Optimism, resilience and depression

Relation

Kleiman EM, Chiara AM, Liu RT, Jäger-Hyman SG, Choi JY, Alloy LB. Optimism and well-being: A prospective multi-method and multi-dimensional investigation of optimism as a resilience factor after the occurrence of stressful life events.Cogn Emot. 2017;31(2):269-283.

Draft

Prospective multi-method and multi-dimensional study using principal component analysis (PCA) with subsequent evaluation using the instrument of confirmatory factor analysis (CFA).

Participant

The study volunteers (N = 464) were undergraduate college students enrolled in introductory psychology courses. 76 percent were female, with an average age of 19.5 years. The composition of the sample was as follows: 43% Caucasian, 34% African American, 12% Asian, 3% Hispanic, and 7% other. A subset (n=96) of the original sample was invited for the prospective phase of the study. In this phase, participants were 82% female and comprised of the following: 39% Caucasian, 36% African American, 10% Asian, 4% Hispanic, and 10% other.

Study parameters assessed

The following study parameters were used:

1. Beck Hopelessness Scale (BHS) – 20-Punkte-Selbstberichtetes Maß für Hoffnungslosigkeit, ein Hauptsymptom depressiver Emotionen; Die Gesamtpunktzahl reicht von 0 bis 20, wobei die niedrigeren Punktzahlen weniger Pessimismus zeigen.
2. Revised Life Orientation Test (LOT-R) – 10-Punkte-Fragebogen zur Identifizierung von Unterschieden im allgemeinen Optimismus vs. Pessimismus eines Teilnehmers.
3. Cognitive Style Questionnaire (CSQ) – schlägt hypothetische Szenarien vor, um das Selbstgefühl des Teilnehmers nach einem positiven oder negativen Lebensereignis zu bewerten.
4. Ereignisfragebogen (EQ) – stellt hypothetische Ereignisse dar, die jeder Teilnehmer als wahrscheinlich im wirklichen Leben einschätzen kann. Höhere Werte für positive Ereignisse und niedrigere Werte für negative Ereignisse werden verwendet, um Vorurteile widerzuspiegeln, die jede Person anwendet, um ihr eigenes Leben zu betrachten.

Primary outcome measures

Primary outcome measures include the Beck Depression Inventory (BDI), a 21-item self-report measure of depression symptoms in the past 2 weeks, and the Beck Anxiety Inventory (BAI), a 21-item self-report measure of anxiety symptoms. In addition, the Expanded Schedule for Affective Disorders and Schizophrenia-Change Interview (exp-SADS-C) was used to assess psychopathological situation for appropriate DSM-IV diagnoses.

Key insights

The study found that optimism is a multifaceted construct and identified 4 dimensions of optimism: positive expectations (PEs), inferential style (IS), sense of invulnerability (SI), and overconfidence (O). Different dimensions of optimism have been found to have different effects on well-being. PE reduced the impact of stressful events on depressive symptoms and was associated with fewer depressive episodes. SI moderated the effects of stress on anxiety symptoms.

Practice implications

Optimism is generally anathema to depression. A person who is generally optimistic is unlikely to be depressed.

Against this background, it is important to consider the aspects of optimism that this study tries to explain for us. Overall, this study shows us that optimism doesn't just mean "thinking positively" but, as the authors describe it, optimism is truly "a multifaceted construct" and each facet can have different effects on mood.

In their introduction, the authors provide reasons why they believe this study is useful. They explain that a limitation of previous research on optimism is that most studies have a single measure of optimism, even though it is a multidimensional concept. The authors also criticize previous work for relying too heavily on self-reports, as self-reports are subject to each volunteer's own subjective or idiosyncratic sensitivities. Study interviews are used in this study. These are scales that attempt to balance this effect among participants and avoid participant bias. Finally, the authors criticize previous work that has focused primarily on the relationship of optimism only to depression and not to other conditions (e.g., anxiety).

Overall, this study shows us that optimism doesn't just mean "thinking positively" but, as the authors describe it, optimism is truly "a multifaceted construct" and each facet can have different effects on mood.

Understandably, the relationship between optimism and mental and physical health outcomes found in this study appears to be complex, with notable differences between what the authors call four “optimism dimensions”:

Positive Expectations (PEs)

PEs explain the view that one's future will be positive and that one's overall situation or character is in a better position than that of another person in the same situation. In this study, the authors showed that, as expected, individuals with PEs had a lower risk of developing major depression and lower levels of depressive symptoms, even after controlling for initial depressive episodes or symptoms. PE was the dimension most consistently associated with lower depression symptoms and lower risk of major depressive disorder, confirming previous research findings in both adults and children. This study also found that PEs can buffer the negative effects of high life stress on depressive symptoms.

Inference style (IS)

A person with an optimistic IS is inclined to see positive events as a standard situation and negative events as temporary anomalies. In other words, he expects good things to happen normally. In contrast, pessimistic people see negative events as the default. In this study, the authors were surprised that the IS dimension did not predict depression (which they suggested may be due to the underpowered design of this particular study).

Feeling of invulnerability (SI)

A person with SI expects negative outcomes to occur more often in others than in themselves. In this study, the presence of SI was associated with a reduced risk of anxiety symptoms, even in the face of high life stress. Interestingly and surprisingly to the authors, this dimension also appeared to confer greater risk of complaints about physical health symptoms (not less risk).

overestimation of oneself (O)

Overconfidence is the tendency to believe one's own abilities and characteristics are better than they really are, and often better than those of other people. Overconfidence showed a correlation with anxiety and depression, but these did not predict changes in physical illness.

So does optimism really prevent and alleviate both mental and physical illness? And how can we, as health practitioners, best harness a patient’s optimism to support his or her health goals?

In short, when it comes to depression, a person who views themselves as naturally protected (not vulnerable) and the world as generally a good place tends to be happier, have less depression, and is more able to weather periods of high stress effectively. It stands to reason that these are attributes that can use improvement for depression-prone patients. This study demonstrated an association between these constructs of optimism with reduced risk of major depression and lower levels of depressive symptoms.

It is also important to note that those who believe themselves to be more invincible are more likely to endure physical discomfort, perhaps because they genuinely do not believe that anything bad will happen to them. That makes sense; If you're the kind of person who doesn't believe this can happen to you, you tend not to be preventative (you don't control your blood pressure, you keep smoking). These patients may need more education about how vulnerable everyone is to disease and how good health care can prevent adverse outcomes. Of course, we must be careful about which patients we expose to this rhetoric, as such emphasis on possible adverse outcomes can increase the anxiety of an already anxious patient. While optimism has clear benefits, appropriate “pessimism” can also be protective by motivating patients to seek health-promoting behaviors and care.

Also of interest is that the authors suggest that positivity breeds positivity. In this mindset, optimism not only buffers the effects of life stress on health, but could also increase the likelihood of future positive events while decreasing the occurrence of negative events, similar to a self-fulfilling prophecy.

In the author's words, this fascinating study finds "partial support for prospective relationships between different conceptualizations and mental and physical health outcomes." While this isn't a groundbreaking statement, it confirms what we already seemed to know.

restrictions

The final number of participants included in the prospective phase was 96, while the original sample size was 464. Due to the small sample size, the authors described these prospective results as “exploratory” and in need of replication, which is a fair statement.

Perhaps most disappointing is that this small prospective sample did not allow for better examination of the relationship between optimism dimensions and clinically significant anxiety. The authors noted that previous studies focused only on depression; Unfortunately, this study discussed factors that influenced depression. Given that 18% of the population struggles with some form of anxiety, it would have been helpful to further clarify the relationship between optimism and anxiety. Additionally, the majority of participants were female, which may suggest that the results may not apply as easily to men.