How Disorder-Specific are Depressive Attributions? A Comparison of Individuals with Depression, Post-Traumatic Stress Disorder and Healthy Controls

In accordance with previous findings on the role of attributional style in depression (Abramson et al. 1978; Försterling and Bühner 2003), individuals with major depression endorsed more internal, stable, and global attributions of negative events than participants without depression. This finding provides further support for cognitive theories of depression (Abramson et al. 1978; Abramson et al. 1989; Beck 1967).

The present results extend these previous findings, as this study compared participants with MD only (and no PTSD) with those who only had PTSD (and no depression). We found a significantly higher degree of depressive attributions in those with MD only than in those with PTSD only, who did not differ from healthy controls. Thus, the study provided evidence for some specificity of depressive attributions to depression. Individuals with major depression and comorbid PTSD endorsed depressive attributions to a greater extent than those with PTSD only, but did not differ significantly from those with major depression only. This pattern of results suggests that major depression may be the crucial factor in the endorsement of depressive attributions.

However, in the correlational analyses, depressive attributions correlated with both the severity of depression and PTSD symptoms. This probably reflects the overlap of symptoms of both disorders (e.g., diminished interest in activities, sleep disturbance, difficulty concentrating) and the high comorbidity rates. It may also indicate that depressive attributions are a common transdiagnostic process. Finally, it may also reflect the fact that symptom severity was assessed by self-report and thus shares method variance with the DAQ scores, whereas diagnoses are based on clinicians’ judgements.

DAQ scores correlated with PTCI scores, indicating that causal attributions of negative events in general and negative interpretations about the implications of traumatic events for the self and the world may overlap to some extent (e.g., see DAQ item: “When something I do goes wrong, I think it is because I am incapable”; PTCI item: “I am inadequate”). The multiple regression analyses further showed that depressive attributions and trauma-related negative beliefs were independent predictors of both depressive and PTSD symptoms. This indicates that although they show some overlap, there are also important differences. Whereas the DAQ focuses on the process of assigning a cause to rather generic events (e.g., “When things go well, I think it is just due to good luck”), the PTCI addresses a wider range of cognitions about the meaning of the trauma (e.g., “My life has been destroyed by the event,” “I have to be on guard all the time”), and thus possibly explains a wider range of post-trauma symptoms, including those not found in depression, such as hypervigilance.

Individuals who reported more pronounced depressive attributions also reported a higher degree of rumination. Due to the cross-sectional nature of our data, we cannot make inferences about the temporal and potentially causal patterns of these processes. However, one possibility could be that rumination may maintain depressive symptoms as it involves repetitively and passively focusing on the possible causes of symptoms, which may include and enhance depressive cognitions (e.g., Nolen-Hoeksema et al. 2008). Existing research in this area has shown that rumination indeed interacts with depressive symptoms to predict negative attributional style (Lo et al. 2010) and that the interaction between negative cognitive style and stress-reactive rumination predicts the onset, number, and duration of prospective depressive episodes (Robinson and Alloy 2003).

Depressive attributions were also associated with greater and more severe exposure to trauma. Again, the cross-sectional nature of the data precludes causal interpretations. One could hypothesise a dose–response relationship in that re-exposure to trauma is more likely to result in more pronounced depressive attributions and learned helplessness than one single event. There is evidence that multiple trauma is associated with higher levels of PTSD symptoms (Follette et al. 1996; Green et al. 2000), as well as substance abuse, suicide attempts (McCauley et al. 1997), and mood disorder (Miranda et al. 1997) than single trauma.

It is also relevant to highlight how the DAQ compares with other measures of attributional style, which have been most widely used until now, such as the Attributional Style Questionnaire (ASQ; Peterson et al. 1982) and its expanded and modified version, the Cognitive Style Questionnaire (CSQ; Haeffel et al. 2008). Both these questionnaires require participants to generate one major cause to positive and negative hypothetical situations from the achievement and affiliation domains (e.g., “You have been looking for a job unsuccessfully for some time”, or “You meet a friend who acts hostilely towards you”). In contrast, the DAQ offers short statements containing negative attributions (e.g., “When something I do goes wrong, I think it is because I am incapable”) and requires participants to answer on a 0–4 scale how much each statement applies to them. Thus, the DAQ aims to take up less mental processing time and effort, which is crucial during clinical assessment. For instance, depressed individuals often have cognitive deficits in concentration, executive function and over-general memory (Williams et al. 2000) and individuals with PTSD often also present with over-general memory (Schönfeld and Ehlers 2006). In terms of length, the ASQ contains 12 hypothetical events with a total of 60 questions and the CSQ contains 24 hypothetical events, making both these measures much lengthier and more mentally demanding than the DAQ, which contains only 16 brief statements. During the validation process of the DAQ, the ASQ was also administered and several aspects of both questionnaires compared. Mean completion times for the DAQ (M = 2.36 min, SD = 1.15) and the ASQ (M = 17.32 min, SD = 7.73) were found to be significantly different for both depressed and non-depressed participants (Kleim et al. 2011). This validation study also showed that both depressed and non-depressed participants found the DAQ significantly easier to fill in than the ASQ. The same study showed that the mean number of ASQ situations for which participants were able to retrieve personal memories was 7.36, SD = 2.30 (61%) and they also specified some difficulties completing the ASQ but not the DAQ. In addition, both the ASQ and the CSQ were validated in samples of college students, whereas the DAQ was validated in participants from various diagnostic groups and healthy controls, making the latter a more appropriate tool for clinical use. Finally, the ASQ’s low reliability has been criticised in some studies (e.g., Sweeney et al. 1986) and there are sparse data on its validity. In contrast the DAQ has been shown to have high internal reliability, test–retest reliability, and convergent, discriminant and construct validity. Thus, although the differences between the DAQ and other measures might make it difficult to compare results across studies, it is important to introduce a measure of attributional style, which addresses the shortcomings of previous ones, i.e. (1) ease of use, (2) applicability to different participant groups, and (3) validity and reliability in clinical and research settings.

This study is not without limitations. First, we used the DAQ to index core aspects of depressive attributions, namely internal, stable and global attributions of negative events. It might also be useful to investigate other attributional dimensions reported in the literature, such as controllability, expectedness, and importance of events. Second, our study is cross-sectional. It would be clinically relevant to test the predictive power of depressive attributions in the development of depression and PTSD symptoms in prospective studies. If these yielded positive results, a measure of depressive attributions could be used as a screening tool to detect individuals at high risk of developing MD or PTSD. Finally, our results would be strengthened by replication in further samples. Our analysis into the specificity of depressive attributions is limited to the comparison between MD and PTSD. It would be interesting to include further groups into the comparison, such as individuals with substance abuse or bipolar disorder.

The present results have implications for theory, as well as practical clinical implications. Some effective empirically-based therapies, for instance cognitive-behavioural therapies, address patients’ maladaptive beliefs, and attempt to modify them by developing alternative explanations for events and gathering evidence for various explanations to create more evidence-based adaptive beliefs (Beck 1976; Ehlers et al. 2005; Ingram 2007; Kuyken et al. 2007; Markowitz 2008). According to current cognitive behavioural models, thoughts, including depressive attributions and negative trauma-related beliefs, influence behaviour, and may lead to the development and maintenance of clinical disorders, such as MD or PTSD. Attributional retraining has been described as an empirically based cognitive-behavioural technique, for instance in the treatment of child victims of sexual abuse, which involved decreasing abuse-related self-blame and encouraging the child to attribute responsibility for the abuse to the perpetrator (Celano et al. 2002). Dieser and Ruddell (2002) examined the effects of attributional retraining on attributions and explanatory style in depressed adolescent inpatients and reported that the training led to higher endorsement of personal control and stability attributions. Moreover, a recent experimental study by Peters, Constans, and Mathews (2011) showed that attributional style can be manipulated by use of computer-based cognitive bias modification (CBM). This training resulted in a decreased tendency to engage in negative causal attributions for poor performance and in less depressed mood. Identifying and modifying disorder-specific attributions and appraisals and their identification may thus be an important target of disorder-specific psychological therapies (e.g. Miller et al. 1975).