Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies

Abstract

Background: The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted selfmonitoring and dysfunctional self-evaluation with depressive symptoms. Methods: Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n=140; 67.9% female; Mage=40.0) and without (n=80; 65.0% female; Mage=36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passiveaggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional selfevaluation and self-reported depressive symptoms in 200 undergraduate Psychology students. Results: Compared to outpatients without depressive disorders, outpatients with depressive disorder reported signifcantly more self-directed passive aggression (d=0.51). Furthermore, Study 2 verifed self-directed passiveaggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs=.22, 95%-CI: .14, .31), attributional style (abcs=.20, 95%-CI: .13, .27), ruminative response style (abcs=.15, 95%-CI: .09, .21) and depressive symptoms. Conclusion: Self-directed passive-aggressive behaviour partially mediates the association between distorted selfmonitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression. Trial registration: Both studies were preregistered at the German Clinical Trials Register (DRKS00014005 and DRKS00019020).