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Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders

Published online by Cambridge University Press:  11 April 2017

T. Østefjells ,
J. U. Lystad ,
A. O. Berg ,
R. Hagen ,
R. Loewy ,
L. Sandvik ,
I. Melle  and
J. I. Røssberg
T. Østefjells*
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway Department for Specialised Inpatient Treatment, Division of Mental Health and Addiction, Akershus University Hospital, Lørenskog, Norway
J. U. Lystad
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
A. O. Berg
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
R. Hagen
Affiliation:
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
R. Loewy
Affiliation:
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
L. Sandvik
Affiliation:
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
I. Melle
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
J. I. Røssberg
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
*
*Address for correspondence: T. Østefjells, Division of Mental Health and Addiction, Psychosis Research Unit/TOP, Oslo University Hospital HF, Ullevål Hospital, Building 49, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway. (Email: tiril.ostefjells@medisin.uio.no)
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Abstract

Background

Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.

Method

Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.

Results

Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R2 = 0.21–0.29).

Conclusion

Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

Keywords

Bipolar disordermediationmetacognitionpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2323 - 2333
Copyright
Copyright © Cambridge University Press 2017 

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