Journal of Affective Disorders
Volume 122, Issue 1 , Pages 46-52, April 2010

Cognitive reactivity: Investigation of a potentially treatable marker of suicide risk in depression

  • Niki Antypa

      Affiliations

    • Institute of Psychology, Leiden University, Leiden, The Netherlands
    • Corresponding Author InformationCorresponding author. Tel.: +31 71 527 3377; fax: +31 71 527 4678.
    • ,
  • A.J. Willem Van der Does

      Affiliations

    • Institute of Psychology, Leiden University, Leiden, The Netherlands
    • Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Brenda W.J.H. Penninx

      Affiliations

    • Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands

Received 27 March 2009; received in revised form 11 June 2009; accepted 11 June 2009.

Abstract 

Background

Suicidal ideation is the most stable symptom of depression across episodes. This relative stability may be brought about by increased cognitive reactivity to sad mood (CR) during periods of remission. The idea is that a network of depressive cognitions, which include suicidal ideation, becomes strengthened with each episode of depression. Consequently, the whole network may be more easily re-activated, for instance by an episode of low mood. We examined the association between reactivity of suicidal cognitions during recovery and the presence of suicidal ideation and behavior during the previous depressive episode.

Methods

In a case–control design, the CR profiles of recovered depressed participants with (N=355) and without (N=250) a history of suicidal ideation were compared. Structured clinical interviews were used to determine diagnoses and prior symptoms. Cognitive reactivity profile was measured with the Leiden Index of Depression Sensitivity-Revised (LEIDS-R).

Results

Suicidal ideation during a depressive episode was associated with a distinct CR profile during remission: elevated hopelessness reactivity scores. This relationship between prior suicidality and current CR was independent of anxiety disorder comorbidity. Moreover, a history of suicide attempt(s) was also associated with a distinct CR profile. These individuals had both higher hopelessness reactivity and higher aggression reactivity than the non-suicidal and suicidal ideation groups.

Limitations

Symptoms during the previous depressive episode were assessed retrospectively.

Conclusions

This is the first study to show that CR may underlie the relative stability of suicidal symptoms independent of anxiety comorbidity and that suicidal ideation and suicidal behavior are associated with distinct patterns of CR. Since CR is a potentially treatable vulnerability marker of depression recurrence, this has important clinical implications.

Keywords: Cognitive reactivity, Suicidal ideation, Suicidal behavior, Depression recurrence, Hopelessness

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PII: S0165-0327(09)00272-9

doi:10.1016/j.jad.2009.06.013

Journal of Affective Disorders
Volume 122, Issue 1 , Pages 46-52, April 2010

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