The study of vulnerabilities to depression typically identifies factors that are thought to be universally maladaptive or adaptive. In contrast, researchers recently have theorized that the ability to flexibly engage in different thoughts and behaviors that fit situational demands may be most indicative of psychological health. We review empirical evidence from 147 studies reporting associations between five components of flexibility (set-shifting, affective set-shifting, cardiac vagal control, explanatory flexibility, and coping flexibility) and depression and classify studies according to strength of study design. Evidence from correlational and case-controlled studies suggests cross-sectional relationships, but few prospective studies have been conducted. We discuss limitations of existing studies, identify new directions for programmatic research, and discuss implications that flexibility has for the prevention and treatment of depression.

Objective We examined the concurrent associations between multiple cognitive vulnerabilities to depression featured in Hopelessness Theory, Beck’s Theory, and Response Styles Theory and depressive symptoms and diagnoses in a sample of early adolescents. We also examined the specificity of these cognitive vulnerabilities to depression versus anxiety and externalizing psychopathology, controlling for co-occurring symptoms and diagnoses. Method Male and female, Caucasian and African-American, 12–13 year old adolescents were assessed in a cross-sectional design. Cognitive vulnerabilities of hopelessness, inferential style, rumination, and self-referent information processing were assessed with self-reports and behavioral tasks. Symptoms and diagnoses of depressive, anxiety, and externalizing disorders were assessed with self-report questionnaires and diagnostic interviews. Results Hopelessness exhibited the greatest specificity to depressive symptoms and diagnoses, whereas negative inferential styles, rumination, and negative self-referent information processing were associated with both depressive and anxiety symptoms and diagnoses and, in some cases, with externalizing disorders. Conclusions Consistent with cognitive theories of depression, hopelessness, negative inferential styles, rumination, and negative self-referent information processing were associated with depressive symptoms and diagnoses. However, with the exception of hopelessness, most of the remaining cognitive vulnerabilities were not specific to depression. With further maturation of our sample, these cognitive vulnerabilities may become more specific to depression as cognitive styles further develop and consolidate, the rates of depression increase, and individuals’ presentations of psychopathology become more differentiated.

Introduction Bipolar disorder is characterized by recurrent episodes of depression and/or mania along with inter-episodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, many individuals with bipolar disorder continue to experience substantial residual mood symptoms that often lead to the recurrence of mood episodes. Aims The present study explored whether a new mindfulness-based cognitive therapy (MBCT) for bipolar disorder would increase mindfulness, reduce residual mood symptoms, and increase emotion regulation abilities, psychological well-being, positive affect and psychosocial functioning. Following a baseline clinical assessment, 12 individuals with DSM-IV bipolar disorder were treated with 12 group sessions of MBCT. Results At the end of treatment, as well as at the 3-months follow-up, participants showed increased mindfulness, lower residual depressive mood symptoms, less attentional difficulties, and increased emotion regulation abilities, psychological well-being, positive affect and psychosocial functioning. Conclusions These findings suggest that treating residual mood symptoms with MBCT may be another avenue to improving mood, emotion regulation, well-being and functioning in individuals with bipolar disorder.

Although cognitive vulnerabilities to depression have received considerable empirical support, little research has evaluated the differential development of cognitive vulnerabilities in adolescent girls and boys. The current study examined the role of stressful life events, as well as sex differences in reactivity and exposure to stress, in the development of negative cognitive style and rumination in a multi-wave study of 382 adolescents. Path analyses indicated that interpersonal dependent stress predicted higher prospective levels of negative cognitive styles and rumination. Additionally, girls’ greater exposure to interpersonal dependent stress explained their higher levels of rumination, which accounted for girls’ higher levels of depressive symptoms than boys. These findings suggest that interpersonal dependent stress is a significant risk factor for the formation of cognitive vulnerabilities to depression during adolescence, and that the sex difference in depressive symptoms may result from girls’ greater exposure to interpersonal dependent stress and ruminative response style than boys.

Many individuals with major depressive disorder (MDD) experience cognitive dysfunction including impaired cognitive control and negative cognitive styles. Functional connectivity MRI studies of individuals with current MDD have documented altered resting-state connectivity within the default-mode network and across networks. However, no studies to date have evaluated the extent to which impaired connectivity within the cognitive control network (CCN) may be present in remitted MDD (rMDD), nor have studies examined the temporal stability of such attenuation over time. This represents a major gap in understanding stable, trait-like depression risk phenotypes. In the present study, resting-state functional connectivity data were collected from 52 unmedicated young adults with rMDD and 47 demographically-matched healthy controls, using three bilateral seeds in the CCN (dorsolateral prefrontal cortex, inferior parietal lobule, and dorsal anterior cingulate cortex). Mean connectivity within the entire CCN was attenuated among individuals with rMDD, was stable and reliable over time, and was most pronounced from the right dorsolateral prefrontal cortex and right inferior parietal lobule to the three bilateral CCN seeds. Attenuated connectivity in rMDD appeared to be specific to the CCN as opposed to representing attenuated within-network coherence in other networks (e.g., default-mode, salience). In addition, attenuated connectivity within the CCN mediated relationships between rMDD status and cognitive risk factors for depression, including ruminative brooding, pessimistic attributional style, and negative automatic thoughts. Given that these cognitive markers are known predictors of relapse, these results suggest that attenuated connectivity within the CCN could represent a biomarker for trait phenotypes of depression risk.

Objective-Bipolar disorder is highly comorbid with substance use disorders, and this comorbidity may be associated with a more severe course of illness, but the impact of comorbid substance abuse on recovery from major depressive episodes in these patients has not been adequately examined. The authors hypothesized that comorbid drug and alcohol use disorders would be associated with longer time to recovery in patients with bipolar disorder.Method-Subjects (N=3,750) with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were followed prospectively for up to 2 years. Prospectively observed depressive episodes were identified for this analysis. Subjects with a past or current drug or alcohol use disorder were compared with those with no history of drug or alcohol use disorders on time to recovery from depression and time until switch to a manic, hypomanic, or mixed episode.Results-During follow up, 2,154 subjects developed a new-onset major depressive episode; of these, 457 subjects switched to a manic, hypomanic, or mixed episode prior to recovery. Past or current substance use disorder did not predict time to recovery from a depressive episode relative to no substance use comorbidity. However, those with current or past substance use disorder were more likely to experience switch from depression directly to a manic, hypomanic, or mixed state.Conclusions-Current or past substance use disorders were not associated with longer time to recovery from depression but may contribute to greater risk of switch into manic, mixed, or hypomanic states. The mechanism conferring this increased risk merits further study.People with bipolar disorder are at extraordinarily high risk for co-occurring substance use disorders. The lifetime prevalence of substance use disorder is higher in bipolar disorder than in any other psychiatric illness, with lifetime rates in epidemiological and clinical samples ranging from 40%-60% (1-3). This association is of great clinical significance, as it has generally been thought that co-occurring substance abuse worsens the course of illness. More recently, however, reports have suggested that some people with bipolar disorder and substance abuse may do as well-or sometimes better-than those with no substance abuse history (4-6).Several reports have suggested that comorbid bipolar disorder and substance use disorder are marked by more severe symptoms, more frequent mood episodes, more suicide attempts, medical comorbidity, lower functioning, and lower life satisfaction (7)(8)(9)(10)(11)(12)(13)(14). Even low levels of alcohol use have been associated with more symptoms in bipolar disorder, suggesting that any drinking among patients with bipolar disorder-not merely in those with substance use disorders-may be associated with a more severe course of illness (4). It is not known, however, whether substance use disorders are the cause of this increased morbidity or rather that substance use disorders are prevalent in patient...

During adolescence, rates of depression dramatically increase and girls become twice as likely as boys to develop depression. Research suggests that overgeneral autobiographical memory and rumination are vulnerability factors for depressive symptoms in adolescence that may be triggered by stressful life events. The current longitudinal study included 160 early adolescents (Mage = 12.44 years, 60.0 % African American, 40.0 % Caucasian, and 56.2 % female). At baseline, adolescents completed measures of current depressive symptoms, rumination, and specificity of autobiographical memories. Approximately 9 months later, the adolescents completed measures of current depressive symptoms and stressful life events that had occurred between baseline and follow-up. Analyses indicated that girls with more overgeneral autobiographical memories in combination with higher levels of rumination were most vulnerable to experiencing increases in depressive symptoms following stressful life events. Additionally, retrieving more specific autobiographical memories appeared to buffer against the impact of negative life events on depressive symptoms among both boys and girls. Memory specificity may play a protective role in depression risk, suggesting that memory specificity training interventions may prove beneficial for adolescents.

Objective Extensive comorbidity between depression and anxiety has driven research to identify unique and shared risk factors. This study prospectively examined the specificity of three interpersonal stressors (emotional abuse, emotional neglect, and relationally-oriented peer victimization) as predictors of depressive versus anxiety symptoms in a racially-diverse community sample of adolescents. We expanded on past research by examining hopelessness as a mediator of the relationships between these interpersonal stressors and symptoms. Method Participants included 225 adolescents (55% African-American; 59% female; Mean age = 12.84 years) who completed measures at baseline (Time 1) and two follow-up assessments (Times 2 and 3). Symptoms of depression and anxiety (social, physical, total) were assessed at Time 1 and Time 3, while intervening emotional maltreatment, peer victimization, and hopelessness were assessed at Time 2. Results Hierarchical linear regressions indicated that emotional abuse was a nonspecific predictor of increases in both depressive symptoms and symptoms of social, physical, and total anxiety, whereas relationally-oriented peer victimization predicted depressive symptoms specifically. Emotional neglect did not predict increases in depressive or anxiety symptoms. In addition, hopelessness mediated the relationships between emotional abuse and increases in symptoms of depression and social anxiety. Conclusions These findings suggest that emotional abuse and relationally-oriented peer victimization are interpersonal stressors that are relevant to the development of internalizing symptoms in adolescence, and that hopelessness may be one mechanism through which emotional abuse contributes to an increased risk of depression and social anxiety.