Modeling and estimating the feedback mechanisms among depression, rumination, and stressors in adolescents

• Published in: PloS one Vol. 13; no. 9; p. e0204389
• Main Authors: Hosseinichimeh, Niyousha, Wittenborn, Andrea K, Rick, Jennifer, Jalali, Mohammad S, Rahmandad, Hazhir
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27-09-2018; Public Library of Science (PLoS)
• Subjects: Adolescents; Analysis; Biology and Life Sciences; Care and treatment; Children & youth; Clinical psychology; Computer and Information Sciences; Computer simulation; Engineering and Technology; Families & family life; Feedback; Girls; Health aspects; Long-term depression; Major depressive disorder; Medicine and Health Sciences; Mental depression; People and Places; Physical Sciences; Post traumatic stress disorder; Psychological aspects; Research and Analysis Methods; Rumination; Rumination (Digestion); Schools; Simulation; Social Sciences; Stress; Studies; System dynamics; Teenagers; Youth; East Lansing Michigan; United States > US; Massachusetts; Connecticut; Michigan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0204389

The systemic interactions among depressive symptoms, rumination, and stress are important to understanding depression but have not yet been quantified. In this article, we present a system dynamics simulation model of depression that captures the reciprocal relationships among stressors, rumination, and depression. Building on the response styles theory, this model formalizes three interdependent mechanisms: 1) Rumination contributes to 'keeping stressors alive'; 2) Rumination has a direct impact on depressive symptoms; and 3) Both 'stressors kept alive' and current depressive symptoms contribute to rumination. The strength of these mechanisms is estimated using data from 661 adolescents (353 girls and 308 boys) from two middle schools (grades 6-8). These estimates indicate that rumination contributes to depression by keeping stressors 'alive'-and the individual activated-even after the stressor has ended. This mechanism is stronger among girls than boys, increasing their vulnerability to a rumination reinforcing loop. Different profiles of depression emerge over time depending on initial levels of depressive symptoms, rumination, and stressors as well as the occurrence rate for stressors; levels of rumination and occurrence of stressors are stronger contributors to long-term depression. Our systems model is a steppingstone towards a more comprehensive understanding of depression in which reinforcing feedback mechanisms play a significant role. Future research is needed to expand this simulation model to incorporate other drivers of depression and provide a more holistic tool for studying depression.