Implicit and Explicit Self-Esteem in Current, Remitted, Recovered, and Comorbid Depression and Anxiety Disorders: The NESDA Study

Abstract

BackgroundDual processing models of psychopathology emphasize the relevance of differentiating between deliberative self-evaluative processes (explicit self-esteem; ESE) and automatically-elicited affective self-associations (implicit self-esteem; ISE). It has been proposed that both low ESE and ISE would be involved in major depressive disorder (MDD) and anxiety disorders (AD). Further, it has been hypothesized that MDD and AD may result in a low ISE “scar” that may contribute to recurrence after remission. However, the available evidence provides no straightforward support for the relevance of low ISE in MDD/AD, and studies testing the relevance of discrepant SE even showed that especially high ISE combined with low ESE is predictive of the development of internalizing symptoms. However, these earlier findings have been limited by small sample sizes, poorly defined groups in terms of comorbidity and phase of the disorders, and by using inadequate indices of discrepant SE. Therefore, this study tested further the proposed role of ISE and discrepant SE in a large-scale study allowing for stricter differentiation between groups and phase of disorder.MethodIn the context of the Netherlands Study of Depression and Anxiety (NESDA), we selected participants with current MDD (n = 60), AD (n = 111), and comorbid MDD/AD (n = 71), remitted MDD (n = 41), AD (n = 29), and comorbid MDD/AD (n = 14), recovered MDD (n = 136) and AD (n = 98), and never MDD or AD controls (n = 382). The Implicit Association Test was used to index ISE and the Rosenberg Self-Esteem Scale indexed ESE.ResultsControls reported higher ESE than all other groups, and current comorbid MDD/AD had lower ESE than all other clinical groups. ISE was only lower than controls in current comorbid AD/MDD. Discrepant self-esteem (difference between ISE and ESE) was not associated with disorder status once controlling for ESE.LimitationsCross-sectional design limits causal inferences.ConclusionFindings suggest a prominent role for ESE in MDD and AD, while in comorbid MDD/AD negative self-evaluations are also present at the implicit level. There was no evidence to support the view that AD and MDD would result in a low ISE “scar”.

Psychometric evaluation of the Swedish version of Rosenberg’s self-esteem scale

“…Criterion validity in relation to quality of life (satisfaction with life domains) was excellent in both samples, further underscoring that both response scales functioned well. The strongest indication of criterion validity concerned depression, which is in agreement with international research [12,13]. Swedish RSES showed further criterion validity by discriminating between the sexes and diagnostic groups (depression vs. other).…”

“…The same study also showed that female gender and low education were related with low self-esteem. Furthermore, the RSES has shown to be sensitive in identifying persons with depression and anxiety [12,13], and also in groups that do not primarily have a mental health disorder, such as stroke survivors and their spouses [14].…”

Self-esteem consistency predicts the course of therapy in depressed patients

“…The RSES mean score (ESE) in the present sample was 36.6 (SD = 9.9) with a scale range from 10 to 60. Although this seems to be a relatively high mean for a clinical sample of patients in a depressive episode, it is similar to the RSES mean score (of 26.1 ( SD = 5.2) with a scale range from 10 to 40) in a comparable study including 60 patients with a current major depressive disorder [ 29 ]. ISE scores did not significantly differ between patients with a major depressive disorder ( M = 24.5, SD = 90.7) and patients with a recurrent depressive disorder ( M = 1.5, SD = 106.1), t (29) = 0.64, p = .527, d = 0.24, yet there was a significant difference in ESE between patients with a major depressive disorder ( M = 42.1, SD = 10.4) and patients with a recurrent depressive disorder ( M = 32.0, SD = 7.0), t (29) = 3.22, p = .003, d = 1.20.…”

“…Creemers et al [ 28 ] examined the effects of extent and direction of the discrepancy between ISE and ESE on suicidal ideation, depressive symptoms, and loneliness in a student sample, and found that the extent of discrepancy had an impact on suicidal ideation as well as depressive symptoms only when ISE was higher than ESE (damaged self-esteem). In a recent study by van Tuijl et al [ 29 ] the discrepancy between ISE and ESE was not associated with disorder status (current major depressive disorder versus never depressed controls) after controlling for ESE. ESE was higher in healthy controls compared to patients with a current, remitted, and recovered major depressive disorder.…”

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

“…Clearly the findings are mixed, however, and suggest there are important unresolved questions about when, for whom, and under which conditions depression-relevant implicit associations will be evident. Important contextual factors include comorbidity status (e.g., Valiente et al 2011, Van Tuijl et al 2016) and whether a mood induction was used prior to evaluating implicit measures (e.g., Hussey & Barnes-Holmes 2012, van Tuijl et al 2018b; see the review in Roefs et al 2011). Additionally, the valence and types of stimuli used are critical.…”