Women who hold negative beliefs about themselves are at greater risk of developing depression later in their lives, according to a new study.
Psychiatrists say these strongly-held negative beliefs – such as “If others knew the real me, they wouldn’t like me” - are not early symptoms of depression, but signs of vulnerability that last for some time. In future doctors might be able to act earlier to help such people avoid developing depression.
The findings, based on mothers taking part in the Children of the 90s study at the University of Bristol, confirm an influential theory of psychology which was first published in 1967, but which up until now has never been properly verified.
It is known that negative beliefs about the self, the world and the future are common during an episode of depression According to Beck’s Cognitive Theory put forward by American psychiatrist Dr Aaron T Beck, individuals who hold negative self schemas or beliefs when otherwise well, are vulnerable to depression in the future.
While it was widely accepted, no-one was able to test his theory on a large population of people who were not suffering from depression in the first place.
Dr Jonathan Evans, a psychiatrist from the University of Bristol, set out to test whether the theory was true by going back through records on 8,539 pregnant women taking part in the Children of the 90s study. At the time – none of these women were suffering from depression.
In the 18th week of pregnancy – they were asked to fill out a questionnaire on their personal beliefs. To the statement "I avoid saying what I think for fear of being rejected", 6.5 per cent of the women agreed that it was "Very like me." 11.7 per cent said "My value as a person depends enormously on what others think of me" was "Very like me."
The women were also asked to respond to:
- If other people knew what I am really like, they would think less of me (Very like me 3.2 pc)
- If others knew the real me, they would not like me (2.0 pc)
- I always expect criticism (7.4 pc)
- I don’t like people to really know me (5.5 pc)
At the same time, and in subsequent surveys, the women’s state of mind were assessed using the widely-established Edinburgh Postnatal Depression Scale.
Of all the 8,539 women, 736 (8.6 per cent) had become depressed 14 weeks later, at week 32 of their pregnancy. Eight weeks after birth, 4.4 per cent had developed depression.
Significantly, Dr Evans found that there was a direct relationship between those who agreed most strongly with negative statements and the later onset of depression. Women with the highest scores for negative self-beliefs were 60 per cent more likely to become depressed than those with the lowest scores. The effect was the same in women who became depressed three years later.
He says: “The size of the association between negative self-beliefs score at baseline and later onset of depression at 8 weeks, 8 months, 21 months and 32 months after childbirth remained relatively constant.
“The fact that high levels of negative self-beliefs can predict onset of depression more than three years later suggests that such beliefs represent a long-lasting vulnerability to depression, rather than being an early sign of a depressive episode.
“Our findings support the hypothesis that individuals who have negative self-schemas are more vulnerable to developing depression.
“While the origins of these negative self-schema haven’t been investigated, it is thought that they may arise from adverse experiences particularly during childhood when social schemas relating to the self are first formed.
“Understanding how individuals develop these negative self schemas should lead to opportunities to prevent depression in the future.”
Academic paper reference
Negative self-schemas and the onset of depression in women: A longitudinal study. Jonathan Evans, Jon Heron, Glyn Lewis, Ricardo Araya, Dieter Wolke and the ALSPAC study team. The British Journal of Psychiatry, April 2005. doi 10.1192/bjp.186.4.302
Notes
According to the mental health charity MIND, and the Office of National Statistics, depression occurs in one in 10 adults in Britain at any one time. Estimates of lifetime prevalence vary from one in six to one in four. A summary of studies on more severe depression gives a figure of one in 20 people at any one time who suffer major or ‘clinical’ depression.
A schema is a cognitive system which helps us organise and make sense of information. For example, you may have a conceptual framework or developed a schema that all homeless people are rude. Because of this schema, you organise your actions around it and more readily look for information that supports this view while discarding information that disagrees with this perspective. Schemas exert a great deal of influence over us and sometimes hinder us from remembering new information because it does not fit into our cognitive framework.
ALSPAC The Avon Longitudinal Study of Parents and Children (also known as Children of the 90s) is a unique ongoing research project based in the University of Bristol. It enrolled 14,000 mothers during pregnancy in 1991-2 and has followed most of the children and parents in minute detail ever since.
The ALSPAC study could not have been undertaken without the continuing financial support of the Medical Research Council, the Wellcome Trust, and the University of Bristol among many others.