title: Does rumination mediate the relationship between mindfulness and depressive relapse?
abstract: OBJECTIVE
  Major depressive disorder is a significant mental illness that is highly likely to recur, particularly after three or more previous episodes. Increased mindfulness and decreased rumination have both been associated with decreased depressive relapse. The aim of this study was to investigate whether rumination mediates the relationship between mindfulness and depressive relapse.
  
  
  METHODS
  This prospective design involved a secondary data analysis for identifying causal mechanisms using mediation analysis.
  
  
  METHODS
  This study was embedded in a pragmatic randomized controlled trial of mindfulness-based cognitive therapy (MBCT) in which 203 participants (165 females, 38 males; mean age: 48 years), with a history of at least three previous episodes of depression, completed measures of mindfulness, rumination, and depressive relapse over a 2-year follow-up period. Specific components of mindfulness and rumination, being nonjudging and brooding, respectively, were also explored.
  
  
  RESULTS
  While higher mindfulness scores predicted reductions in rumination and depressive relapse, the relationship between mindfulness and relapse was not found to be mediated by rumination, although there appeared to be a trend.
  
  
  CONCLUSIONS
  Our results strengthen the argument that mindfulness may be important in preventing relapse but that rumination is not a significant mediator of its effects. The study was adequately powered to detect medium mediation effects, but it is possible that smaller effects were present but not detected.
  
  
  CONCLUSIONS
  Mindfulness may be one of several components of MBCT contributing to prevention of depressive relapse. Although the original rationale for MBCT rested largely on a model of relapse causally linked to rumination, our findings suggest that the mechanism by which mindfulness impacts relapse is more complex than a simple effect on rumination.
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Kearns
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Shawyer
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.|Cabrini Monash Psycho-Oncology, Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Brooker
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Graham
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.|School of Primary Health Care, Monash University, Melbourne, Victoria, Australia.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Enticott
authors.affiliation: School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Martin
authors.affiliation: Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.|Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.|Mental Health Program, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Graham N
authors.initials: GN
authors.lastname: Meadows
mesh_terms: D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods; D012008:Recurrence; D013850:Thinking
keywords: depression; depressive relapse; mediation analysis; mindfulness; mindfulness-based cognitive therapy; relapse; rumination