Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies

Abstract

Background The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Methods Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n = 140; 67.9% female; Mage = 40.0) and without (n = 80; 65.0% female; Mage = 36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passive-aggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional self-evaluation and self-reported depressive symptoms in 200 undergraduate Psychology students. Results Compared to outpatients without depressive disorders, outpatients with depressive disorder reported significantly more self-directed passive aggression (d = 0.51). Furthermore, Study 2 verified self-directed passive-aggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs = .22, 95%-CI: .14, .31), attributional style (abcs = .20, 95%-CI: .13, .27), ruminative response style (abcs = .15, 95%-CI: .09, .21) and depressive symptoms. Conclusion Self-directed passive-aggressive behaviour partially mediates the association between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression. Trial registration Both studies were preregistered at the German Clinical Trials Register (DRKS00014005 and DRKS00019020).

Longitudinal association between depressive symptoms and self-directed passive aggression: A random intercept cross-lagged panel analysis

“…The results of our cross-sectional analyses correspond with our hypotheses, based on the selfcontrol model of depression (35). In line with previous studies (16,59), passive SD-AB was moderate to strongly associated with depressive symptoms, even when general symptom severity was controlled for. Passive SD-AB also accounted for a significant amount of variance in depressive symptoms when controlled for perceived stress.…”

“…The current study has three aims: First, to replicate previous findings (15,16) on the association between passive SD-AB and depressive symptoms. Second, to analyse if passive SD-AB moderates the association between subjective stress and depressive symptoms, which would support the notion of SD-AB being a dysfunctional self-regulation strategy.…”

“…Several studies show an association between DD and active SD-AB (14). Furthermore, two recent studies demonstrate a moderate to strong association between passive SD-AB and depressive symptoms in inpatients, outpatient as well as student samples (15,16).…”

The paradox of aggression in adolescent depression: A systematic review

“…Addressing problems, people, or issues through inactivity or omission is a feature of passive aggression. Sulking, passing back-handed compliments, procrastination, withdrawal, giving excuses, refusing to communicate, or showing avoidance are signs of passive aggression-also signs of depression (Rudolph & Clark, 2001;Schanz et al 2022; Rey-Pena & Pacheno, 2012).…”