The Psychopathology of Worthlessness in Depression

Phillippa Harrison; Andrew J Lawrence; Shu Wang; Sixun Liu; Guangrong Xie; Xinhua Yang; Roland Zahn

doi:10.3389/fpsyt.2022.818542

The Psychopathology of Worthlessness in Depression

Front Psychiatry. 2022 May 19:13:818542. doi: 10.3389/fpsyt.2022.818542. eCollection 2022.

Authors

Phillippa Harrison¹, Andrew J Lawrence¹, Shu Wang², Sixun Liu², Guangrong Xie³, Xinhua Yang¹, Roland Zahn^{1

4}

Affiliations

¹ Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
² Department of Psychology, Institute of Education, Hunan Agricultural University, Changsha, China.
³ Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Central South University, Changsha, China.
⁴ National Service for Affective Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom.

Abstract

Background: Despite common dissatisfaction with the syndromic heterogeneity of major depression, investigations into its symptom structure are scarce. Self-worthlessness/inadequacy is a distinctive and consistent symptom of major depression across cultures.

Aims: We investigated whether self-worthlessness is associated with self-blaming attribution-related symptoms or is instead an expression of reduced positive feelings overall, as would be implied by reduced positive affect accounts of depression.

Methods: 44,161 undergraduate students in Study 1, and 215 patients with current Major Depressive Disorder (MDD) and 237 age-matched healthy control participants in Study 2 completed the well-validated Symptom Check List-90. Depression-relevant items were used to construct regularized partial correlation networks with bootstrap estimates of network parameter variability.

Results: Worthlessness co-occurred more strongly with other symptoms linked to self-blaming attributions (hopelessness, and self-blame), displaying a combined edge weight with these symptoms which was significantly stronger than the edge weight representing its connection with reduced positive emotion symptoms (such as reduced pleasure/interest/motivation, difference in edge weight sum in Study 1 = 2.95, in Study 2 = 1.64; 95% confidence intervals: Study 1: 2.6-3.4; Study 2: 0.02-3.5; Bonferroni-corrected p < 0.05).

Conclusions: This confirms the prediction of the revised learned helplessness model that worthlessness is most strongly linked to hopelessness and self-blame. In contrast, we did not find a strong and direct link between anhedonia items and a reduction in self-worth in either study. This supports worthlessness as a primary symptom rather than resulting from reduced positive affect.

Keywords: anhedonia; depression; network analysis; positive emotion; psychopathology; self-blame; self-esteem.