title: Cognitive reactivity, self-depressed associations, and the recurrence of depression.
abstract: BACKGROUND
  Mixed evidence exists regarding the role of cognitive reactivity (CR; cognitive responsivity to a negative mood) as a risk factor for recurrences of depression. One explanation for the mixed evidence may lie in the number of previous depressive episodes. Heightened CR may be especially relevant as a risk factor for the development of multiple depressive episodes and less so for a single depressive episode. In addition, it is theoretically plausible but not yet tested that the relationship between CR and number of episodes is moderated by the strength of automatic depression-related self-associations.
  
  
  OBJECTIVE
  To investigate (i) the strength of CR in remitted depressed individuals with a history of a single vs. multiple episodes, and (ii) the potentially moderating role of automatic negative self-associations in the relationship between the number of episodes and CR.
  
  
  METHODS
  Cross-sectional analysis of data obtained in a cohort study (Study 1) and during baseline assessments in two clinical trials (Study 2). Study 1 used data from the Netherlands Study of Depression and Anxiety (NESDA) and compared never-depressed participants (n=901) with remitted participants with either a single (n=336) or at least 2 previous episodes (n=273). Study 2 included only remitted participants with at least two previous episodes (n=273). The Leiden Index of Depression Sensitivity Revised (LEIDS-R) was used to index CR and an Implicit Association Test (IAT) to measure implicit self-associations.
  
  
  RESULTS
  In Study 1, remitted depressed participants with multiple episodes had significantly higher CR than those with a single or no previous episode. The remitted individuals with multiple episodes of Study 2 had even higher CR scores than those of Study 1. Within the group of individuals with multiple episodes, CR was not heightened as a function of the number of episodes, even if individual differences in automatic negative self-associations were taken into account.
  
  
  CONCLUSIONS
  The study employed a cross-sectional design, which precludes a firm conclusion with regard to the direction of this relationship.
  
  
  CONCLUSIONS
  The findings are consistent with the view that high CR puts people at risk for recurrent depression and is less relevant for the development of an incidental depressive episode. This suggests that CR is an important target for interventions that aim to prevent the recurrence of depression.
authors.affiliation: Department of Clinical Psychology, University of Groningen, The Netherlands. Electronic address: h.j.elgersma@rug.nl.
authors.forename: Hermien J
authors.initials: HJ
authors.lastname: Elgersma
authors.affiliation: Department of Clinical Psychology, University of Groningen, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: de Jong
authors.affiliation: Department of Clinical Psychology, University of Groningen, The Netherlands.
authors.forename: Gerard D
authors.initials: GD
authors.lastname: van Rijsbergen
authors.affiliation: Department of Clinical Psychology, University of Groningen, The Netherlands.
authors.forename: Gemma D
authors.initials: GD
authors.lastname: Kok
authors.affiliation: Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.affiliation: Institute of Psychology, Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: van der Does
authors.affiliation: Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.affiliation: Department of Clinical Psychology, University of Groningen, The Netherlands; Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands.
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D003071:Cognition; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D009426:Netherlands; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult
keywords: Cognitive reactivity; Depression; Implicit self-association; Recurrence; Remitted; Vulnerability