O'Garro-Moore Jared K, Adams Ashleigh Molz, Abramson Lyn Y, Alloy Lauren B
Temple University, United States.
University of Wisconsin-Madison, United States.
J Affect Disord. 2015 Mar 15;174:180-7. doi: 10.1016/j.jad.2014.11.024. Epub 2014 Nov 21.
Bipolar spectrum disorders (BSDs) are highly comorbid with anxiety, which is associated with an extended duration and exacerbation of depressive symptoms. Unfortunately, the underlying mechanisms are not known. This study examined the role of maladaptive cognitive styles in the co-occurrence of BSDs and anxiety disorders and prediction of depressive symptoms.
Participants included 141 young adults (69.6% female, mean age=20.24, SD=2.11), in one of three groups: a BSD group (bipolar II, cyclothymia, n=48), a comorbid BSD/anxiety group (n=50), and a demographically-matched healthy control group (n=43), who were followed prospectively. Participants completed the Cognitive Style Questionnaire (CSQ), Depressive Experiences Questionnaire (DEQ), Dysfunctional Attitudes Scale (DAS), Sociotropy Autonomy Scale (SAS), Halberstadt Mania Inventory (HMI) and Beck Depression Inventory (BDI) at the initial assessment. One year later, participants completed the BDI and HMI again to assess severity of depressive and hypomanic/manic symptoms.
A multivariate analysis of co-variance (MANCOVA) revealed significant differences between the three groups on their DAS Perfectionism, DEQ Dependency, DEQ Self-Criticism, CSQ Negative, SAS Autonomy, and Time 2 BDI scores, with the BSD/anxiety group scoring higher than the BSD only group on all measures except the CSQ. Preacher and Hayes׳ (2008) bootstrapping method was used to test for mediational effects of the significant cognitive style measures on depressive symptoms at follow-up. The 95% confidence intervals for the indirect effect of group on follow-up depressive symptoms through DAS Perfectionism did not include zero, indicating the presence of a significant mediating relationship for perfectionism.
This study only used two waves of data; three waves of data would allow one to investigate the full causal effect of one variable on another. Further, a comorbid anxiety diagnosis consisted of any anxiety disorder. Further research should separate groups by their specific anxiety diagnoses; this could afford a more complete understanding of the effect of types of anxiety on prospective depressive symptoms.
After taking into account initial levels of depressive and hypomanic/manic symptoms, we found that those with BSD/anxiety comorbidity experienced more severe depressive symptoms, but not more severe hypomanic/manic symptoms. Further, their more severe prospective depressive symptoms are explained by a perfectionistic cognitive style.
双相谱系障碍（BSD）与焦虑症高度共病，焦虑症与抑郁症状的持续时间延长和加重有关。遗憾的是，其潜在机制尚不清楚。本研究探讨了适应不良认知方式在双相谱系障碍与焦虑症共病及抑郁症状预测中的作用。
研究对象包括141名年轻人（69.6%为女性，平均年龄=20.24，标准差=2.11），分为三组：双相谱系障碍组（双相II型、环性心境障碍，n=48）、双相谱系障碍/焦虑共病组（n=50）和人口统计学匹配的健康对照组（n=43），对其进行前瞻性随访。参与者在初始评估时完成了认知方式问卷（CSQ）、抑郁体验问卷（DEQ）、功能失调性态度量表（DAS）、社会依赖自主量表（SAS）、哈尔伯施塔特躁狂量表（HMI）和贝克抑郁量表（BDI）。一年后，参与者再次完成BDI和HMI，以评估抑郁和轻躁狂/躁狂症状的严重程度。
多变量协方差分析（MANCOVA）显示，三组在DAS完美主义、DEQ依赖、DEQ自我批评、CSQ消极、SAS自主和第二次测量时的BDI得分上存在显著差异，除CSQ外，双相谱系障碍/焦虑共病组在所有测量指标上的得分均高于仅双相谱系障碍组。采用Preacher和Hayes（2008年）的自抽样法检验显著认知方式测量指标对随访时抑郁症状的中介效应。组通过DAS完美主义对随访时抑郁症状的间接效应的95%置信区间不包括零，表明完美主义存在显著的中介关系。
本研究仅使用了两波数据；三波数据将使人们能够研究一个变量对另一个变量的完整因果效应。此外，共病焦虑症诊断包括任何焦虑症。进一步的研究应按特定焦虑症诊断对组进行区分；这可能会更全面地了解焦虑类型对前瞻性抑郁症状的影响。
在考虑了抑郁和轻躁狂/躁狂症状的初始水平后，我们发现双相谱系障碍/焦虑共病者经历了更严重的抑郁症状，但轻躁狂/躁狂症状并不更严重。此外，他们更严重的前瞻性抑郁症状可由完美主义认知方式来解释。
