A Clinical Study On The Changes Of Negative Cognitive Bias In Patients With Depression During Acute Treatment

Background:People with depression often have negative cognitive biases.Beck’s cognitive theory points out that negative cognitive bias is a key factor related to the onset and maintenance of depressive symptoms.Current studies have mixed conclusions about whether negative cognitive biases can be alleviated with a reduction in depressive symptoms.Exploring the changes of negative cognitive bias during acute treatment,and exploring the relationship between negative cognitive bias and depressive symptoms,will help to find targeted interventions to help patients reduce negative cognitive bias,and may also reduce the recurrence of depressive symptoms.Combined with previous research results,this study hypothesizes that some of the negative cognitive biases in patients with depression can be alleviated during acute treatment.A high level of negative cognitive bias before treatment indicates that the efficacy of antidepressant treatment is worse,and the direct relatives of patients with depression may also have a certain degree of negative cognitive bias.This study intends to explore whether the symptoms of depression are related to the recovery of negative cognitive biases,and to evaluate the level of negative cognitive biases in the patients’ direct relatives,so as to provide ideas for systematic treatment of depression.Method:This study included patients from July 2020 to March 2022 in the psychiatric outpatient department and inpatient department of the Second Xiangya Hospital of Central South University,who had never taken antidepressants or had taken antidepressants in the past but have been discontinued at least 1 month.Direct relatives of patients without depressive symptoms were also included.The study design used the case itself as a before-and-after control.Assessment tools: Psychological assessment tools include 17-item Hamilton Depression Rating Scale(HAMD-17),Hamilton Anxiety Rating Scale(HAMA),Self-Rating Depression Scale(SDS),32-item Hypomania Checklist(HCL-32),Cognitive Bias Questionnaire(CBQ).Study time points: Before medication,2 weeks,4 weeks,8 weeks after medication.Statistical methods: The normality test of each variable was performed using the method of kurtosis and skewness coefficient.Paired-samples t-test or paired-samples Wilcoxon Signed Rank Test was used to compare patients’ levels of depression,anxiety,and negative cognitive bias from baseline at different follow-up time points.Pearson or Spearman correlation tests were used to analyze the correlation between baseline negative cognitive bias levels and the efficacy of depressive symptoms.Repeated-measures ANOVA was used to analyze the trend of depressive symptoms and cognitive bias levels in patients followed up at multiple time points.Differences in negative cognitive bias scores between patients and direct relatives of patients were compared using independent samples t-test and Mann-Whitney U test.Results:1.Sample size follow-up: Seventy-five patients with depression were included in this study,of which 46 patients completed the two-week follow-up(61.3%),43 patients completed the four-week follow-up(57.3%),and 33 patients completed the eight-week follow-up(44.0%).Among them,14 patients completed the baseline,2nd and 8th week assessments(18.7%),and 22 patients completed the baseline,4th and 8th week assessments(29.3%).Baseline,Week 2,Week 4,and Week 8assessments were completed in 10 patients(13.3%).And included 23 immediate family members(patients’ parents or children)of the enrolled patients.2.Comparison of psychological evaluation indicators before and after the case itself: The levels of depressive symptoms and anxiety symptoms of the patients after two weeks,four weeks and eight weeks of treatment were significantly reduced compared with the baseline(all P<0.001).However,there was no significant change in the level of cognitive bias after two weeks and four weeks of treatment compared with the baseline(P>0.05).After the eighth week of treatment,the depressed-distorted(DD)score in CBQ was significantly decreased(P<0.01),and the nondepressed-nondistorted(ND-ND)score was significantly increased(P<0.01),while the scores of depressed-nondistorted(D-ND)and nondepressed-distorted(ND-D)were not significantly different from those before treatment(P>0.05).3.The relationship between cognitive bias and depression: We performed repeated-measures ANOVA in 22 patients who completed baseline,four-week,and eight-week follow-up,and it was found that patients’ HAMD scores decreased significantly over time at baseline,week4,and week 8(P=0.002).This is consistent with our results of comparing patients’ HAMD scores with baseline scores at week 4 and week 8,respectively.However,there was no significant difference in the decline in HAMD between the cognitively distorted and non-cognitively distorted groups.(P=0.155).Depressed-distorted(D-D)scores decreased significantly over time(P=0.030),and nondepressed-nondistorted(NDND)scores increased significantly over time in 22 patients at baseline,week 4,and week 8(P=0.025),which is consistent with our results of comparing the CBQ scores of patients with their pre-treatment scores in the 4th and 8th weeks respectively.There was no significant change in the two indexes of depressed-nondistorted(D-ND)and nondepresseddistorted(ND-D)over time(all P>0.05).However,there was no significant difference in the changes of the four indexes of CBQ between the two groups of moderate depression and severe depression(all P>0.05).4.The relationship between baseline cognitive bias status and antidepressant efficacy: We analyzed the correlation between baseline cognitive bias scores and antidepressant efficacy and found that in patients with two-week,four-week,and eight-week follow-up,there was still no significant correlation between the post-treatment HAMD score reduction rate and its corresponding baseline cognitive bias level.(P>0.05).5.Differences in the level of negative cognitive bias between patients and direct relatives of patients: Depressed-distorted(D-D)and depressednondistorted(D-ND)scores in direct relatives were lower than those in patients before and after treatment at week 8(P <0.001),the nondepresseddistorted(ND-D)and nondepressed-nondistorted(ND-ND)scores of direct relatives were higher than those of patients(P<0.05).On the cognitive distortion dimension of the CBQ scale,before the patient’s treatment,the cognitive distortion score of the direct relatives was lower than that of the patient(P=0.020),and the cognitive non-distortion score of the direct relatives was higher than that of the patient(P=0.019).After the8 th week of treatment,the cognitive distortion scores and cognitive nondistortion scores of direct relatives were not significantly different from those of the patients(P>0.05).The cognitive bias level of the patient’s direct relatives was significantly different from the patient’s negative cognitive bias score at both baseline and eight weeks.The scores of "depressed-distorted" and "depressed-nondistorted" of direct relatives were lower than those of patients,and the scores of "nondepresseddistorted" and "nondepressed-nondistorted" of direct relatives were higher than those of patients.Conclusions:Some of the patients’ negative cognitive biases can be alleviated during the acute treatment period,but the reduction of negative cognitive biases significantly lags behind the reduction of emotional symptoms.The level of negative cognitive bias before treatment is not sufficient as a predictor of depression prognosis in patients.The level of negative cognitive bias in the patient’s direct relatives was not significantly different from that of the patient.