van Tuijl Lonneke A, Glashouwer Klaske A, Bockting Claudi L H, Tendeiro Jorge N, Penninx Brenda W J H, de Jong Peter J
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.
PLoS One. 2016 Nov 15;11(11):e0166116. doi: 10.1371/journal.pone.0166116. eCollection 2016.
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.
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.
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.
Cross-sectional design limits causal inferences.
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".
精神病理学的双重加工模型强调区分审慎的自我评估过程（外显自尊；ESE）和自动引发的情感自我关联（内隐自尊；ISE）的相关性。有人提出，低ESE和低ISE都与重度抑郁症（MDD）和焦虑症（AD）有关。此外，有人假设MDD和AD可能会导致低ISE“疤痕”，这可能会导致缓解后复发。然而，现有证据并未直接支持低ISE在MDD/AD中的相关性，而且测试差异自尊相关性的研究甚至表明，尤其是高ISE与低ESE相结合可预测内化症状的发展。然而，这些早期发现受到样本量小、在共病和疾病阶段方面分组定义不明确以及使用不充分的差异自尊指标的限制。因此，本研究在一项大规模研究中进一步测试了ISE和差异自尊的作用，该研究允许在组和疾病阶段之间进行更严格的区分。
在荷兰抑郁症和焦虑症研究（NESDA）的背景下，我们选择了患有当前MDD（n = 60）、AD（n = 111）和共病MDD/AD（n = 71）、缓解期MDD（n = 41）、AD（n = 29）和共病MDD/AD（n = 14）、康复期MDD（n = 136）和AD（n = 98）的参与者，以及从未患过MDD或AD的对照组（n = 382）。使用内隐联想测验来衡量ISE，使用罗森伯格自尊量表来衡量ESE。
对照组报告的ESE高于所有其他组，当前共病MDD/AD的ESE低于所有其他临床组。仅当前共病AD/MDD中的ISE低于对照组。一旦控制了ESE，差异自尊（ISE与ESE之间的差异）与疾病状态无关。
横断面设计限制了因果推断。
研究结果表明ESE在MDD和AD中起重要作用，而在共病MDD/AD中，负性自我评价在隐性水平也存在。没有证据支持AD和MDD会导致低ISE“疤痕”这一观点。
