بررسی اجتناب در افسردگی اساسی در مقایسه با اختلال اضطراب اجتماعی

Abstract The construct of avoidance has begun to receive attention in theoretical models and empirical investigations of depression. However, little is known about relative levels of avoidance across diagnostic categories or about the relationships between avoidance and other correlates of depression. The present study compared levels of avoidance across groups of depressed women without social anxiety disorder (MDD without SAD), depressed women with social anxiety disorder (MDD with SAD), women with social anxiety disorder (SAD), and nonclinical women, and investigated the relationships among avoidance, and sociotropy and autonomy, rumination, and negative and positive problem orientations within the clinically depressed group. Avoidance was found to be significantly higher in all clinical groups relative to the nonclinical group of women, and highest in the comorbid MDD with SAD group. Avoidance showed significant positive relationships with sociotropy, autonomy, rumination, and negative problem orientation, and a significant negative relationship with positive problem orientation within the overall sample of depressed women. These results suggest that avoidance should be given greater consideration in psychosocial models of depression and point to several important directions for future research.

Results All statistical tests of study hypotheses were tested with a Type I error rate of .05. All one-way analyses of variance (ANOVAs) conducted to test for questionnaire order effects were not significant. Demographic characteristics across groups Demographic characteristics across groups are presented in Table 1. With the exception of employment status, which showed significant differences across groups, none of the other demographic variables was found to differ significantly across groups, all ps > .05. The MDD without SAD and the MDD with SAD groups of women demonstrated higher levels of unemployment than the SAD only and nonclinical groups of women. Employment status did not interact with participant group status (MDD without SAD, MDD with SAD, SAD, and nonclinical groups) to significantly affect primary outcome measures on CBAS-measured avoidance, and thus employment status was not included as factor in the between-group comparisons of avoidance. Table 1. Demographic information and BDI-II and CBAS scores across participant groups. Overall MDE (n = 60) MDE without SAD (n = 29) MDE with SAD (n = 31) SAD (n = 30) Nonclinical (n = 30) Age M 42.05 43.41 40.77 35.60 36.53 (SD) (13.46) (13.79) (13.24) (10.79) (12.17) Ethnicity (%) Asian 1.7 3.4 0 6.7 6.7 Caucasian 95.0 93.1 96.8 83.3 80.0 Other 3.3 3.4 3.2 10.0 13.3 Martial status (%) Single 33.3 24.1 41.9 43.3 46.7 Married/CL 45.0 50.0 38.7 50.0 53.3 Divorced 18.3 20.7 16.1 6.7 0 Widowed 3.3 3.4 3.2 0 0 Employment status (%) Unemployed 46.7 55.2 38.7 20.0 13.3 Employed PT 21.7 10.3 32.3 16.7 23.3 Employed FT 31.7 34.5 29.0 63.3 63.3 BDI-II score M 31.78 33.31 30.35 9.80 2.73 (SD) (10.10) (10.67) (9.49) (5.68) (2.61) CBAS total score M 87.15 79.59 94.23 77.90 43.87 (SD) (22.73) (21.59) (21.76) (13.13) (11.04) CBAS be havioral social score M 23.12 20.17 25.87 24.47 10.87 (SD) (8.46) (8.28) (7.77) (6.57) (4.18) CBAS behavioral nonsocial score M 19.35 17.79 20.81 16.00 8.77 (SD) (5.56) (5.49) (5.30) (4.52) (2.40) CBAS cognitive social score M 18.12 16.28 19.84 15.60 11.00 (SD) (6.40) (6.68) (5.70) (4.88) (4.19) CBAS cognitive nonsocial score M 26.57 25.34 27.71 21.83 13.23 (SD) (8.72) (8.38) (9.02) (6.44) (3.22) Note. MDE = Major Depressive Episode, SAD = Social Anxiety Disorder, CL = common law, PT = part-time, FT = full-time, BDI-II = Beck Depression Inventory-II, CBAS = Cognitive Behavioral Avoidance Scale. Table options Between-group comparisons of CBAS-measured avoidance Mean scores on the CBAS avoidance scales across the participant groups are displayed in Table 1. Separate one-way ANOVAs were computed to test the hypotheses that levels of avoidance on all CBAS subscales would differ across groups. The ANOVA that examined levels of Behavioral Social avoidance revealed significant differences across participant groups, F (3, 116) = 29.24, p < .001. Consistent with hypotheses, planned t-tests showed that all clinical groups, including the MDD without SAD [t (41.10) = 5.42, p < .001], MDD with SAD [t (46.36) = 9.43, p < .001], and SAD [t (49.20) = 9.57, p < .001] groups, showed significantly higher levels of Behavioral Social Avoidance than the nonclinical control group. Also consistent with hypotheses, it was found that women in the MDD with SAD group and the SAD group demonstrated significantly higher levels of Behavioral Social avoidance than the MDD without SAD group, t (58) = 2.75, p = .008 and t (57) = 2.21, p = .031, respectively. However, the remaining group contrast between levels of Behavioral Social avoidance in the comorbid MDD with SAD and the SAD group was not significant, t (59) = .76, p = .45. Levels of Behavioral Nonsocial avoidance also differed significantly across participant groups, F (3, 116) = 37.56, p < .001. As hypothesized, all clinical groups, including the MDD without SAD [t (38.06) = 8.13, p < .001], MDD with SAD [t (42.12) = 11.49, p < .001], and SAD [t (44.18) = 7.74, p < .001] groups, had significantly higher levels of Behavioral Nonsocial avoidance than the nonclinical control group. Also as hypothesized, the comorbid MDD with SAD group showed higher levels of Behavioral Nonsocial avoidance than the MDD without SAD group, t (58) = 2.16, p = .035, and the SAD group, t (59) = 3.81, p < .001. Contrary to hypothesis, Behavioral Nonsocial avoidance was not found to be higher in the MDD without SAD versus the SAD group, t (57) = 1.37, p = .18. The one-way ANOVA on levels of Cognitive Social avoidance showed significant differences across participant groups, F (3, 116) = 13.59, p < .001. In line with study hypotheses, all clinical groups, including the MDD without SAD [t (46.83) = 3.62, p < .001], MDD with SAD [t (55.12) = 6.92, p < .001], and SAD [t (58) = 3.92, p < .001] groups, showed significantly higher levels of Cognitive Social avoidance than the nonclinical control group. Also as hypothesized, the comorbid MDD with SAD group showed higher levels of Cognitive Social avoidance than both the MDD without SAD group, t (58) = 2.23, p = .03, and the SAD group, t (59) = 3.12, p = .003. The remaining contrast between the MDD without SAD and SAD groups on levels of Cognitive Social avoidance was non-significant, t (57) = .45, p = .66. There was a significant difference in Cognitive Nonsocial avoidance across participant groups, F (3, 116) = 23.83, p < .001. Consistent with hypotheses, all clinical groups, including the MDD without SAD [t (35.87) = 7.28, p < .001], MDD with SAD [t (37.77) = 8.40, p < .001], and SAD [t (42.68) = 6.54, p < .001] groups, had significantly higher levels of Cognitive Nonsocial avoidance than the nonclinical group. Whereas the comorbid MDD with SAD group showed significantly higher levels of Cognitive Nonsocial avoidance than the SAD group, t (54.34) = 2.94, p = .005, the contrast between the comorbid MDD with SAD group and the MDD without SAD group was non-significant, t (58) = 1.05, p = .30. The hypothesized difference between the MDD without SAD group and the SAD group on Cognitive Nonsocial avoidance was marginally significant, t (57) = 1.81, p = .08, with higher levels of avoidance in the MDD without SAD group. Finally, the one-way ANOVA on total CBAS avoidance scores across the participant groups revealed significant differences, F (3, 116) = 44.59, p < .001. Consistent with hypotheses, all clinical groups, including the MDD without SAD [t (41.39) = 7.96, p < .001], MDD with SAD [t (44.80) = 11.45, p < .001], and SAD [t (58) = 10.87, p < .001] groups, showed significantly higher levels of total CBAS avoidance than the nonclinical control group. Also consistent with hypotheses, the comorbid MDD group reported significantly higher levels of overall CBAS avoidance than the MDD without SAD group [t (58) = 2.61, p = .011] and the SAD group [t (49.56) = 3.56, p = .001]. Levels of overall CBAS avoidance were not found to differ significantly across the MDD without SAD and the SAD groups [t (45.93) = .36, p = .72]. Relationships among avoidance and psychosocial variables in depression Mean scores in the overall MDD sample (n = 60) on the psychosocial measures of sociotropy, autonomy-independence, autonomy-solitude, rumination, including brooding and reflection, and positive and negative problem orientations are presented in Table 2. Within the sample of depressed women, correlational analyses were conducted to examine hypotheses pertaining to the relationships among CBAS-measured dimensions of avoidance and each of the psychosocial variables, and are presented in Table 2. Table 2. Mean scores on psychosocial variables and correlations between CBAS scales and psychosocial variables in the overall MDD sample (n = 60). Criterion measure Mean (SD) Behavioral social Behavioral nonsocial Cognitive social Cognitive nonsocial Total CBAS SAS Sociotropy 76.80 (18.54) .25 .41** .28* .45** .44** Autonomy-S 21.35 (7.07) .36** .29* .55** .42** .52** Autonomy-I 40.13 (8.98) −.10 −.19 −.08 −.14 −.16 RSQ Rumination 60.53 (11.03) .19 .39** .26* .42** .40** Brooding 14.63 (3.28) .25 .33** .12 .37** .35** Reflection 12.38 (3.66) .07 .03 −.06 −.07 −.01 SPSI-R NPO 23.92 (8.96) .31* .69** .34** .54** .59** PPO 8.60 (3.68) .01 −.33** −.28** −.30* −.27* Note. SAS = Sociotropy-Autonomy Scale, Autonomy-S = Autonomy-Solitude, Autonomy-I = Autonomy-Independence, RSQ = Response Styles Questionnaire, SPSI-R = Social Problem-Solving Inventory – Revised, NPO = Negative Problem Orientation, PPO = Positive Problem Orientation. *Indicates correlation is significant at the p < .05 level (2-tailed). **Indicates correlation is significant at the p < .01 level (2-tailed). Table options All of the CBAS scales showed significant positive correlations with sociotropy (range of r = .28 to .45), with the exception of the Behavioral Social subscale, which showed a marginally significant correlation with sociotropy of r = .25, p = .053. All of the CBAS scales showed significant positive correlations with autonomy–solitude (range of r = .29 to .55), but no significant correlations with the independence factor of the autonomy construct, as expected. Contrary to the hypothesis that sociotropic individuals would show higher levels of avoidance in social domains, Steiger’s z-test ( Steiger, 1980) showed that correlations between sociotropy and social forms of avoidance were not statistically different in magnitude from correlations between sociotropy and nonsocial forms of avoidance, all ps > .05. The hypothesis that both behavioral and cognitive avoidance would show significant positive correlations with rumination was generally supported, as there were significant positive correlations between all CBAS avoidance dimensions, except the Behavioral Social subscale, with the overall RRS rumination construct. When the RRS was subdivided into brooding and reflection factors, Behavioral Nonsocial and Cognitive Nonsocial subscales correlated significantly with the brooding factor of rumination. The correlation between brooding and Behavioural Social avoidance was marginally significant (r = .25, p = .058), whereas the correlation between brooding and the Cognitive Social subscales was non-significant (r = .12, p = .352). As hypothesized, CBAS-measured avoidance scales were not found to be significantly related to the reflection factor of rumination. Consistent with hypotheses, all CBAS dimensions showed significant positive correlations with NPO. As predicted, it was found that the CBAS scales generally showed significant negative correlations with PPO. The Behavioral Social avoidance scale, however, was not found to be significantly related to PPO.