Elsevier

Journal of Psychosomatic Research

Volume 91, December 2016, Pages 89-101
Journal of Psychosomatic Research

The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: A systematic review

https://doi.org/10.1016/j.jpsychores.2016.11.004Get rights and content

Highlights

  • Perseverative negative thinking correlated with outcomes (r = 0.23 to r = 0.73).

  • 25 studies controlled for confounders, and an association was found in 15 of those.

  • Findings varied according to long term condition and study quality.

  • Perseverative negative thinking may be a target for treatment of depression in LTCs.

Abstract

Objective

Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions.

Method

Four electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized.

Results

Thirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r = 0.23 to r = 0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes.

Conclusion

Strongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes.

Introduction

Chronic physical illnesses (i.e. long term conditions – LTCs) are conditions that cannot currently be cured but can be managed with treatment e.g. asthma, diabetes, coronary heart disease. It is estimated that 15 million people in England have a LTC, and people with LTCs account for 70% of all health and care spending [1].

Depression is common in people with chronic physical illnesses [2], [3] and is associated with worse medical outcomes such as increased morbidity and mortality [4], [5], [6], [7], worse health-related quality of life [8], [9], [10], and increased healthcare utilisation [11], [12]. Understanding the factors contributing to the development of depression among people with LTCs could therefore: i) help identify who is at increased risk of developing depression and worse medical outcomes, ii) facilitate the stratification and personalisation of psychological and/or medical management and iii) lead to the development of novel interventions that might improve both depression and other health outcomes. Biological, psychological and social risk factors for depression have been identified among people with long term conditions [13], [14], [15], [16], [17], though findings from previous research are often mixed and contradictory. Furthermore, many of the risk factors identified are inter-related and the most important factors predicting (and potentially causing) depression in people with LTCs remain unclear [18].

Perseverative negative thinking is a term used to describe processes such as worry and rumination, in which individuals experience repetitive, prolonged and recurrent negative thoughts about themselves, their symptoms, their problems, or their concerns [19]. Perseverative negative thinking predicts negative affect [20], [21], [22], [23], [24], [25], including the onset, maintenance and relapse of depression (e.g. [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40]). Such thinking also predicts adverse medical outcomes, such as poor cardiovascular health, impaired wound healing and immune dysfunction [41], [42], [43]. These findings suggest that perseverative negative thinking could be a potential target for interventions aimed at improving both medical and psychological outcomes. Most previous prospective research into perseverative negative thinking has focused on physically healthy populations, however. The characteristics of perseverative negative thinking and the nature of its associations with psychological outcomes among people with LTCs are not clear.

The aims of this systematic review are to clarify the temporal relationship and the strength of association between perseverative negative thinking and depression, anxiety and emotional distress among people with LTCs.

Section snippets

Method

This review was conducted following the guidance of the University of York Centre for Reviews and Dissemination [44] and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [45]. The review protocol was previously published [46].

Study selection

Details of study selection are shown in Fig. 1. Thirty eligible studies were included in the review [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82]. Authors of a further 46 potentially eligible studies were contacted for additional data; authors of 15 studies were unable to provide additional data, and authors of 31 did not respond. It was not possible

Discussion

We conducted a systematic review to clarify among people with LTCs the temporal relationship between perseverative negative thinking, on the one hand, and depression, anxiety or emotional distress, on the other, and to determine the strength of the prospective associations. Findings were limited mainly to the association of rumination and/or catastrophizing with subsequent depression. The majority of uncontrolled studies showed an association between measures of perseverative negative thinking

Acknowledgements

The authors declare that they have no competing interests. This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This research was also supported by a University of Exeter Medical School PhD Studentship awarded

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