Scheurich A, Fellgiebel A, Schermuly I, Bauer S, Wölfges R, Müller M J
Department of Psychiatry, University of Mainz, Mainz, Germany.
Psychol Med. 2008 Feb;38(2):237-46. doi: 10.1017/S0033291707002206. Epub 2007 Nov 16.
Diagnostic criteria and empirical evidence support the existence of cognitive deficits in depression. However, depressed mood, loss of interest and low self-efficacy might influence cognitive performance.
Goal-setting instructions were used to promote motivation in depressed patients and control subjects during neuropsychological assessment. The resulting performance was compared with performance using standard instructions. Sixty in-patients with non-psychotic unipolar depression and 60 age- and education-matched healthy control subjects were assessed with standard neuropsychological tests [the Auditory Verbal Learning Test (AVLT), the Digit Symbol Test (DST), the Regensburg Word Fluency Test (RWT), and the Number Combination Test (Zahlen-Verbindungs-Test, ZVT)] using either goal-setting or standard test instructions.
Depressed patients showed lower baseline performance and lower generalized self-efficacy (p<0.0005) than controls. However, goal-setting instructions significantly improved patients' memory performance by 10% [AVLT: F(5, 54)=3.611, p=0.007] and psychomotor performance by 13% [ZVT: F(3, 56)=3.667, p=0.017]. Consequently, patients and control subjects demonstrated similar results when goal-setting instructions were applied. Goal-setting instructions showed a statistical trend, increasing patients' performance in the DST by 12% [F(1, 58)=2.990, p=0.089], although their verbal fluency measured by the RWT did not increase. No significant correlations of increased performance with generalized self-efficacy were found.
Cognitive deficits in depressed patients are influenced by motivational shortcomings. Because generalized self-efficacy failed to correlate to increased test performance, future research needs to disentangle the effective components of goal-setting instructions. Task-specific self-efficacy as well as enhancement of task-focused attention might underlie the significant goal-setting effect in depressed patients.
诊断标准和实证证据支持抑郁症中存在认知缺陷。然而，抑郁情绪、兴趣丧失和低自我效能感可能会影响认知表现。
在神经心理学评估期间，使用目标设定指导来提高抑郁症患者和对照受试者的动机。将由此产生的表现与使用标准指导的表现进行比较。使用目标设定或标准测试指导，对60名非精神病性单相抑郁症住院患者和60名年龄及教育程度匹配的健康对照受试者进行标准神经心理学测试[听觉言语学习测试（AVLT）、数字符号测试（DST）、雷根斯堡词语流畅性测试（RWT）和数字组合测试（Zahlen-Verbindungs-Test，ZVT）]。
与对照组相比，抑郁症患者表现出更低的基线表现和更低的一般自我效能感（p<0.0005）。然而，目标设定指导显著提高了患者的记忆表现10%[AVLT：F(5, 54)=3.611，p=0.007]和心理运动表现13%[ZVT：F(3, 56)=3.667，p=0.017]。因此，当应用目标设定指导时，患者和对照受试者表现出相似的结果。目标设定指导显示出一种统计趋势，使患者在DST中的表现提高了12%[F(1, 58)=2.990，p=0.089]，尽管通过RWT测量的言语流畅性没有增加。未发现表现提高与一般自我效能感之间存在显著相关性。
抑郁症患者的认知缺陷受动机不足的影响。由于一般自我效能感与测试表现的提高无关，未来的研究需要理清目标设定指导的有效成分。特定任务的自我效能感以及对任务专注度的增强可能是抑郁症患者目标设定显著效果的基础。
