The feeling of being worthless is the most important cause of depression, researchers say
Have you ever felt worthless? A large Norwegian study now points to this as perhaps the most important driver and cause of worsening depression.
Low spirits. Bad sleep. Impaired concentration. Lack of joy, initiative and interest.
A depressive state can express itself in many ways and can develop differently from person to person.
But not all symptoms carry an equal risk of a person developing a depressive state, or of making it worse.
This is what researchers from Modum Bad, a private clinic that offers treatment for psychological problems, and the University of Oslo (UiO) have concluded in a new study.
They now think their findings can tell us what drives this disorder the most. And they now know more about the signs that tell us a person’s depression is worsening.
Large amounts of data about emotions
The study was based on information from roughly 1,700 adults. They were followed closely by researchers for 40 days during the pandemic.
Each day, the participants told the researchers how they felt. This left the researchers with a total of nearly 70,000 observations about the participants’ symptoms, feelings and thought processes.
When all these observations were added together, the researchers discovered what had the greatest influence on developing and remaining in a depressive state.
Feeling that you are worthless
“We found that the painful feeling of being worthless over time is among the most central symptoms that drive a depressive state. The same applies to the feeling of lack of energy,” Omid V. Ebrahimi said to sciencenorway.no.
On the other hand, symptoms such as a depressed mood and loss of interest are symptoms that only develop later.
“They are to a greater extent driven by rather than driving other depressive symptoms,” he said.
Ebrahimi is a psychologist and the researcher who led the study. Researchers Asle Hoffart and Sverre Urnes Johnson at the University of Oslo and Modum Bad have also contributed.
Low spirits don't come first
The researchers used a method in this study that enables them to compare the effects of several processes that psychologists know can initiate a depressive state.
This has enabled them to discover which symptoms come first — and which come later.
The researchers also know more about which symptoms have the greatest connection with specific depressive disorders.
The results can provide a clue as to what is most important to focus on during treatment, Ebrahimi said.
Feeling down and losing interest and joy are, for example, typical characteristics of depression.
But feeling depressed comes after the feeling of being worthless, the researchers now see. It doesn’t typically come before other symptoms.
This suggests it may be important for psychologists and other therapists to first address a person’s feeling of worthlessness, because this feeling will often reinforce a person's low mood and eventually make the person increasingly depressed.
One can lead to the other
Psychological ailments or symptoms build on each other. They can reinforce each other.
The researchers tried to find out how these symptoms are connected. This can also help them better understand what makes some of us more vulnerable to developing depression.
Ebrahimi believes that this is a slightly different way of studying depression than what other researchers have done in the past.
“Most other studies see depression as a phenomenon that gives rise to the symptoms. We see depression as a process. Symptoms intertwine and develop into a bigger problem over time. Finally, it can become a depressive state,” he said.
Three central processes
The researchers looked at three signs of depressive states. All three are well known from previous research.
Brooding or ruminating is the first. This is when you repeatedly think negative thoughts.
Regulation of emotions is the second. This concerns the fact that we all, consciously or unconsciously, use different strategies to deal with feelings such as discomfort, restlessness, boredom, sadness, irritation, loss, stress and anxiety. A weakened ability to regulate feelings is important in this regard.
Learned helplessness is the third process the researchers looked at. This is a psychological state where a person feels that he or she has no influence over his or her environment, life or problems. The person thinks there is no point in doing anything because he or she feels nothing can be done about the situation.
Brooding less important than thought
In this study, the researchers established that 'learned helplessness' is the active driving force behind the initiation and maintenance of long-term depressive disorders.
Learned helplessness was, among other things, central in initiating the depressive symptoms of worthlessness and low spirits.
This finding contrasts with findings from previous research.
“Several previous studies have concluded that brooding is the most important mechanism behind the maintenance of depressive states,” Ebrahimi said.
- Often associated with children. Adults can, through their attitudes and reactions, teach a child that their actions have little or no effect on their ability to feel good about themselves and be happy.
- The child is taught to think that all attempts to change one's own situation will fail.
- An example: A dog is alerted by a flashing light that an unpleasant electric shock is coming. It will quickly learn to move to a safe part of the experimental cage. The dog thus learns to do something to escape discomfort
- If, before learning this, the dog is given electric shocks that it cannot avoid, it will later be inhibited in learning. The dog has learned that action does nothing to protect it from discomfort.
- In adults, learned helplessness can make a person remain passive in situations where something can be done. Instead, the person may react with depressive symptoms.
Significance for treatment
“We find that brooding, on the contrary, is something that is set in motion by other processes, such as learned helplessness. You develop a state where you feel you have little influence over your situation, before this sets in motion repetitive negative thought patterns,” he said.
Learned helplessness was also directly related to depressive symptoms, which was not the case for brooding.
The order of the various processes and symptoms is of great importance in understanding how depressive conditions occur and how professionals should proceed in treating them.
Follow the development
If you live with a person who is in the process of developing depression, it is important to listen to what that person says about their own feelings, Ebrahimi said.
“People who over longer periods experience a strong sense of worthlessness and lack of energy, show symptoms that are more strongly associated with being on the way to a more lasting depressive state,” he said.
If the person in question has problems controlling their emotions, such as irritation, it may be an indication that their depressive symptoms are about to worsen, the researcher said.
More suffered from depressive symptoms during the pandemic
The study was carried out while COVID-19 was at its worst. This was a period when more people than what is usual experienced mental health problems, previous research has shown.
A Norwegian study from 2021 carried out by the same researchers found a significant temporary increase in symptoms of depression, loneliness and anxiety in the population during the most intensive periods of the pandemic.
“For most, these symptoms fortunately decreased again when the pandemic measures were lifted and society moved towards pre-pandemic times. But unfortunately there was also a smaller group that showed long-term problems,” Ebrahimi said.
What does the pandemic mean for the results?
The fact that this new study was carried out during the pandemic is no coincidence, says the researcher.
“We wanted to take advantage of the pandemic as a period when more people were aware of these kinds of problems. This allowed us to gain greater insight into which processes seem to occur simultaneously and actualize the activation of a depressive state,” he said.
But the pandemic was also a period when everyday life was different. This may have affected the results, he said.
“We will now look at whether the particular context has something to say about the connections we found. We are in the process of collecting data on this,” he said.
Exciting and important work
Catharina Elisabeth Arfwedson Wang is professor of clinical psychology at UiT, the Arctic University of Norway. She herself has studied depression for almost 30 years.
Wang has read the new study. She thinks it's interesting that the researchers have turned their attention to the negative cycles you can find yourself in when depression develops and which can lead to serious illness.
“We have known a lot about the symptoms of depression, but not so much about how these symptoms affect each other,” she said.
She believes that the researchers have done exciting and important work by trying to explain the inner dynamics of depression.
“These researchers have the cutting-edge expertise to look at depression. They have used new types of statistical methods and approaches in this study, which are both demanding and comprehensive. It’s not easy to get so many people to answer so many questions over a long period,” she said.
Says little about treatment
Wang believes that the weakest part of the article is that the researchers say little about what their findings have to say for the treatment of people with depression.
“This is basic research, of course. But the findings will probably influence how we think about treatment. I think it can help us tailor therapies to a greater extent when we know more about what is the most important thing to work on for each individual,” she said.
Confirmation that external factors matter a lot
Wang believes that the study confirmed that it is important to think about the external factors that can trigger depression, and that the community around us is of great importance for mental health.
“Having the experience of control over one's own life — on everything from finances to the climate — and not feeling helpless and lonely, is very important in counteracting low moods and depression,” she said.
Omid V. Ebrahimi et.al: Within- and across-day patterns of interplay between depressive symptoms and related psychopathological processes: a dynamic network approach during the COVID-19 pandemic. BMC Medicine, 2021.
Read the Norwegian version of this article at forskning.no