Repetitive Negative Thinking outperforms loneliness and lack of social connectedness as a predictor of prospective depressive symptoms in adolescents

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology Vol. 8:149-156 (2020) DOI 10.21307/sjcapp-2020-015 Research Article Open Access Repetitive Negative Thinking outperforms loneliness and lack of social connectedness as a predictor of prospective depressive symptoms in adolescents Filip Raes¹, Margot Bastin²β, Tina Pede¹, Eline Belmans¹ Luc Goossens², Janne Vanhalst³ ¹Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium ²Research Unit School Psychology and Development in Context, KU Leuven, Belgium; ³Department of Developmental, Personality and Social Psychology, Ghent University, Belgium *Corresponding author: βjoint first author Abstract Background: Repetitive Negative Thinking (RNT) is a well-established predictor in adolescents of emotional problems, such as depression. Surprisingly little research, however, has looked at the relative importance of RNT vs. more interpersonally relevant variables in the context of depression, such as loneliness and lack of social connectedness. Objective: The present study, therefore, set out to examine whether RNT is a significant predictor when taking into account the contribution of loneliness and social connectedness. Methods: A sample of 135 typically developing adolescents (N = 135; 79.3% girls; Mage = 17.5; range 16-21) completed measures of depressive symptoms, RNT, loneliness and social connectedness at two time points with a 3-month interval. Results: Results showed that above and beyond baseline depressive symptoms, RNT was the only other significant predictor of prospective depressive symptoms. Conclusions: According to these results, RNT seems a relatively more important factor to consider in the context of adolescent depression than factors in the interpersonal or social context. Consequently, targeting RNT might be expected to yield more significant gains in reducing or preventing depressive symptoms in adolescents compared to focusing on feelings of loneliness or social connectedness – a hypothesis that remains to be tested. Keywords: depression; Repetitive Negative Thinking; loneliness Introduction Knowledge about reliable risk factors for depression is of critical importance, especially in adolescence, given (a) the high prevalence of both clinical and subsyndromal levels of depression in that period (1, 2) combined with (b) the well-documented detrimental and far-reaching consequences of adolescent depression later in life (3, 4) that even exist for subclinical levels of depression (5). The identification of risk factors, therefore, is crucial for targeted prevention. An accumulating body of research suggests that Repetitive Negative Thinking (RNT) may be one such risk factor. Repetitive Negative Thinking (RNT) refers to excessive and repetitive thinking about current concerns, problems, past experiences or worries about the future (6, p. 192). Depressive rumination and anxious worry are two prototypical examples of RNT. A vast body of research has shown that RNT is a reliable risk factor for a range of emotional problems and disorders such as depression and anxiety in both adults and adolescents (for reviews, see: 6, 7, 8). For example, in a longitudinal cohort study in 658 at-risk adolescents Wilkinson et al. (9) found that RNT predicted both the onset of a depressive episode and levels of depressive symptoms over a 12month interval, when controlled for baseline symptomatology. Likewise, Bijttebier and colleagues (10) showed that, again when controlled for baseline symptom levels, RNT predicted prospective levels of depressive symptoms at 3-month follow-up in 701 adolescents. Given the above reviewed substantial evidence for RNT as a risk factor for adolescent depression, RNT has also become the focus of preventive © 2020 Authors. This is an Open Access article licensed under the Creative Commons CC BY-NC-ND 4.0 license. https://creativecommons.org/licenses/by-nc-nd/4.0/ Repetitive Negative Thinking and loneliness interventions in adolescence (e.g., 8, 11). However, prevention programs targeting an individual or intrapersonal risk factor such as RNT could be criticized because they fail to take the interpersonal or social context into account to a sufficient degree. The same critique applies to research on RNT in adolescent samples. Particularly in adolescence, when forming and maintaining relationships with peers becomes a central developmental task, peer relationships and deficits thereof are known to affect different aspects of psychological health, including depressive symptoms (12). Both loneliness and lack of connectedness could be indicators of such problems in the relational realm. Loneliness refers to the negative feelings that people experience when they are dissatisfied with their social network (13). Lack of connectedness, by contrast, refers to the generalized and presumably deeper feeling that one is a social outsider (14). Loneliness is known to predict levels of and increases in symptoms of depression in adolescents (e.g., 15). Higher scores on measures of social connectedness, which typically comprise both positively phrased items about belongingness and negatively phrased items about feeling an outsider (which are reverse coded), have been found to be associated with lower scores for depressive symptoms in this age group (e.g., 16). Although loneliness and the experience of failed belongingness, such as lack of social connectedness, clearly are related constructs, it has been suggested that they represent distinct psychological experiences (17). As a result, they may differently predict depressive symptoms. Together, it may very well be that once these social determinants of depression are taken into account, the role of RNT as an individual risk factor for depression would be considerably reduced. Or, vice versa, it may be the case that the role of loneliness and lack of social connectedness in the prospective prediction of depressive symptoms diminishes once RNT is brought into the picture. Surprisingly little research, however, has looked at the relative importance of RNT vs. loneliness or social connectedness in predicting depressive symptoms in adolescents. The present study had three main objectives. First, we set out to replicate whether RNT is a predictor of prospective depressive symptomatology in a group of adolescents. Second, we checked to what extent RNT would remain a significant predictor when taking into account the role of loneliness and social connectedness, given the salience of social relationships in this developmental phase. Third, and finally, we examined potential moderating effects between RNT and both loneliness and connectedness. It could be, for example, that RNT interacts with such social factors in predicting depressive symptoms, such that loneliness and/or lack of connectedness would be especially detrimental in the context of depression for adolescents who are characterized by high levels of RNT (cf. 18). Method (...truncated)