Yaşlılarda Depresyon ve Tekrarlayan Olumsuz Düşünce: Yürütücü İşlev Bozukluğunun Özgün Rolü

Abstract

Yaşlılarda depresyon ciddi sonuçlara sebebiyet vermektedir, bu yüzden depresyona hassasiyet yaratan faktörleri anlamak, gerekli terapi yöntemlerinin geliştirilmesinde ve uygulanmasında faydalı olacaktır. Yaşlılıkta depresyona sebep olan risk faktörlerinden birisi yürütücü işlev bozukluklarıdır. Yürütücü işlevler üzerinde olumsuz etkisi olabilecek bir faktör geçmişte olmuş veya gelecekte olabilecek olaylara ilişkin kontrol edilemez, soyut, tekrarlayan ve genelde olumsuzluk içeren düşünme eğilimi olarak tanımlanan tekrarlayan olumsuz düşünce şeklidir. Bu araştırmanın amacı farklı yürütücü işlevlerin geriyatrik depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkide biçimlendirici etkisini araştırmaktır. Araştırmanın örneklemini 60-82 yaşları arasında 128 (63 kadın, 65 erkek) bağımsız yaşayan katılımcı oluşturmaktadır. Katılımcılara depresyon (Geriatrik Depresyon Ölçeği) ve tekrar eden düşünce eğilimini ölçen (Penn State Endişe Ölçeği) özbildirim ölçekleri ile inhibisyon (Stroop Renk-Kelime Testi) ve işler bellek kapasitesini ölçen (Sayı Dizisi Tersten) nöropsikolojik testler uygulanmıştır. Katılımcıların tamamı İstanbul’da ikamet etmektedir ve anadillerini Türkçe olarak belirtmişlerdir. Analizler, işler bellek kapasitesinin depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkiyi biçimlendirdiğini göstermiştir. Sonuçlara göre, düşük düzeyde tekrarlayan olumsuz düşünce gösteren katılımcılarda, işler bellek kapasitesinin depresyon üzerinde bir etkisi olmadığı bulunmuştur. Buna karşın, yüksek düzeyde tekrarlayan olumsuz düşünce gösteren yaşlılarda işler bellek kapasitesinin yüksek olması tekrarlayan olumsuz düşüncelerin olumsuz etkilerini yumuşattığı ve düşük depresyon puanları ile ilişkili olduğu belirlenmiştir. Ancak aynı biçimlendirici etki inhibisyon için bulunamamıştır. Elde edilen bulgular yaşlılıkta yüksek işler bellek kapasitesinin, depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkide tampon görevi üstlendiğini göstermiştir. Bu çalışmanın tekrarlayan olumsuz düşünce ve yütürücü işlev bozukluğunun da etkisiyle daha komplike bir hal alan geriyatrik depresyonun tedavisinde önemli bir yol gösterici olduğu düşünülmektedir.

Keywords

• Geriyatrik depresyon
• tekrarlayan olumsuz düşünce
• yürütücü işlevler
• işler bellek
• endişe

Depression and Repetitive Negative Thinking among Older Adults: The Specific Role of Executive Dysfunction

Abstract

Depression in older adults poses serious consequences, thus understanding vulnerability factors may contribute to the development and implementation of appropriate clinical interventions. Executive function deficits have been proposed as risk factors for geriatric depression. One possible factor that may facilitate the impact of executive function deficits is Repetitive Negative Thinking (RNT) patterns that had been defined as an inclination to entertain uncontrollable, abstract, repetitive, and mainly negative thoughts about events that took place in the past or will take place in the future. The present study aimed to test the moderator roles of different dimensions of executive function on the relationship between repetitive negative thinking and geriatric depression. A sample of 128 community-dwelling older adults (63 women, 65 men), between 60 and 82 years of age, were administered both self-report questionnaires measuring depression (Geriatric Depression Scale), and repetitive negative thinking (Penn State Worry Questionnaire) and neuropsychological tests measuring inhibition (Stroop Color-Word Test) and working memory (Digit Span Backward). All participants lived independently in Istanbul, and spoke Turkish as their native language. The results showed that working memory capacity significantly moderated the relationship between repetitive negative thinking and depression as predicted. However, the results did not indicate the same moderator effect of inhibition. The present data suggests that high working memory capacity is able to moderate the relationship between repetitive negative thinking and depression among older adults. This finding has important implications for clinical interventions targeting depression in older adults whose clinical presentations are complicated with repetitive negative thinking and executive dysfunction.

Keywords

• Geriatric depression
• repetitive negative thinking
• executive function
• working memory
• worry

References

1. Alexopoulos, G. S. (2003). The role of executive function in late-life depression. The Journal of Clinical Psychiatry, 64(14), 18-23.
2. Alexopoulos, G. S., Borson, S., Cuthberth, B. N., Devanand, D. P., Mulsant, B. H., Olin, J. T., & Oslin, D. W. (2002). Assessment of late life depression. Biological Psychiatry, 52(3), 164-174. https://doi.org/10.1016/S0006-3223(02)01381-1
3. Alexopoulos, G. S., Bruce, M. S., & Hull, J. (1999). Clinical determinants of suicidal ideation and behavior in geriatric depression. Archives of General Psychiatry, 56(11). 1048-1053. doi:10.1001/archpsyc.56.11.1048
4. Alexopoulos, G. S., Kiosses, D. N., Heo, M., Murphy, C. M., Shanmugham, B., & Gunning-Dixon, F. (2005). Executive dysfunction and the course of geriatric depression. Biological Psychiatry, 58(3), 204-210. https://doi.org/10.1016/j.biopsych.2005.04.024
5. Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kalayam, B., Kakuma, T., Gabrielle, M., ... Hull, J. (2000). Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry, 57(3), 285-290. doi:10.1001/archpsyc.57.3.285
6. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238-246. http://dx.doi.org/10.1037/0033-2909.107.2.238
7. Buck, J. M., Kelly, W. E., & Silver, N. C. (2008). An investigation of the relationship between depression and worry: A research note. Individual Differences Research, 6(2), 120-122.
8. Byrne, B. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming. New York: Routledge.

9. Conwell, Y., Duberstein, P. R., & Caine, E. D. (2002). Risk factors for suicide in later life. Biological Psychiatry, 52(3), 193-204. https://doi.org/10.1016/S0006-3223(02)01347-1
10. Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750
11. Doraiswamy, P. M., Khan, Z. M., Donahue, R. M. J., & Richard, N. E. (2002). The spectrum of quality-of-life impairments in recurrent geriatric depression. The Journals of Gerontology: Series A, 57(2), M134-M137. https://doi.org/10.1093/gerona/57.2.M134
12. Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192-205. https://doi.org/10.1521/ijct.2008.1.3.192
13. Ertan, T., & Eker, E. (2000). Reliability, validity and factor structure of the geriatric depression scale in Turkish elderly: Are there different factor structures for different cultures? International Psychogeriatrics, 12(2), 163-162. https://doi.org/10.1017/S1041610200006293
14. Ertan, T., Eker, E., Güngen, C., Engin, F., Yaşar, R., & Kılıç, G., & Özel, S. (1999, August). The standardized mini mental state examination for illiterate Turkish elderly population. Paper presented at the 2nd International Symposium on Neurophysiological and Neuropsychological Assessment of Mental and Behavioral Disorders, Bursa, Turkey.
15. Ertan, T., Eker, E., & Şar, V. (1997). Reliability and validity of the geriatric depression scale in Turkish elderly population. Archives of Neuropsychiatry (Turkish), 34(1), 62-71.
16. Fischer, C., Schweizer, T. A., Atkins, J. H., Bozanovic, R., Norris, M., Herrmann, N., ... Rourke, S. B. (2008). Neurocognitive profiles in older adults with and without major depression. International Journal of Geriatric Psychiatry, 23, 851-856. https://doi.org/10.1002/gps.1994
17. Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363-389. https://doi.org/10.1146/annurev.clinpsy.032408.153621
18. Friedman, N. P., & Miyake, A. (2004). The relations between inhibition and interference control functions: A latent-variable analysis. Journal of Experimental Psychology: General, 133(1), 101-135. doi: 10.1037/0096-3445.133.1.101
19. Friedman, N. P., & Miyake, A. (2017). Unity and diversity of executive functions: Individual differences as a window on cognitive structure. Cortex, 86, 186-204. https://doi.org/10.1016/j.cortex.2016.04.023
20. Gathercole, S. E. (1994). Neuropsychology and working memory: A review. Neuropsychology, 8(4), 494-505. Gazzaley, A., Cooney, J. W., Rissman, J., & D’Esposito, R. (2005). Top-down suppression deficit underlies working memory impairment in normal aging. Nature Neuroscience, 8, 1298-1300. doi:10.1038/nn1543
21. Golden, C. J. (1978). Stroop Color and Word Test. A Manual for Clinical and Experimental Uses. Illinois: Stoelting Company.
22. Güngen, C., Ertan, T., Eker, E., Yaşar, R., & Engin, F. (2002). Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turkish Journal of Psychiatry (Turkish), 13(4), 273-281.
23. Hasher, L., Quig, M. B., & May, C. P. (1997). Inhibitory control over no-longer-relevant information: Adult age differences. Memory & Cognition, 25(3), 286-295. https://doi.org/10.3758/BF03211284
24. Hayes, A.F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: The Guilford Press.
25. Hayes, S., Hirsch, C., & Matthews, A. (2008). Restriction of working memory capacity during worry. Journal of Abnormal Psychology, 117(3), 712-717. http://dx.doi.org/10.1037/a0012908
26. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
27. Hu, L., Bentler, P. M., & Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychological Bulletin, 112(2), 351-362.
28. Hubbard, N. A., Hutchison, J. L., Hambrick, D. Z., & Rypma, B. (2016). The enduring effects of depressive thoughts on working memory. Journal of Affective Disorders, 190, 208-213. https://doi.org/10.1080/02699931.2014.991694
29. Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: relation to cognitive inhibition. Cognition and Emotion, 24(2), 281-298. https://doi.org/10.1080/02699930903407948
30. Joormann, J., Siemer, M., & Gotlib, I. H. (2007). Mood regulation in depression: Differential effects of distraction and recall of happy memories on sad mood. Journal of Abnormal Psychology, 116, 484–490. doi:10.1037/0021-843X.116.3.484
31. Kalayam, B., & Alexopoulos, G. S. (1999). Prefrontal dysfunction and treatment response in geriatric depression. Archives of General Psychiatry, 56(8), 713-718. doi:10.1001/archpsyc.56.8.713
32. Karakaya, M. G., Bilgin, S. Ç., Ekici, G., Köse, N., & Otman, A. S. (2009). Functional mobility, depressive symptoms, level of independence, and quality of life of the elderly living at home and in the nursing home. Journal of the American Medical Directors Association, 10(9), 662-666. doi.org/10.1016/j.jamda.2009.06.002
33. Kerem, M., Meriç, A., Kırdı, N., & Cavlak, U. (2001). Evaluation of elderly living at home and rest house. Turkish Journal of Geriatrics, 4(3), 106-112.
34. Kline, R. B. (1998). Principles and practices of structural equation modeling. New York: Guilford.
35. Koster, E. H., De Lissnyder, E., Derakshan, N., & De Raedt, R. (2011). Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesis. Clinical Psychology Review, 31(1), 138-145. https://doi.org/10.1016/j.cpr.2010.08.005
36. Lockwood, K. A., Alexopoulos, G. S., & van Gorp, W. G. (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry, 159(7), 1119-1126. https://doi.org/10.1176/appi.ajp.159.7.1119
37. Luppa, M., Sikorski, C., Luck, T., Ehreke, L., Konnopka, A., Wiese, B., ... Riedel-Heller, S. G. (2012). Age- and gender-specific prevalence of depression in latest-life – Systematic review and meta-analysis. Journal of Affective Disorders, 136(3), 212-221. https://doi.org/10.1016/j.jad.2010.11.033
38. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28(6), 487-495. https://doi.org/10.1016/0005-7967(90)90135-6
39. Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49-100. https://doi.org/10.1006/cogp.1999.0734
40. Moran, T. P. (2016). Anxiety and working memory capacity: A meta-analysis and narrative review. Psychological Bulletin, 142(8), 831. http://dx.doi.org/10.1037/bul0000051
41. Nebes, R. D., Butters, M. A., Mulsant, B. H., Pollock, B. G., Zmuda, M. D., Houck, P. R., & Reynolds, C. F. (2000). Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychological Medicine, 30(3), 679-691.
42. Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorder and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504-511. doi: 101037/10021-843X.109.3.504
43. Pe, M. L., Raes, F., & Kuppens, P. (2013). The cognitive building blocks of emotion regulation: ability to update working memory moderates the efficacy of rumination and reappraisal on emotion. PLOS one, 8(7), e69071. https://doi.org/10.1371/journal.pone.0069071
44. Philippot, P., & Agrigoroaei, S. (2017). Repetitive thinking, executive functioning, and depressive mood in the elderly. Aging & Mental Health, 21(11), 1192-1196. https://doi.org/10.1080/13607863.2016.1211619
45. Samtani, S., & Moulds, M. N. (2017). Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures. Clinical Psychology Review, 53, 14-28. https://doi.org/10.1016/j.cpr.2017.01.007
46. Sari, B. A., Koster, E. H. W., & Derekshan, N. (2017). The effects of active worrying on working memory capacity. Cognition and Emotion, 31(5), 995-1003. https://doi.org/10.1080/02699931.2016.1170668
47. Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. E. (2000). Worry and rumination: Repetitive thought as a concomitant predictor of negative mood. Cognitive Therapy and Research, 24(6), 671-688. https://doi.org/10.1023/A:1005587311498
48. Sezgin, N., Baştuğ, G., Yargıcı-Karaağaç, S., & Yılmaz, B. (2014). Turkish Standardization of Wechsler Adult Intelligence Scale-Revised (WAIS-R): Pilot Study. Ankara Üniversites, Dil ve Tarih-Coğrafya Fakültesi Dergisi (Turkish), 54(1), 451-480.
49. Stout, D. M., Shackman, A. J., Johnson, J. S., & Larson, C. L. (2015). Worry is associated with impaired gating of threat from working memory. Emotion, 15(1), 6-11. doi: 10.1037/emo0000015
50. Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643-662.
51. Snyder, H. R. (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychological Bulletin, 139(1), 81. doi: 10.1037/a0028727
52. Şahin, E. M., & Yalçın, B. M. (2003). Comparing the incidence of depression at the elderly living in nursing home or at their own homes. Turkish Journal of Geriatrics, 6(1), 10-13.
53. von Hippel, W., Vasey, M. W., Gonda, T., & Stern, T. (2008). Executive function deficits, rumination, and late-onset depressive symptoms in older adults. Cognitive Therapy and Research, 32(4), 474-487. https://doi.org/10.1007/s10608-006-9034-9
54. Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford Press. Wechsler, D. (1981). Wechsler Adult Intelligence Scale-Revised Manual. New York: Psychological Corporation.
55. West, R. & Alain, C. (2000). Age-related decline in inhibitory control contributes to the increased Stroop effect observed in older adults. Psychophysiology, 37(2), 179-189. https://doi.org/10.1111/1469-8986.3720179
56. Wuthrich, V. M., Johnco, C., & Knight, A. (2014). Comparison of the Penn State Worry Scale (PSWS) and abbreviated version (PSWS-A) in a clinical and non-clinical populations of older adults. Journal of Anxiety Disorders, 28, 657-663. https://doi.org/10.1016/j.janxdis.2014.07.005
57. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a Geriatric Depression Scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. https://doi.org/10.1016/0022-3956(82)90033-4
58. Yılmaz, A. E., Gençöz, T., & Wells, A. (2008). Psychometric characteristics of the Penn State Worry Questionnaire and Metacognitions Questionnaire-30 and metacognitive predictors of worry and obsessive–compulsive symptoms in a Turkish sample. Clinical Psychology and Psychotherapy, 15(6), 424-439. https://doi.org/10.1002/cpp.589