Study On The Relationship Between Cognitive Characteristic And Depressive Symptoms Among College Students In A Medical University

Objective: To know the prevalence of depressive symptom in college students, and todetermine the relationship between depressive symptoms and cognitive featuresincluding attributions, coping style and dysfunctional attitudes by cross-sectionalsurvey, as well as to know the changes and stability of the of cognitivecharacteristics including attributions style, coping style and dysfunctional attitude,and to examine the influence of these cognitive characteristic on the occurrence ofdepressive symptoms by corhort study.Methods：A total of1498students participated the cross-sectional survey, who weremajoring in clinical medicine in a medical university in Anhui Province. Depressivesymptoms were evaluated with Center for Epidemiological Survey Depression Scale(CES-D) and the scores of20and higher was defined as having depressive symptoms.Dysfunctional Attitudes Scales (DAS), Attributional Style Questionnaire and CopingStyle Questionnaire were used to evaluate the perceived abnormal degrees, attributionstyle and coping style respectively. In order to know the prevalence of depressivesymptom in college students and to investigate the relationship between depressivesymptoms and cognitive features including attributions, coping style anddysfunctional attitudes, and documented for study on cognitive susceptibility relatedto depression, we used those questionnaires to do the cross-sectional study.In the cohort study, totally298freshman without depressive symptoms participatedthe survey, who were majoring in clinical medicine in a medical university in Anhui Province. Depressive symptoms were evaluated with Center for EpidemiologicalSurvey Depression Scale (CES-D), and the scores of25and higher was defined ashaving depressive symptoms. Dysfunctional Attitudes Scales (DAS), AttributionalStyle Questionnaire and Coping Style Questionnaire were used to evaluate theperceived abnormal degrees, attribution style and coping style respectively. We usedcohort study to know the characteristics of cognitive characteristic changes includingattributions style, coping style and dysfunctional attitude, and to explore therelationship between cognitive characteristic and the occurrence of depressivesymptoms.Results: In this survey,1498students from the1stgrade to the4thgrade of medicalcollege school participated and1467of they valid answered questionnaires wereobtained, with male55.3%and female44.7%. The proportion of students from ruralarea (including countryside and town) is70.5%, and from cities is29.5%. All studentsincluding freshman, sophomore, juniors, senior were24.2%,30.7%,25.8%,19.3%respectively. The prevalence of depression in all students was28.2%,31.2%and24.5%in male and female accordingly (χ~2=7.925，P<0.01). The prevalence ofdepression in students from rural area was higher than students fromcities(χ~2=10.269，P<0.01). The prevalence of depression was different between gradesstudents significantly (χ~2=10.306， P<0.05). There was a significant positivecorrelation between scores of passive external attribution of attribution style and thescores of depressive symptoms among all students as well as students of differentgender, and different grades（γ=0.202~0.275，P<0.01）. The scores of depressivesymptoms of students in different gender as well as scores of students with the1stgrade、2st grade and the3rdgrade had a negative correlation with the positiveexternal attribution （γ=-0.088~-0.179， P<0.05）.The total score of depressivesymptoms in all students，male and sophomore students showed a negative correlationwith passive internal attribution (γ=-0.088~-0.129， P<0.05). The scores ofdepressive symptoms had a significant negative positive correlation with resolving question and turning to someone’s help of coping style （γ=-0.417~-0.230，P<0.01），and had a significant positive correlation with self-blame, illusion, wince andrationalization of coping style（γ=0.216~0.466，P<0.01）. Scores of depressivesymptoms of students in different gender, different grades,and dysfunctional attitudesshowed a positive correlation(γ=0.460~0.526，P<0.01).In this survey,254and278students participated in the first and second follow-upsurvey, with follow-up rate was85.2%and93.3%.76.7%of the students who wereassessed as normal in the dysfunctional attitudes baseline survey maintained a normalstate in the six months follow-up survey, and23.3%into the abnormal.68.2%of thestudents who were assessed as abnormal in the dysfunctional attitudes baseline surveymaintained abnormal state in the six months follow-up survey, and31.8%into thenormal (P<0.01).87.6%of the students who were assessed as normal in thedysfunctional attitudes baseline survey maintained a normal state in the one yearfollow-up survey, and12.4%into the abnormal.65.4%who were assessed asabnormal turned to normal, and34.6%maintained the abnormal state in the one yearfollow-up survey. The charges of attribution style and coping style were notsignificant different during the half year and one year follow-up survey (P>0.05). Asthe results of six months follow-up survey showed, The incidence of depressionsymptoms was5.6%of those students with three positive cognitive characteristics,and15.8%of students with negative cognitive characteristics. The incidence was lower inpositive cognitive group than negative group (χ~2=6.383，P<0.05).The incidence ofdepression symptoms was13.2%of those students with three positive cognitivecharacteristics, and29.3%of students with negative cognitive characteristics duringthe one year follow-up survey. The incidence was significant lower in positive groupthan negative group (χ~2=10.192，P <0.01). As the results of six months follow-upsurvey showed, the students who adopted optimistic and pessimistic attribution styleoccurred depression symptoms was7.9%and15.8%respectively (χ~2=3.909，P<0.05).and the results of one year follow-up survey showed that of the students who adoptedpositive8.9%occurred depression symptoms and21.6%in those with negative coping style (χ~2=6.502，P <0.05). The incidences of depression were9.5%amongstudents with normal dysfunctional attitude, and20.5%among students withabnormal dysfunctional attitude was (χ~2=4.298，P<0.05); As the results of one yearfollow-up survey showed, the students who adopted positive and negative copingstyle occurred depression symptoms was17.7%and42.3%respectively (χ~2=14.774，P<0.01); The incidence of depression symptoms of follow-up among students withabnormal dysfunctional attitude was higher than those with normal dysfunctionalattitude and The incidence was48.1%and16.4%respectively (χ~2=24.523，P<0.01);As the six months follow-up study showed, the incidence of depression symptom washighest in students with three negative cognitive characteristics (36.4%), the middleand the lowest was17.1%and12.8%respectively (χ~2=10.639，P<0.01);As the oneyear follow-up study showed, the incidence of depression symptom was highest instudents with three negative cognitive characteristics (70.0%), the middle was thestudents with two (36.4%), and the lowest was the students with one (22.3%)(χ~2=21.225，P<0.01). The results from Cox regression showed that negative copingstyle and abnormal dysfunctional attitude were risk foctors of depression symptomoccurence （RR=1.79,95%CI：1.01~3.17）and RR=2.39,95%CI：1.40~4.08respectively）.Conclusions: The proportion of depressive symptoms among students was higher andrelated with cognitive distortions, negative internal attribution and immature copingstyle. Negative coping style and abnormal dysfunctional attitude might playconsiderable role to predict the occurrence of depression.