Research paperHostile interpretation bias in depression
Introduction
Interpretation bias is emphasized in the literature as an important feature in the development and maintenance of major depressive disorder (MDD). Cognitive theory suggests that negative interpretation bias increases emotional distress and leads to deficits in the individual's ability to generate positive, future-oriented thoughts due to preferential processing of depressogenic information (Ahrens and Haaga, 1993, Beck, 1979, Cropley and MacLeod, 2003, Eysenck et al., 1991, Holmes et al., 2008, Lawson et al., 2002, Mogg et al., 2006, Reardon and Williams, 2007, Richards and French, 1992). Researchers have conceptualized depressive interpretation bias as both the tendency to interpret ambiguous information as negative and as a propensity to predict negative outcomes of ambiguous situations (Mathews and Mackintosh, 2000, Wisco and Nolen-Hoeksema, 2010). In a recent review of extant literature, misperception of social interactions was found to mediate the relationship between depression and interpersonal difficulties (Gadassi and Rafaeli, 2015).
Problematic anger and hostility have been highlighted as severity markers for the course of depression, and epidemiological studies have linked high levels of anger to a more chronic, comorbid, and symptomatic presentation (Benazzi and Akiskal, 2005, Fava et al., 2010, Judd et al., 2013, Perlis et al., 2009). Theoretically, this link can be understood through an interpersonal lens, in which problematic anger is implicated as a potential social repellent that may diminish an individual's support network and contribute to feelings of isolation and worthlessness (Coyne, 1976, Joiner and Metalsky, 1995). Hostility is considered a cognitive component of anger which, at high levels, is theorized to cause individuals to be habitually suspicious of others and to behave in a defensive or aggressive manner toward others due to – often erroneously – perceived threat (Moreno et al., 1993, Riley et al., 1989). Specifically, severely depressed individuals endorse higher rates of intropunitive thoughts and suspicion of others compared to individuals with mild dysphoria or healthy controls (Moreno et al., 1993). Other research has found that depressed individuals were more likely to preferentially interpret ambiguous sentences or homophones as threatening than their non-depressed counterparts (Mogg et al., 2006). Interpreting ambiguous scenarios as threatening may translate to elevations in hostility such that individuals who are predisposed to threatening perceptions or mistrust may respond to situations with opposition or aggression (Moreno et al., 1993). Additionally, depression featuring irritability and proneness to anger may promote a hostile worldview or elevations in interpersonal hostility (Riley et al., 1989). This may conversely contribute to increased depressive features such as reactive irritability, social withdrawal, and isolation.
Hostile interpretation bias is an information processing bias that reflects an individual's tendency to assume hostile or aggressive intent in others' actions. Although this construct inherently overlaps with the cognitive component of hostility, hostile interpretation bias does not measure aggressive disposition. This type of interpretation bias was first assessed in adolescents with problematic aggression (Dodge and Newman, 1981) and has since been evidenced in adult individuals with high levels of trait anger (Bond et al., 2004, Epps and Kendall, 1995, Hazebroek et al., 2001, Wenzel and Lystad, 2005). Researchers have suggested that hostile interpretation bias may represent a potentially instrumental maintenance factor in depression, particularly with regard to associated social impairment (Mogg et al., 2006, Moreno et al., 1993, Riley et al., 1989); however, it has yet to be empirically evaluated in a clinically depressed sample, to the authors' knowledge. The current paper sought to investigate hostile interpretation bias within the context of depression.
Section snippets
Study 1
Study 1 examined the role of hostile interpretation bias in depression by comparing depressed and non-depressed college students. Participants completed measures of hostile interpretation bias, trait hostility, and depression symptom severity. We hypothesized that individuals with depression would show greater hostile interpretation bias scores than those without a mood disorder diagnosis. Further, based on extant research suggesting elevated levels of hostility in depressed individuals (Riley
Participants
Participants were undergraduate students who met criteria for current Major Depressive Disorder (MDD; n=36) or no mood diagnosis (n=35) based on responses to a brief, structured clinical interview (MINI; Sheehan et al., 2006). The sample was predominantly White (83.6%) and female (86.3%) with a mean age of 18.8 (SD=.99). Other ethnicities represented included Hispanic (6.8%), Black (5.5%), and Asian/Pacific Islander (4.1%).
Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 2006)
The full MINI was administered to each participant in the depressed
Results
Descriptives and group comparisons are presented in Table 1. The groups did not differ in gender, ethnicity, or age. Scores on the BDI-II were positively correlated with WSAP-H hostile ratings (r=.33, p=.006) and negatively correlated with WSAP-H benign ratings (r=−.39, p=.001). WSAP-H hostile ratings were also positively correlated with trait hostility (r=.34, p=.03). WSAP-H benign ratings were not significantly related to trait hostility (r=−.19, p =.10).
ANOVAs indicated that depressed
Study 2
In Study 2, we sought to replicate findings from Study 1 in a larger clinical sample. We recruited individuals seeking treatment for elevated trait anger to evaluate the relationship between symptoms of depression and hostile interpretation bias. It is possible that the depressive symptoms of irritability and associated anger give rise to hostile interpretation bias in depressed individuals; thus, it was important to examine whether this relationship would be accounted for by trait anger. If
Participants
Participants (N=132) were adult citizens of the United States, who were seeking treatment for problematic anger. They were recruited through flyers in the community and online via Craigslist.org and Reddit.com. Each participant reported elevated trait anger based on the trait subscale of the State Trait Anger Expression Inventory (STAXI scores ≥19; Spielberger, 1999). All participants were medically stable, and did not meet criteria for any psychotic disorders based on SCID-I/P criteria.
Results
See Table 2 for zero-order correlation analyses. A significant positive relationship was found between scores on the BDI-II and the hostile ratings subscale of the WSAP-H; no significant correlation was found between the BDI-II and the benign ratings subscale. Further, a significant positive correlation was shown between trait anger and WSAP-H hostile ratings and a significant negative correlation was shown between trait anger and benign ratings.
We conducted a linear regression analyses to
Discussion
The present studies examined the unique relationship between hostile interpretation bias and depressive symptom severity. Consistent with hypotheses, Study 1 showed higher hostile interpretations of ambiguous interpersonal scenarios in the depressed group than the non-depressed group. The depressed group also reported lower benign interpretations of interpersonal ambiguous situations. Similarly, Study 2 demonstrated a unique, positive relationship between the hostile ratings and depression
Acknowledgements
This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-10-2-0181). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the MSRC or the Department of Defense.
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