Absolutist word usage in spoken language as a marker of depression: an ecological momentary assessment study

Cognitive distortions are central to the maintenance of depression, as they bias information processing and negatively impact adaptive emotion regulation. As one manifestation of cognitive distortions, usage of absolutist words (e.g., always, never, must, completely) in written texts has been found to be indicative of underlying depression. Since absolutist word usage may allow important insights into maladaptive thinking patterns, it could be a relevant target for both monitoring and treating depressive symptoms. Therefore, we tested the relationships between absolutist word usage in spoken language with depression diagnosis, depressive symptom severity and current depressed mood.

We recruited 144 age- and gender-matched participants with clinical depression (n = 48), subclinical depression (n = 48), and no history of depression (n = 48). By conducting smartphone-based ecological momentary assessments (EMA) three times daily for two weeks, participants provided ratings of depressed mood and speech samples, which included mood descriptions and mood-regulating statements. The Hamilton Rating Scale for Depression (HRSD) was administered at the end of the 2-week period to assess depressive symptom severity retrospectively. Group differences were calculated with ANOVAs, associations between depressed mood and absolutist word usage were evaluated with multilevel models, and the relationship between depressive symptom severity and absolutist word usage was calculated with regression models.

Results showed more frequent absolutist word usage over the EMA phase in individuals with clinical depression compared to individuals with no history of depression. Furthermore, absolutist word usage was negatively associated with momentary depressed mood among individuals with elevated depressive symptoms. Additional analyses testing the temporal relationship showed that greater absolutist word usage was associated with higher levels of depressed mood after 12-24 h. Accordingly, absolutist word usage was positively associated with depressive symptom severity assessed after the 2-week period.

Our results have several implications: First, absolutist word usage in spoken language appears to be an indicator of depression, which may be relevant for the optimization of depression assessment and monitoring approaches. Second, the finding that absolutist word usage was associated with lower depressed mood in the short-term, but higher depressed mood in the long-term provides important insights into the mechanisms of depression, and may help identify relevant treatment targets for clinicians.

German Clinical Trial Registration DRKS00023670 on 19/01/2021 ( https://drks.de/search/en/trial/DRKS00023670 ).