Depressed and Alone
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Depressed and Alone: The Relationship between Depression and Social Cognitive Functioning
Depressed and Alone: The Relationship between Depression and Social Cognitive Functioning
In the United States, about 6.7 percent of the population – about 16 million individuals – suffers from major depression annually (Knight, Air, & Baune, 2018). Major Depressive Disorder (MDD) is generally characterized by withdrawal and sadness, for no objective reason. (Shouse, Rowe, & Mast, 2013). Unlike sadness that may temporarily affect someone considering a circumstance, MDD significantly impacts an individual’s quality of life and ability to function over prolonged periods. Symptoms must persist for twelve months for the individual to be diagnosed with Major Depressive Disorder, (Air, Weightman, & Baune, 2015). In addition to general prolonged sadness, MDD leads to persistent symptoms of overwhelming grief, reduced energy, irritability on minor issues, poor anger management, poor \appetite, thoughts of suicide, and low interests in activities that were previously pleasurable for the suffers, such as sex. Additionally, research indicates that individuals with MDD experience various and significant cognitive and social impairments such as poor memory and thinking skills, risk of dementia or Alzheimer, and poor or no association with other people (Zhu, Zhu, Jiang, & Shi, 2018; Vidyanidhi, & Sudhir, 2009).
There are various risk factors for depression, like preexisting personality or anxiety disorders, abuse, chronic health conditions, and family history, but Air, Weightman, and Baune (2015) argue that it is more difficult to parse apart the cause and effect relationships between depression and the associated cognitive and social impairments. Therefore, understanding the effects of depression on these impairments, as well as the effects of preexisting impairments on depression risk is crucial for developing effective interventions. This paper is a current review of empirical research investigating the relationship between these common impairments and depression.
Specifically, this paper will first summarize studies investigating depression and social impairments, like loneliness and isolation. Second, the paper will focus on studies examining the relationship between depression and cognitive impairments, like the ability to perform daily tasks. Last, yet importantly the paper will draw conclusions based on the critical review of research and provide recommendations for future research and practice.
Depression and Social Impairment
Social impairment is a common characteristic among suffers of MDD. It can include dissociating and failing to involve oneself from relationships with other people (Zhu, Zhu, Jiang, & Shi, 2018). Social impairment manifests with a series of mental issues such as loneliness or traumatic experiences (van Winkel, Wichers, Collip, Jacobs, Derom, Thiery, & Peeters, 2017). For instance, a person may act negatively by refusing consent to proposals and replying negatively to requests or perform dismally in the presence of other people. Research has identified several social impairments associated with MDD, as well as various relationships between these impairments, the disorder, and other risk factors.
In one such study, Zhu, Zhu, Jiang, and Shi (2018) looked at how treating social impairments could alleviate depression. Researchers recruited 70 inpatient adult participants with MDD. The researchers assigned the participants to either a Social Cognition and Interaction training group or a treatment as usual group, and all participants received anti-depression medications. Participants in the social cognition training group completed three different sessions that focused on emotion perceptions, difficulty and attribution bias, and integration of the acquired skills in coping with daily emotional issues. The researchers assessed the severity of participants’ depression using the Hamilton depression scale with the help of experienced clinicians. The results did not indicate a significant difference in depression across the Social Cognition and Interaction Training and treatment as usual groups, but depression was reduced by more than 50% for both. These results indicated that there is a close association between depression and poor social functioning, social impairments and social risk factors (Zhu, Zhu, Jiang, & Shi, 2018).
The most significant social impairment associated with depression may be the resulting loneliness. Loneliness can be characterized as being isolated and friendless, which is accompanied by a feeling of depression. In a longitudinal study on loneliness by van Winkle and colleagues (2017), researchers aimed to examine how negative appraisals of the social company contribute to loneliness and depression. Researchers recruited 417 female participants with MDD aged between 34 and 69 and examined their social appraisal. The social appraisal helps to understand the importance of socialness and suggests that people tend to influence one another in the manner they feel about the same events. The researcher also examined their loneliness, which is the state of being friendless, and the state of feeling rejected for a prolonged period. The researchers established the correlation between the factors and on how they related to the development of major depressive disorders. To do this, a follow-up went on for a period of 20 months. The researchers used an interview in the first shift, questionnaires in the second shift, and repeated the procedure three times. The study recorded fewer social appraisals among the sufferers of depression. This meant that the sufferers of depression felt differently about the same events compared to healthy individuals, which followed a higher tendency of one being alone. This consequently followed a state of loneliness for the participant, and increased loneliness significantly predicted fewer positive appraisals of social company. From the results, researchers suggested that avoidance of social contact following negative social company appraisal would possibly contribute to the onset of MDD (van Winkle et al., 2017).
In a different study on the symptoms of Major Depressive Disorder and whether cognitive dysfunction prevailed among sufferers of MDD, Air, Weightman, and Baune (2015) asked 108 participants suffering from MDD to get into their respective groupings, which included remitted group (66), current group (42), as well as 52 participants under healthy control. The researchers assessed all of them using the Wechsler advanced clinical solutions such as body language interpretations, social perception subtest, and facial affect recognition. The tests showed no significant variance between healthy groups and remitted cases concerning subscales of social cognition (Air, Weightman, & Baune, 2015). Sufferers of MDD showing more severe anxious and depressive symptoms find it hard to accomplish social cognitive tasks that are complex. This makes the sufferer unable to effectively run the day to day functions and thus the deficit implicates on targeted therapeutic interventions.
Contributions of Cognitive Impairment
Various studies have researched the effects of cognitive functioning on the symptoms of depression. Cognitive functioning includes processes in the mind that enable an individual to be conscious, perceive and comprehend ideas, and perform daily tasks as a function of multiple factors (Shouse, Rowe, & Mast, 2013). Past research has indicated that depression uniquely influences the magnitude of functional impairment. Reduced ability to execute daily tasks and possible loss of independence are significant concerns among the adult population. Only a few studies have attempted to examine how depression affects the daily functioning of adults (Shouse, Rowe, & Mast, 2013).
One study by Knight, Air, and Baune (2018) researched the contribution of cognitive impairment to relationship problems experienced among those with MDD. Specifically, researchers were interested in domains relevant to productivity in daily tasks. Participants included 182 male and female individuals. The researchers assessed participants’ cognitive functioning using a battery of repeated tests as well as multiple standard measures of cognition (e.g., Tower of London task) and subsequently compared the depressed and non-depressed groups across the measures. The results suggested that the most significant predictor of major depression was a failure to perform daily tasks efficiently. Among the healthy participants, various cognitive domains predicted psychosocial functioning, looking at social, environmental, and psychological factors. The researchers stated that executive cognition is significant in helping suffers from major depression recover and should be among the primary target in such treatment.
Other studies have looked at the effect of cognitive impairment on social functioning. In one such study, Shouse, Rowe, and Mast (2013) analyzed how cognitive function, the ability of an individual to perform daily activities, and perceived quality of life correlates. The participants were 78 elderly individuals aged 85 with Major depression disorder and 70 elderly individuals aged between 80 and 85. To assess Cognitive functioning among the participants suffering from depression, and the effect of cognitive impairment on social functioning, researchers asked participants to complete a cross-sectional descriptive survey using questionnaires and interviews method, which was done using inclusive criteria. The researchers used a 15-item Geriatric Depression Scale (GDS-15) and Mini-Mental State Examination (MMSE) to collect data. The researchers then used T-test, mean, Pearson correlation coefficient, and standard deviation to analyze the data. The results were a high rate of depression among 68.1% of elders. Among the depressed elders, 87.1% of them registered declined cognitive functioning as opposed to only 21.3% of those that showed declined cognitive functioning among the non-depressed participants. The relationship between cognitive functioning and depression was statistically significant. The results led to the conclusion that most sufferers of depression experience deficits in executive functioning. They experience difficulties in solving problems, making decisions, and making timely and correct judgments. The findings further indicated that cognitive impairment affects daily life and lowers the perceived quality of life. The results of this study showed that individuals suffering from major depressive disorders are less attentive, more forgetful, and experience apathy, and difficulty in finding words in their speech. They also tend to suffer from mental slowness. The findings of this study too indicated that cognitive impairment affects daily life and lowers the perceived quality of life.
Another study by Vidyanidhi and Sudhir (2009) on dysfunctional cognition and interpersonal sensitivity among the sufferers of depression used 30 participants aged 22-34 years who suffered from depression. The researchers compared the depressed participants with 30 healthy participants of the same age concerning dependency and interpersonal sensitivity. Thus, the researchers required the participants to respond to a general health questionnaire on interpersonal sensitivity and interpersonal dependency. The results of the study recorded significant differences in interpersonal sensitivity. This suggests that dysfunctional attitudes, interpersonal sensitivity, and dependency positively correlate among depressed individuals.
Conclusions
This paper looked at studies investigating depression and social impairments, like loneliness and isolation, and focused on the relationship between depression and cognitive impairments, like the ability to perform daily activities. Most individuals suffering from MDD have deficits in executive functioning; they may find it hard to solve problems, make decisions, and respond with timely and correct judgments (Shouse, Rowe, & Mast, 2013). Poor memory and low attention to daily tasks also characterize the sufferers of MDD (Shouse, Rowe, & Mast, 2013). Such individuals tend to be less attentive and quickly forget events. They experience apathy, difficulty in finding words in their conversations, and may also tend to suffer from mental slowness (Shouse, Rowe, & Mast, 2013). Previous research on loneliness and depression coupled with the current studies have led to the conclusions that improving executive functioning is crucial for treating MDD (Zhu, Zhu, Jiang, & Shi, 2018; Vidyanidhi & Sudhir, 2009). Avoidance of social contact following negative social company appraisal contributes to the onset of major depressive disorder (Shouse, Rowe, & Mast, 2013). Less positive appraisal of the social company follows a higher tendency of one being alone, which is consequently followed by a state of loneliness (van Winkle et al., 2017).
There has been increasing knowledge concerning loneliness in the recent past, but there are still several gaps regarding loneliness that should be addressed in future research. First, there is a need for epidemiological studies to investigate the distribution of loneliness among the Americans at a larger scale representative sample. There is also a need for research in the high-risk groups, like individuals who recently divorced, lost their spouses or children, are physically challenged, unemployed, or terminally ill. Such studies are important for caregivers to understand the aggressiveness of loneliness and offer better interventions.
Depression and Social Cognitive Functioning also relate to the sense that cognitive impairment plays an important role in psychosocial functioning for depressed individuals. A study by Knight, Air, and Baune, (2018) indicated that cognitive dysfunction is widespread and invalidating symptom of major depressive disorder and is frequently manifested in the remitted stage of the condition. The evidence-based study associated cognitive impairment and the dysfunction in various psychosocial domains such as effectiveness at one’s job and on how the individual socially relates with others. According to the study, executive cognition impacts on the transfer of functions from the affected areas of the brain to the unaffected areas; referred to as functional recovery. This could be a crucial target for any treatment of MDD. In another study, Air, Weightman, and Baune, (2015) compared individuals experiencing depression with healthy individuals regarding social cognitive functioning, and assessed the effect of symptom severity. The study concluded that when an individual is depressed, symptom severity is proportional to the difficulty in handling compounded social cues, visual cues, and auditory cues. Also, Vidyanidhi and Sudhir, (2009) in their study on dysfunctional cognition and interpersonal sensitivity in depression and social anxiety researched on sufferers of depression and social order. Despite their limited literature in this area, their findings have increased the knowledge of interpersonal sensitivity in social phobia among depressed individuals. Their study indicated the need for further study on depressed patients experiencing social anxiety.