Effect of rejection sensitivity on the development of anxious-depressive attack in Japanese outpatients: The mediating roles of rumination, social anxiety, and depressive symptoms

Abstract

ObjectiveAnxious-depressive attack (ADA) is a cluster of symptoms, including sudden and intense anxiety or depression, intrusive rumination about negative memories or future worries, prominent agitation, impatient behavior, and/or loneliness; in some cases, symptoms include a wide range of violent coping behaviors to manage emotional distress. Four characteristics—rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms—are thought to be associated with the development of ADA. However, the complex relationships among these factors have not been clarified. In this study, we aimed to examine the mechanism by which these four characteristics influence the development of ADA.MethodsWe conducted a structured interview about ADA with 332 outpatients, who completed several self-report measures, to assess rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms.ResultsA structural equation model showed goodness-of-fit with the data. These findings suggest that rejection sensitivity may demonstrate a direct effect on the occurrence of ADA. Furthermore, rejection sensitivity might affect depressive symptoms through rumination and social anxiety symptoms and consequently contribute to the development of ADA.ConclusionThese results provide preliminary evidence that rejection sensitivity contributes to the development of ADA.

The Relationship of Rejection Sensitivity to Depressive Symptoms in Adolescence: The Indirect Effect of Perceived Social Acceptance by Peers

“…However, this seems important given that depressive symptoms and aggressive behaviour appear to be closely related [19,20], particularly in adolescent samples [21], while anger is associated with both childhood and adolescent depression [22]. Recent research has confirmed that the constant anticipation of rejection-whether anxious or angry-creates feelings of anxiety that promote depressive symptoms [23,24]. Therefore, it is assumed in the present research that angry RS could equally predict depressive symptoms.…”

Anxious‐depressive attack and rejection sensitivity—Toward a new approach to treatment‐resistant depression

“…As per the criteria, RS is contained in two out of the four TA B L E 1 Diagnostic criteria for anxious-depressive attack. 3 (A) Anxious-depressive attack occurs suddenly and recurrently regardless of one's situation in various mental disorders (B) The following symptoms proceed in descending order; however, symptom no. 4 is elective: (1) Sudden instantaneous negative emotions occur.…”

“…ADA is trans‐diagnostically observed in various disorders such as major depressive disorder with or without atypical features, bipolar disorder, social anxiety disorder, panic disorder with or without agoraphobia, specific phobia, obsessive‐compulsive disorder, and schizophrenia. 3 The proportion of patients having ADA was 43.2% among outpatients who presented regularly for treatment 2 but only 16.9% among first‐time visiting patients. 4 This discrepancy could be partially explained by the fact that patients with ADA were refractory.…”

“…with or without agoraphobia, specific phobia, obsessive-compulsive disorder, and schizophrenia. 3 The proportion of patients having ADA was 43.2% among outpatients who presented regularly for treatment 2 but only 16.9% among first-time visiting patients. 4 This discrepancy could be partially explained by the fact that patients with ADA were refractory.…”

“…ADA is rarely noticed by physicians or third parties, as it is almost impossible for the patient to objectively inform others of his or her own experiences during intense anxious seizures (Table 1). ADA is trans‐diagnostically observed in various disorders such as major depressive disorder with or without atypical features, bipolar disorder, social anxiety disorder, panic disorder with or without agoraphobia, specific phobia, obsessive‐compulsive disorder, and schizophrenia 3 . The proportion of patients having ADA was 43.2% among outpatients who presented regularly for treatment 2 but only 16.9% among first‐time visiting patients 4 .…”