Hidden scars in depression? Implicit and explicit self-associations following recurrent depressive episodes.

Abstract

To help explain the recurrent nature of major depressive disorder, we tested the hypothesis that depressive episodes and/or the duration of depressive symptoms may give rise to persistent dysfunctional implicit and/or more explicit self-associations, which in turn may place people at risk for the recurrence of symptoms. We therefore examined, in the context of the Netherlands Study of Depression and Anxiety, whether the strength of self-depressed associations at baseline was related to the number of past episodes (retrospective analysis; n ϭ 666), and whether the duration of symptoms between baseline and follow-up predicted self-depressed associations at 2-year follow-up (prospective analysis; n ϭ 726). The lifetime Composite International Diagnostic Interviews and Life Chart Interview were used to index the number of depressive episodes; the Implicit Association Test and its explicit equivalent were used to index self-associations. Consistent with the hypothesis that self-depressed associations strengthen following prolonged activation of negative self-associations during depressive episodes, individuals' implicit and explicit self-depressed associations correlated positively both with the number of prior depressive episodes at baseline and with the duration of depressive symptoms between baseline and 2-year follow-up. There was evidence that these relationships held, particularly in the prospective study, even when controlling for neuroticism and current depressive symptoms, whereas the retrospective relationship between number of episodes and implicit self-associations fell just short of significance.

Neural correlates of self-referential processing and implicit self-associations in chronic depression

“…These findings are in line with one previous study that used the same depression specific SC-IAT in patients with episodic depression (Lemmens et al, 2014). Based on previous research showing that implicit depressive-self associations are associated with depressive episode duration (Elgersma et al, 2013), we expected that chronically depressed patients in the current study would show increased implicit negative self-associations that would correlate with brain responses associated with self-referential processing. Future studies should aim to directly compare implicit negative self-associations in patients with nonchronic depression and patients with chronic depression.…”

“…Given that the duration of a depressive episode (i.e. chronicity) is associated with stronger implicit negative self-associations (Elgersma et al, 2013) it is intriguing to study negative self-associations and the neural correlates of self-referential processing in patients with chronic depression.…”

Implicit and explicit drinking identity predict latent classes that differ on the basis of college students’ drinking behaviors

“…These findings suggest that drinking identity may be more strongly influenced by past events that were relatively risky rather than by recent drinking without intoxication or consequences. This pattern of findings is somewhat analogous to those from a study evaluating self-depressed associations, which indicated that having a previous episode of depression was positively correlated with self-depressed associations even after controlling for current depressive symptoms (Elgersma et al, 2013). Elgersma and colleagues (2013) described those self-depressed associations as “hidden scars,” and the current results suggest that previous risky drinking behaviors could also leave a “scar” via increased drinking identity.…”

Cognitive reactivity, self-depressed associations, and the recurrence of depression

“…Dysfunctional self-associations may become increasingly easy to activate, even during mild stress or mild negative mood states, lowering the threshold for a depressive episode. In line with the idea that repeated episodes may give rise to such a 'hidden scar', we recently found that individuals with a relatively high number of previous episodes also had relatively strong self-depressed associations (Elgersma et al, 2013). Moreover, the duration of depressive symptoms also predicted the increase in strength of self-depressed associations (Elgersma et al, 2013).…”