Perseverative negative cognitive processes are associated with depression in people with long-term conditions

Perseverative negative cognitive processes, such as worry, suppression and avoidance of undesirable thoughts, have been linked to persistence and relapse of depression. Such processes could account for poor treatment response though they have received little research attention in people with long-term conditions (LTCs).

We conducted a cross-sectional study to investigate the associations of perseverative negative cognitive processes with depression among medical outpatients with LTCs. In 190 patients, we recorded levels of depression (Hospital Anxiety and Depression Scale), worry (Penn State Worry Questionnaire), suppression (White Bear Suppression Inventory) and avoidance of undesirable thoughts (Acceptance and Action Questionnaire). Associations between these constructs were assessed using linear correlation and logistic regression.

Both depression (32%) and anxiety (40%) were common in patients recruited. After controlling for demographic and medical confounders, subjects in the top tertile of worry, suppression and avoidance of undesirable thoughts were 20 (95% CIs, 6.6-58.3), 10 (95% CIs, 3.5-25.9) and 22 (95% CIs, 6.0-80.0) times more likely to have possible depression compared to those in the lowest tertile.

Prospective research is required to investigate causal relationships between these constructs, and to assess the potential of psychological interventions that target these processes to improve outcomes in patients with LTCs.