انتقاد از خود در مقابل روان رنجوری در برآورد افسردگی و اختلال روانی اجتماعی به مدت 4 سال در یک نمونه بالینی

The present study extended previous findings demonstrating self-criticism, assessed by the Dysfunctional Attitude Scale (DAS) (Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada, 1978), as a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment over time. Using data from a prospective, 4-year study of a clinical sample, DAS self-criticism and neuroticism were associated with self-report depressive symptoms, interviewer-rated major depression, and global domains of psychosocial functional impairment 4 years later. Hierarchical multiple regression results indicated that self-criticism uniquely predicted depressive symptoms, major depression, and global psychosocial impairment 4 years later over and above the Time 1 assessments of these outcomes and neuroticism. In contrast, neuroticism was a unique predictor of self-report depressive symptoms only 4 years later. Path analyses were used to test a preliminary 3-wave mediational model and demonstrated that negative perceptions of social support at 3 years mediated the relation between self-criticism and depression/global psychosocial impairment for 4 years.

In recent years, self-criticism (SC), assessed by the Dysfunctional Attitude Scale (DAS; [1]), has emerged as a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment in clinical samples over time. For example, in a series of studies from the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program, pretreatment DAS SC significantly interfered with symptom reduction, the development of the therapeutic relationship, and the development of adaptive capacities in response to stressful life events at termination and follow-up 18 months after termination [2]. Similarly, in analyses of data from the Collaborative Longitudinal Study of Personality Disorders (CLPS), Dunkley et al [3] found that DAS SC was related to negative social interactions, avoidant coping, perceived social support, and depressive symptoms 3 years later. These findings indicate that DAS SC reflects a pathologic cognitive-personality trait that can be distinguished from a normal personality trait by virtue of its association with significant distress and psychosocial functional impairment over time, similar to personality disorders as conceptualized by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; [4]). In considering DAS SC as a prospective predictor of depression and psychosocial impairment, it is important to distinguish DAS SC from the setting of high standards and goals for oneself [5] and [6]. Contrary to the prevailing assumption that DAS SC primarily refers to high personal standards and motivation to attain perfection [7], DAS SC has been demonstrated to more closely reflect self-critical dimensions than personal standard dimensions of perfectionism. Specifically, factor analytic studies of several scales from different theoretical frameworks of perfectionism [8] and [9] have consistently identified 2 higher order latent factors that are considered to reflect personal standards and self-criticism dimensions [6] and [10]. DAS SC has been found to indicate the self-criticism factor, which reflects constant and harsh self-scrutiny, overly critical evaluations of one's own behavior and chronic concerns about others' criticism [11]. Dunkley and colleagues [6] and [12] noted the close similarity of the self-criticism factor of perfectionism to the self-criticism construct by Blatt [13] and [14], which encompasses these intrapersonal and interpersonal aspects of self-criticism. Contrary to the widespread notion that SC individuals actively engage in perfectionistic strivings, it has been suggested that a defensive interpersonal orientation is the primary means through which SC individuals attempt to bolster and protect a vulnerable sense of self [15]. For example, in relation to the 5-factor model of personality [16], DAS SC and other SC measures have been related to neuroticism, introversion, and antagonism and unrelated to conscientiousness, whereas personal standard measures are most closely associated with conscientiousness [5], [15] and [17]. In keeping with DAS SC [2], SC indicators have been found to have an adverse impact on employment status [18] and a wide range of relationships, including those with parents and friends [6], [10], [19], [20] and [21]. Finally, DAS SC and other SC measures have a stronger, more consistent relation with depressive symptoms than do measures that represent personal standards [5], [7] and [11]. Although previous research suggests that DAS SC is a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment, more research is needed to assess and quantify this relation. First, given that studies have found DAS SC and other SC measures to be relatively stable over time [22] and [23], the association between SC and depressive symptoms and psychosocial functional impairment should endure over several years. There have been several recent longitudinal studies demonstrating SC measures of perfectionism as prospective predictors of maladjustment outcomes, but these studies examined SC measures as prospective predictors of outcome for only periods of 1 year or less [24], [25], [26], [27], [28] and [29]. Second, as theoretical writings have concentrated on perfectionism as a pervasive neurotic style [30], [31] and [32], there is a need to demonstrate the unique contribution of SC over and above broader source traits, such as neuroticism, in predicting depression and psychosocial impairment over time [21], [33] and [34]. Several longitudinal studies have supported neuroticism as a predictor of depression [35] and [36]. Furthermore, Skodol et al [37] found neuroticism to be related to several indices of functional impairment in previous CLPS analyses. Although Dunkley et al [3] distinguished DAS SC from neuroticism in unique relations with negative interpersonal characteristics and depressive symptoms 3 years later, Enns et al [25] found that the longitudinal effects of several other SC measures were nonsignificant once neuroticism was controlled for. The primary purpose of the present study was to extend previous findings by examining DAS SC as a prospective predictor of self-report depressive symptoms and interviewer-rated major depression, specific domains of functioning (eg, employment, relationships with parents, relationships with friends, recreation), and global domains of functioning (global satisfaction, global social adjustment, global assessment of functioning). We examined the predictive use of SC for a substantially longer period (ie, 4 years) than has previously been tested in the literature, which allowed for a compelling test of the stability of associations of SC with depressive symptoms and psychosocial impairment over time. Furthermore, we examined DAS SC as a predictor of negative change in depression and global functional impairment for 4 years by testing the relations between DAS SC and depression and global impairment 4 years later over and above the Time 1 levels of these variables and neuroticism. Potential mediating mechanisms through which SC is related to depressive symptoms and psychosocial impairment over time also need to be examined [3]. A secondary purpose of the present study was to examine whether the relation between SC and both depressive symptoms and global psychosocial functional impairment over time can be explained by SC individuals' negative interpersonal characteristics [3], [21] and [38]. Dunkley et al [3] proposed that SC is related to negative social interactions and negative perceptions of social support, which, in turn, predict depressive symptoms. First, individuals with higher levels of SC are concerned that others will be critical and rejecting as they are of themselves. This becomes expressed in a defensive interpersonal style that draws negative reactions from other people [3], [21], [39] and [40]. Second, because SC individuals perceive that mistakes and shortcomings will result in rejection from others, these individuals perceive that others are unwilling or unavailable to help them in times of stress. In often perceiving that they have less social support available to them, individuals with higher levels of SC lack a critical resource that can make stressful situations seem less overwhelming and protect against the experience of depressive symptoms [12] and [41]. Support for daily stress (or negative social interactions) and lower perceived social support as mediators of the relation between SC and depressive symptoms has been found in studies of nonclinical [12], [26], [27], [42] and [43] and clinical samples [3] and [38]. A limitation of previous longitudinal studies testing mediational models in the literature is that the mediators have been assessed concurrently with maladjustment outcomes [3], [26], [27], [28] and [29], which hinders the ability to make stronger causal statements from these findings. In a subset of the sample of the present study, we tested a preliminary, 3-wave, mediational model of the relation between SC and depression/global psychosocial impairment 4 years later. To better test causal hypotheses, the present study examined SC, negative social interactions and perceived social support, and depression/global impairment at 3 successive time points that allowed considerable time to elapse between assessments, namely Time 1, Time 2 three years later, and Time 3 four years later, respectively [44]. In sum, in addition to further demonstrating SC as an important prospective predictor of depression and psychosocial impairment, the present study sought to preliminarily highlight important mediating processes and contribute to identifying specific targets for clinical interventions across a wide range of clinical problems.