title: Implicit and Explicit Self-Esteem in Current, Remitted, Recovered, and Comorbid Depression and Anxiety Disorders: The NESDA Study.
abstract: BACKGROUND
  Dual processing models of psychopathology emphasize the relevance of differentiating between deliberative self-evaluative processes (explicit self-esteem; ESE) and automatically-elicited affective self-associations (implicit self-esteem; ISE). It has been proposed that both low ESE and ISE would be involved in major depressive disorder (MDD) and anxiety disorders (AD). Further, it has been hypothesized that MDD and AD may result in a low ISE "scar" that may contribute to recurrence after remission. However, the available evidence provides no straightforward support for the relevance of low ISE in MDD/AD, and studies testing the relevance of discrepant SE even showed that especially high ISE combined with low ESE is predictive of the development of internalizing symptoms. However, these earlier findings have been limited by small sample sizes, poorly defined groups in terms of comorbidity and phase of the disorders, and by using inadequate indices of discrepant SE. Therefore, this study tested further the proposed role of ISE and discrepant SE in a large-scale study allowing for stricter differentiation between groups and phase of disorder.
  
  
  METHODS
  In the context of the Netherlands Study of Depression and Anxiety (NESDA), we selected participants with current MDD (n = 60), AD (n = 111), and comorbid MDD/AD (n = 71), remitted MDD (n = 41), AD (n = 29), and comorbid MDD/AD (n = 14), recovered MDD (n = 136) and AD (n = 98), and never MDD or AD controls (n = 382). The Implicit Association Test was used to index ISE and the Rosenberg Self-Esteem Scale indexed ESE.
  
  
  RESULTS
  Controls reported higher ESE than all other groups, and current comorbid MDD/AD had lower ESE than all other clinical groups. ISE was only lower than controls in current comorbid AD/MDD. Discrepant self-esteem (difference between ISE and ESE) was not associated with disorder status once controlling for ESE.
  
  
  CONCLUSIONS
  Cross-sectional design limits causal inferences.
  
  
  CONCLUSIONS
  Findings suggest a prominent role for ESE in MDD and AD, while in comorbid MDD/AD negative self-evaluations are also present at the implicit level. There was no evidence to support the view that AD and MDD would result in a low ISE "scar".
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
authors.forename: Lonneke A
authors.initials: LA
authors.lastname: van Tuijl
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
authors.forename: Klaske A
authors.initials: KA
authors.lastname: Glashouwer
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.|Department of Clinical Psychology and Experimental Psychopathology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
authors.affiliation: Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands.
authors.forename: Jorge N
authors.initials: JN
authors.lastname: Tendeiro
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, Amsterdam, The Netherlands.
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.affiliation: Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: de Jong
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016584:Panic Disorder / Q000453:epidemiology* / Q000523:psychology; D011930:Reaction Time; D012649:Self Concept; D013405:Suicide / Q000523:psychology