of depression. Such processes could account for poor treatment response though they have received little research attention in people with long-term conditions (LTCs).
  
  
  METHODS
  We conducted a cross-sectional study to investigate the associations of perseverative negative cognitive processes with depression among medical outpatients with LTCs. In 190 patients, we recorded levels of depression (Hospital Anxiety and Depression Scale), worry (Penn State Worry Questionnaire), suppression (White Bear Suppression Inventory) and avoidance of undesirable thoughts (Acceptance and Action Questionnaire). Associations between these constructs were assessed using linear correlation and logistic regression.
  
  
  RESULTS
  Both depression (32%) and anxiety (40%) were common in patients recruited. After controlling for demographic and medical confounders, subjects in the top tertile of worry, suppression and avoidance of undesirable thoughts were 20 (95% CIs, 6.6-58.3), 10 (95% CIs, 3.5-25.9) and 22 (95% CIs, 6.0-80.0) times more likely to have possible depression compared to those in the lowest tertile.
  
  
  CONCLUSIONS
  Prospective research is required to investigate causal relationships between these constructs, and to assess the potential of psychological interventions that target these processes to improve outcomes in patients with LTCs.
authors.affiliation: Mental Health Research Group, Peninsula College of Medicine and Dentistry, University of Exeter, Plymouth, UK. chris.dickens@pcmd.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.forename: Peter
authors.initials: P
authors.lastname: Coventry
authors.forename: Angee
authors.initials: A
authors.lastname: Khara
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: Warren
authors.initials: W
authors.lastname: Mansell
authors.forename: Nawar Diar
authors.initials: ND
authors.lastname: Bakerly
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D002908:Chronic Disease / Q000523:psychology*; D003071:Cognition; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires