Early maladaptive schemas and suicidal ideation in depressed patients

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Nam" "autores" => array:1 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Nam" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213616317300095?idApp=UINPBA00004N" "url" => "/02136163/0000003100000003/v1_201709060011/S0213616317300095/v1_201709060011/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Early maladaptive schemas and suicidal ideation in depressed patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "92" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Flink, S.M. Lehto, H. Koivumaa-Honkanen, H. Viinamäki, A. Ruusunen, M. Valkonen-Korhonen, K. Honkalampi" "autores" => array:7 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Flink" "email" => array:1 [ 0 => "nflink@uef.fi" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S.M." "apellidos" => "Lehto" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "H." 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"apellidos" => "Valkonen-Korhonen" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "K." "apellidos" => "Honkalampi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "School of Educational Sciences and Psychology, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS Kuopio, Finland" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 University of Helsinki, Finland" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "South-Savonia Hospital District, Mikkeli, Finland" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "North Karelia Central Hospital, Joensuu, Finland" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "SOTE, Iisalmi, Finland" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Lapland Hospital District, Rovaniemi, Finland" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionThe association between depression, suicidal behaviours and suicidal ideation has been documented extensively.<a class="elsevierStyleCrossRefs" href="#bib0125">1–3</a> Over half the patients with major depressive disorder (MDD) have suicidal ideation and suicidal thoughts tend to be persistent.<a class="elsevierStyleCrossRefs" href="#bib0135">3,4</a> Psychological factors related to suicidal ideation among depressed individuals have received less attention from researchers than nonfatal suicidal attempts or behaviours. Better knowledge of underlying factors in suicidal ideation could aid in suicide prevention, since suicidal ideation often precedes suicidal behaviour among depressed individuals.<a class="elsevierStyleCrossRefs" href="#bib0135">3,5</a> In particular, the severity of depressive symptoms and hopelessness has been linked with suicidal ideation.<a class="elsevierStyleCrossRefs" href="#bib0130">2,3,6</a> However, several other factors, such a history of nonadherence, low levels of social and occupational functioning, low social support and reluctance to admit mental health problems also contribute to suicidal ideation.<a class="elsevierStyleCrossRefs" href="#bib0135">3,6,7</a>Exploring underlying cognitive patterns could offer further insight into the relationship between suicidal ideation and depression. Recent studies have associated early maladaptive schemas (EMSs) with both depression<a class="elsevierStyleCrossRefs" href="#bib0160">8–10</a> and suicidal behaviours in clinical populations.<a class="elsevierStyleCrossRefs" href="#bib0175">11–13</a> In schema theory<a class="elsevierStyleCrossRef" href="#bib0190">14</a> EMSs are defined as stable, trait-like self-perpetuating cognitive patterns that influence thinking and behaviour in a dysfunctional way. EMSs are theorised to emerge from unmet basic needs and traumatic experiences during childhood, combined with the individual's emotional temperament; when triggered, schemas dominate thoughts and feelings, leading to negative emotions and dysfunctional thoughts.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> A total of 18 EMSs have been defined, which are further categorised under five broader schema domains and can be measured using the Young Schema Questionnaire.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> Brief descriptions of EMS domains are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Schemas are thought to represent the deepest level of dysfunctional cognitions.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> In accordance with the schema theory, EMSs have demonstrated high stability over time in depressed patients also after controlling for severity of depression.<a class="elsevierStyleCrossRefs" href="#bib0160">8,9</a> The EMSs from the ‘Disconnection and Rejection’ and ‘Impaired Autonomy and Performance’ schema domains in particular have been associated with depression.<a class="elsevierStyleCrossRefs" href="#bib0160">8–10</a> Depression-related EMSs are consistent with the cognitive model of depression, and place beliefs of failure, loss, and worthlessness at the core of depressive symptoms.<a class="elsevierStyleCrossRef" href="#bib0160">8</a> Even though studies on clinical populations indicate associations between EMSs and suicidality,<a class="elsevierStyleCrossRefs" href="#bib0175">11,12</a> research focusing on suicidal ideation and EMSs has been sparse. Previously EMSs have been shown to correlate with suicidal ideation in a sample of chronically traumatised patients.<a class="elsevierStyleCrossRef" href="#bib0185">13</a> To the best of our knowledge no study has explored the associations between EMSs and suicidal ideation in depressed patients, or in respect to concurrent depressive symptom severity and hopelessness. Given that both EMSs and suicidal ideation are associated with the severity of depressive symptoms,<a class="elsevierStyleCrossRefs" href="#bib0130">2,6,8,10</a> we hypothesised that suicidal ideation would be closely connected to depression-related EMSs.The aim of the present exploratory study was to assess 1) if EMSs among psychiatric outpatients in treatment for MDD differ by presence of current suicidal ideation, 2) if EMSs associated with suicidal ideation are similar to those previously associated with depression, and 3) whether specific EMSs predict suicidal ideation when the effects of severity of depression and hopelessness are taken into account.MethodsParticipants and proceduresThe present study was based on data from a naturalistic follow-up study on psychiatric outpatients with MDD (aged 18–65 years) recruited from the Department of Psychiatry at Kuopio University Hospital. At baseline, the diagnosis of MDD was confirmed by trained mental health professionals using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).<a class="elsevierStyleCrossRef" href="#bib0195">15</a> Patients suffering from epilepsy, bipolar disorder, psychotic depression or other psychotic disorders and depression related directly to somatic conditions or substance abuse were excluded from the study. Of the initial 100 patients, 79 (58.2% women) participated to the present study phase, i.e., 5–13 months after the baseline assessment (mean 8.40 months, SD 2.30). We observed no differences in gender (p=0.630), marital status (p=0.594), severity of depression (p=0.585) or age at first depressive episode (p=0.663) between participants of the present study phase and non-participants. Participants were older than non-participants (mean age 40.53 years, SD 11.73 vs. 34.29 years, SD 12.20, p=0.034). At the time of the present study phase, SCID-I was repeated and participants completed the study questionnaire and measurements for EMSs, depression and hopelessness. Out of the 79 patients, 57.7% met diagnostic criteria for MDD, and 42.3% were in full or partial remission according to SCID-I. All participants provided written informed consent before entering the study. The study protocol was accepted by the Research Ethics Committee of the Northern Savo Hospital District.MeasuresThe study questionnaire gathered information on demographic variables and illness history (sex, age, marital status, age at first depressive episode and number of lifetime MDD episodes). The Young Schema Questionnaire short form-extended (YSQ-S2-extended) was used to measure 18 different EMSs. The questionnaire contains 90 self-statements (five for each schema), which respondents are asked to rate on a Likert scale ranging from 1 (completely untrue) to 6 (describes perfectly). EMS subscales were used as continuous variables based on the mean of the five schema statements. The factor structure and reliability of the Finnish version of the YSQ-S2-extended have been established by Saariaho et al.<a class="elsevierStyleCrossRef" href="#bib0200">16</a> In the present study, the internal reliability coefficient alpha ranged from 0.74 to 0.95 for all 18 EMS subscales (median α=.88).The 21-item version of the Beck Depression Inventory (BDI-21)<a class="elsevierStyleCrossRef" href="#bib0205">17</a> was used to measure the severity of depression. One of its items (i.e., number 9) concerning suicidal thoughts and wishes was used to assess suicidal ideation. Absence of suicidal ideation was based on the response alternative, ‘I don’t have any thoughts of killing myself’, and current suicidal ideation was based on the following three responses: 1) ‘I have thoughts of killing myself, but I would not carry them out’; 2) ‘I would like to kill myself’; and 3) ‘I would kill myself if I had the chance’. Thus, suicidal ideation was defined in agreement with Diekstra and Garnefski<a class="elsevierStyleCrossRef" href="#bib0210">18</a> as cognitions varying from transient thoughts about the worthlessness of life and death wishes to concrete plans for killing oneself and obsessive preoccupation with self-destruction. In calculating BDI scores, the suicidality item was excluded (BDI range 0–60). Hopelessness was measured using the Beck Hopelessness Scale<a class="elsevierStyleCrossRef" href="#bib0215">19</a> (HS), which is a 20-item rating scale measuring negative expectancies concerning oneself and one's future life. The total score of HS ranges from 0 to 20, with higher score indicating higher level of hopelessness.Data analysisDifferences between patients with and without suicidal ideation were examined using the χ2 test for categorical variables and the t test for continuous variables. The magnitude of difference in the EMS subscale scores was calculated using Cohen's d as a measure of effect sizes (small if d=0.2, medium if d=0.5 and large if d=0.8).<a class="elsevierStyleCrossRef" href="#bib0220">20</a> Patients with suicidal ideation were used as a reference group with positive or negative effect sizes indicating, respectively, higher or lower EMS scores in this group. Each EMS subscale found to be significantly associated with suicidal ideation in univariate analysis was further analysed in multivariate logistic models. In additional analyses, any of the demographic and clinical variables that differed significantly between the two groups were used as covariates due to their connection with suicidal ideation. All statistical tests were two-tailed, and analyses were conducted with the SPSS statistical package (IBM® SPSS® Statistics version 22.0).ResultsA total of 60.8% of patients suffered from current suicidal ideation. The demographic characteristics and clinical variables between patients with and without suicidal ideation are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. There were no statistically significant differences between the groups in terms of age, gender, marital status, the mean age at the first depressive episode or the number of lifetime depressive episodes. Those with current suicidal ideation were significantly more depressed (BDI means 27.7 (SD 9.7) vs. 14.3 (10.8), t=5.50, p=<0.001) and hopeless (HS means 12.6 (SD 5.6) vs. 6.3 (4.4) t=5.34, p=<0.001) than those without.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Patients with suicidal ideation scored significantly higher on 11 out of the 18 EMS subscales with at least moderate effect sizes (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The largest differences in EMS subscales between the groups were in ‘Vulnerability to Harm or Illness’ and ‘Dependence/Incompetence’ EMSs from ‘Impaired Autonomy and Performance’ schema domain and ‘Defectiveness/Shame’ and ‘Social isolation/Alienation’ EMSs from ‘Disconnection/Rejection’ schema domain. Moderate differences were observed also in EMSs from ‘Other-Directedness’ and ‘Overvigilance and Inhibition’ schema domains.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Because those with suicidal ideation were significantly more depressed and hopeless, BDI and HS scores were included as covariates in logistic models with significant EMS subscales as predictors of suicidal ideation. In the logistic models with BDI and HS, only the EMS subscale ‘Vulnerability to Harm or Illness’ remained statistically significant in respect to suicidal ideation (p=0.037). This particular model was statistically significant (χ2(3)=32.31, p=0.049) explaining 48.6% (Nagelkerke R2) of the variance in suicidal ideation and correctly classified 88.9% of cases. Neither BDI (p=0.127) or HS (p=0.378) were significant in this model.DiscussionA wide range of subscales for early maladaptive schemas were associated with suicidal ideation among depressed patients, but only ‘Vulnerability to Harm or Illness’ EMS predicted current suicidal ideation independently from depression and hopelessness. Given the exploratory nature of the present study, these findings should be considered as preliminary and need to be replicated in larger samples. However, results support prior research suggesting that EMSs may relate to suicidality,<a class="elsevierStyleCrossRefs" href="#bib0175">11–13</a> while the role of depressive symptoms and hopelessness in suicidal ideation has already been established.<a class="elsevierStyleCrossRefs" href="#bib0135">3–5</a>The ‘Vulnerability to Harm or Illness’ subscale concerns catastrophising beliefs and exaggerated fears of irrationally negative forecasted life-events (such as imminent medical, emotional or external catastrophes).<a class="elsevierStyleCrossRef" href="#bib0190">14</a> Our results suggest, that catastrophising core beliefs could act as an independent risk factor for suicidal ideation among depressed individuals. Suicidality and suicidal ideation have been proposed to represent a particular pattern of information processing, which arises from feelings of entrapment and a sense of no escape.<a class="elsevierStyleCrossRef" href="#bib0225">21</a> Theoretically, fear of unpreventable catastrophes could create a sense of no control over one's life, which could induce hopelessness, depressed mood and suicidal thought processes.In general, patients with suicidal ideation had consistently higher subscale scores in the majority of EMSs in the domains of ‘Disconnection and Rejection’ and ‘Impaired Autonomy and Performance’. These domains deal with beliefs related to inadequate acceptance or security and impaired ability to survive and cope.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> Moderate differences were observed in the EMS subscales of ‘Subjugation’ and ‘Self-sacrifice’ from the ‘Other-Directedness’ domain and in ‘Negativity/Pessimism’ and ‘Punitiveness’ from the ‘Overvigilance and Inhibition’ domain. The first domain places excessive focus on feelings of others, and the second overemphasises suppression of one's feelings.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> Higher EMS subscale scores observed among those with suicidal ideation were similar to those previously associated with severity of depressive symptoms<a class="elsevierStyleCrossRefs" href="#bib0160">8–10,22</a> and support our hypothesis that suicidal ideation in depressed patients is closely connected to more general depression-related maladaptive cognitive patterns.Schema theory proposes that EMSs rise from traumatic experiences and unmet needs during childhood and adolescence.<a class="elsevierStyleCrossRef" href="#bib0190">14</a> Considering the notable stability of depression-related EMSs<a class="elsevierStyleCrossRef" href="#bib0165">9</a> and strong connection between childhood adversities, depression<a class="elsevierStyleCrossRef" href="#bib0235">23</a> and suicidality,<a class="elsevierStyleCrossRef" href="#bib0240">24</a> high EMS scores in patients with suicidal ideation may be related to earlier traumatic life experiences. Further research should focus on clarifying possible mechanisms between early life adversities, EMSs, suicidal ideation and depression.There are important limitations to this study that should be considered. First, suicidal ideation was assessed using single question instead of a scale or structured interview. Second, cross-sectional study setting does not allow causal conclusions. Third, sample size was relatively small, which may affect the generalisability of our findings. Therefore, further replications with larger samples and structured assessment of suicidal ideation are needed.In conclusion, the present study showed that catastrophising cognitive schema may be of particular importance in suicidal ideation among depressed patients. Furthermore, suicidal ideation was found to be associated with several maladaptive cognitive patterns, which are connected to concurrent depressive symptom severity and hopelessness. From a clinical perspective, assessing EMSs may be especially relevant when psychological factors related to suicidal ideation are been identified. Results also highlight the possibility that, in addition to targeting depression and hopelessness, focusing interventions on catastrophising cognitive patterns could be beneficial when treating suicidality among depressed patients. In order to apply these findings into clinical practice, further replications and expanding of the results are, however, needed.FundingSML was supported by a grant from the Paulo Foundation.Conflicts of interestAuthors none were declared." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres897307" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec877642" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants and procedures" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Measures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-16" "fechaAceptado" => "2017-07-18" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec877642" "palabras" => array:3 [ 0 => "Early maladaptive schemas" 1 => "Depression" 2 => "Suicidal ideation" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesSuicidal ideation is a key risk factor for suicidal behaviour among depressed individuals. To explore underlying cognitive patterns associated with suicidal ideation, the present study compared early maladaptive schemas (EMSs) among psychiatric outpatients in treatment for major depressive disorder with and without current suicidal ideation. MethodsThe sample consisted of 79 depressed patients who responded to the background questionnaire and completed the Young Schema Questionnaire short form-extended, 21-item Beck Depression Inventory and Beck Hopelessness Scale. ResultsPatients with suicidal ideation were more maladaptive in respect to the majority of EMSs compared to those without. After controlling for the concurrent depressive symptom severity and hopelessness ‘Vulnerability to Harm or Illness’ EMS, which concerns catastrophising beliefs, remained a predictor for suicidal ideation. ConclusionEMSs may contribute to suicidal ideation among depressed individuals regardless of their mood and future orientation. These results offer implications for the assessment and treatment of suicidality." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1) Disconnection and Rejection domain: Schemas involving expectations that one's needs for security, safety, and stability will not be met. Includes EMSs: Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2) Impaired Autonomy and Performance: Schemas involving expectations that one's ability and capacity to separate, survive, cope independently, or perform successfully will be impaired. Includes EMSs: Dependence/Incompetence, Vulnerability to Harm or Illness, Enmeshment/Underdeveloped Self and Failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3) Impaired Limits: Schemas involving difficulties in setting internal limits, feeling responsibility, or setting long-term goals. Includes EMSs: Entitlement/Grandiosity and Insufficient Self-control/Self-discipline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4) Other-directedness: Schemas where others’ needs, desires, or responses are respected and taken into account at the expense of one's own needs. Includes EMSs: Subjugation, Self-sacrifice and Approval-seeking/Recognition-seeking \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5) Overvigilance and Inhibition: Schemas where spontaneous feelings and impulses are suppressed and replaced by rigid, internalised rules about performance and behaviour. Includes EMSs: Negativity/Pessimism, Emotional Inhibition, Unrelenting Standards/Hypercriticalness and Punitiveness \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1506720.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Definitions of early maladaptive schema (EMS) domains by Young and colleagues.<a class="elsevierStyleCrossRef" href="#bib0190">14</a>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note: SD, standard deviation; BDI-2I, 21-item Beck Depression Inventory (item 9 omitted, range 0–60); HS, Beck Hopelessness Scale." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With suicidal ideation (n=48) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without suicidal ideation (n=31) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistics \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Demographics</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gender (% women) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">χ2=2.03, p=0.154 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean age (SD) in years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.4 (11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.4 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">t=1.12, p=0.267 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Marital status (% of total) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">χ2=1.95, p=0.377 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Single \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Married \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Divorced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Clinical characteristics</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean BDI-21 (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3 (10.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">t=5.50, p=<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean HS (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">t=5.34, p=<0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean age (SD) at first depr. episode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1 (13.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6 (14.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">t=−0.17, p=0.867 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lifetime MDD episodes (% of total) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">χ2=0.21, p=0.977 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">One episode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Two episodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Three episodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Four or more episodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1506721.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical characteristics of depressed patients by suicidal ideation." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early Maladaptive Schema \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With suicidal ideation (n=48) Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without suicidal ideation (n=31) Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">d \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Disconnection and Rejection domain</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Abandonment/Instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.071 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mistrust/Abuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emotional Deprivation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Defectiveness/Shame \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Social Isolation/Alienation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Impaired Autonomy and Performance domain</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dependence/Incompetence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vulnerability to Harm or Illness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Enmeshment/Underdeveloped Self \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.062 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Impaired Limits domain</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Entitlement/Grandiosity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Insufficient Self-control/Self-discipline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.079 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Other-Directedness domain</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Subjugation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Self-sacrifice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.047 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Approval-seeking/Recognition-seeking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.331 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Overvigilance and Inhibition domain</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Negativity/Pessimism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emotional Inhibition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.296 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Unrelenting Standards/Hypercriticalness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.073 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Punitiveness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1506722.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Subscales of the Young Schema Questionnaire short form-extended (YSQ-S2-extended)." ] ] ] "descripcion" => 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Original article

N. Flinka,

Corresponding author

nflink@uef.fi

Corresponding author.

, S.M. Lehtob,c,d, H. Koivumaa-Honkanenb,c,e,f,g,h, H. Viinamäkib,c, A. Ruusunenc, M. Valkonen-Korhonenb,c, K. Honkalampia

a School of Educational Sciences and Psychology, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland

b Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland

c Department of Psychiatry, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS Kuopio, Finland

d Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 University of Helsinki, Finland

e South-Savonia Hospital District, Mikkeli, Finland

f North Karelia Central Hospital, Joensuu, Finland

g SOTE, Iisalmi, Finland

h Lapland Hospital District, Rovaniemi, Finland

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The association between depression&#44; suicidal behaviours and suicidal ideation has been documented extensively&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#8211;3</span></a> Over half the patients with major depressive disorder &#40;MDD&#41; have suicidal ideation and suicidal thoughts tend to be persistent&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#44;4</span></a> Psychological factors related to suicidal ideation among depressed individuals have received less attention from researchers than nonfatal suicidal attempts or behaviours&#46; Better knowledge of underlying factors in suicidal ideation could aid in suicide prevention&#44; since suicidal ideation often precedes suicidal behaviour among depressed individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#44;5</span></a> In particular&#44; the severity of depressive symptoms and hopelessness has been linked with suicidal ideation&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2&#44;3&#44;6</span></a> However&#44; several other factors&#44; such a history of nonadherence&#44; low levels of social and occupational functioning&#44; low social support and reluctance to admit mental health problems also contribute to suicidal ideation&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Exploring underlying cognitive patterns could offer further insight into the relationship between suicidal ideation and depression&#46; Recent studies have associated early maladaptive schemas &#40;EMSs&#41; with both depression<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#8211;10</span></a> and suicidal behaviours in clinical populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;13</span></a> In schema theory<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> EMSs are defined as stable&#44; trait-like self-perpetuating cognitive patterns that influence thinking and behaviour in a dysfunctional way&#46; EMSs are theorised to emerge from unmet basic needs and traumatic experiences during childhood&#44; combined with the individual&#39;s emotional temperament&#59; when triggered&#44; schemas dominate thoughts and feelings&#44; leading to negative emotions and dysfunctional thoughts&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> A total of 18 EMSs have been defined&#44; which are further categorised under five broader schema domains and can be measured using the Young Schema Questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> Brief descriptions of EMS domains are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Schemas are thought to represent the deepest level of dysfunctional cognitions&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> In accordance with the schema theory&#44; EMSs have demonstrated high stability over time in depressed patients also after controlling for severity of depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#44;9</span></a> The EMSs from the &#8216;Disconnection and Rejection&#8217; and &#8216;Impaired Autonomy and Performance&#8217; schema domains in particular have been associated with depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#8211;10</span></a> Depression-related EMSs are consistent with the cognitive model of depression&#44; and place beliefs of failure&#44; loss&#44; and worthlessness at the core of depressive symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a> Even though studies on clinical populations indicate associations between EMSs and suicidality&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#44;12</span></a> research focusing on suicidal ideation and EMSs has been sparse&#46; Previously EMSs have been shown to correlate with suicidal ideation in a sample of chronically traumatised patients&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a> To the best of our knowledge no study has explored the associations between EMSs and suicidal ideation in depressed patients&#44; or in respect to concurrent depressive symptom severity and hopelessness&#46; Given that both EMSs and suicidal ideation are associated with the severity of depressive symptoms&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">2&#44;6&#44;8&#44;10</span></a> we hypothesised that suicidal ideation would be closely connected to depression-related EMSs&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of the present exploratory study was to assess 1&#41; if EMSs among psychiatric outpatients in treatment for MDD differ by presence of current suicidal ideation&#44; 2&#41; if EMSs associated with suicidal ideation are similar to those previously associated with depression&#44; and 3&#41; whether specific EMSs predict suicidal ideation when the effects of severity of depression and hopelessness are taken into account&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Participants and procedures</span><p id="par0025" class="elsevierStylePara elsevierViewall">The present study was based on data from a naturalistic follow-up study on psychiatric outpatients with MDD &#40;aged 18&#8211;65 years&#41; recruited from the Department of Psychiatry at Kuopio University Hospital&#46; At baseline&#44; the diagnosis of MDD was confirmed by trained mental health professionals using the Structured Clinical Interview for DSM-IV Axis I Disorders &#40;SCID-I&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a> Patients suffering from epilepsy&#44; bipolar disorder&#44; psychotic depression or other psychotic disorders and depression related directly to somatic conditions or substance abuse were excluded from the study&#46; Of the initial 100 patients&#44; 79 &#40;58&#46;2&#37; women&#41; participated to the present study phase&#44; i&#46;e&#46;&#44; 5&#8211;13 months after the baseline assessment &#40;mean 8&#46;40 months&#44; SD 2&#46;30&#41;&#46; We observed no differences in gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;630&#41;&#44; marital status &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;594&#41;&#44; severity of depression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;585&#41; or age at first depressive episode &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;663&#41; between participants of the present study phase and non-participants&#46; Participants were older than non-participants &#40;mean age 40&#46;53 years&#44; SD 11&#46;73 vs&#46; 34&#46;29 years&#44; SD 12&#46;20&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;034&#41;&#46; At the time of the present study phase&#44; SCID-I was repeated and participants completed the study questionnaire and measurements for EMSs&#44; depression and hopelessness&#46; Out of the 79 patients&#44; 57&#46;7&#37; met diagnostic criteria for MDD&#44; and 42&#46;3&#37; were in full or partial remission according to SCID-I&#46; All participants provided written informed consent before entering the study&#46; The study protocol was accepted by the Research Ethics Committee of the Northern Savo Hospital District&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Measures</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study questionnaire gathered information on demographic variables and illness history &#40;sex&#44; age&#44; marital status&#44; age at first depressive episode and number of lifetime MDD episodes&#41;&#46; The Young Schema Questionnaire short form-extended &#40;YSQ-S2-extended&#41; was used to measure 18 different EMSs&#46; The questionnaire contains 90 self-statements &#40;five for each schema&#41;&#44; which respondents are asked to rate on a Likert scale ranging from 1 &#40;completely untrue&#41; to 6 &#40;describes perfectly&#41;&#46; EMS subscales were used as continuous variables based on the mean of the five schema statements&#46; The factor structure and reliability of the Finnish version of the YSQ-S2-extended have been established by Saariaho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a> In the present study&#44; the internal reliability coefficient alpha ranged from 0&#46;74 to 0&#46;95 for all 18 EMS subscales &#40;median <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;88&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The 21-item version of the Beck Depression Inventory &#40;BDI-21&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> was used to measure the severity of depression&#46; One of its items &#40;i&#46;e&#46;&#44; number 9&#41; concerning suicidal thoughts and wishes was used to assess suicidal ideation&#46; Absence of suicidal ideation was based on the response alternative&#44; &#8216;I don&#8217;t have any thoughts of killing myself&#8217;&#44; and current suicidal ideation was based on the following three responses&#58; 1&#41; &#8216;I have thoughts of killing myself&#44; but I would not carry them out&#8217;&#59; 2&#41; &#8216;I would like to kill myself&#8217;&#59; and 3&#41; &#8216;I would kill myself if I had the chance&#8217;&#46; Thus&#44; suicidal ideation was defined in agreement with Diekstra and Garnefski<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> as cognitions varying from transient thoughts about the worthlessness of life and death wishes to concrete plans for killing oneself and obsessive preoccupation with self-destruction&#46; In calculating BDI scores&#44; the suicidality item was excluded &#40;BDI range 0&#8211;60&#41;&#46; Hopelessness was measured using the Beck Hopelessness Scale<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> &#40;HS&#41;&#44; which is a 20-item rating scale measuring negative expectancies concerning oneself and one&#39;s future life&#46; The total score of HS ranges from 0 to 20&#44; with higher score indicating higher level of hopelessness&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Differences between patients with and without suicidal ideation were examined using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test for categorical variables and the <span class="elsevierStyleItalic">t</span> test for continuous variables&#46; The magnitude of difference in the EMS subscale scores was calculated using Cohen&#39;s <span class="elsevierStyleItalic">d</span> as a measure of effect sizes &#40;small if <span class="elsevierStyleItalic">d</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2&#44; medium if <span class="elsevierStyleItalic">d</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5 and large if <span class="elsevierStyleItalic">d</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> Patients with suicidal ideation were used as a reference group with positive or negative effect sizes indicating&#44; respectively&#44; higher or lower EMS scores in this group&#46; Each EMS subscale found to be significantly associated with suicidal ideation in univariate analysis was further analysed in multivariate logistic models&#46; In additional analyses&#44; any of the demographic and clinical variables that differed significantly between the two groups were used as covariates due to their connection with suicidal ideation&#46; All statistical tests were two-tailed&#44; and analyses were conducted with the SPSS statistical package &#40;IBM<span class="elsevierStyleSup">&#174;</span> SPSS<span class="elsevierStyleSup">&#174;</span> Statistics version 22&#46;0&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 60&#46;8&#37; of patients suffered from current suicidal ideation&#46; The demographic characteristics and clinical variables between patients with and without suicidal ideation are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were no statistically significant differences between the groups in terms of age&#44; gender&#44; marital status&#44; the mean age at the first depressive episode or the number of lifetime depressive episodes&#46; Those with current suicidal ideation were significantly more depressed &#40;BDI means 27&#46;7 &#40;SD 9&#46;7&#41; vs&#46; 14&#46;3 &#40;10&#46;8&#41;&#44; <span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;001&#41; and hopeless &#40;HS means 12&#46;6 &#40;SD 5&#46;6&#41; vs&#46; 6&#46;3 &#40;4&#46;4&#41; <span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;34&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;001&#41; than those without&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Patients with suicidal ideation scored significantly higher on 11 out of the 18 EMS subscales with at least moderate effect sizes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The largest differences in EMS subscales between the groups were in &#8216;Vulnerability to Harm or Illness&#8217; and &#8216;Dependence&#47;Incompetence&#8217; EMSs from &#8216;Impaired Autonomy and Performance&#8217; schema domain and &#8216;Defectiveness&#47;Shame&#8217; and &#8216;Social isolation&#47;Alienation&#8217; EMSs from &#8216;Disconnection&#47;Rejection&#8217; schema domain&#46; Moderate differences were observed also in EMSs from &#8216;Other-Directedness&#8217; and &#8216;Overvigilance and Inhibition&#8217; schema domains&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Because those with suicidal ideation were significantly more depressed and hopeless&#44; BDI and HS scores were included as covariates in logistic models with significant EMS subscales as predictors of suicidal ideation&#46; In the logistic models with BDI and HS&#44; only the EMS subscale &#8216;Vulnerability to Harm or Illness&#8217; remained statistically significant in respect to suicidal ideation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&#41;&#46; This particular model was statistically significant &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#40;3&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#46;31&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41; explaining 48&#46;6&#37; &#40;Nagelkerke <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; of the variance in suicidal ideation and correctly classified 88&#46;9&#37; of cases&#46; Neither BDI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;127&#41; or HS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;378&#41; were significant in this model&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">A wide range of subscales for early maladaptive schemas were associated with suicidal ideation among depressed patients&#44; but only &#8216;Vulnerability to Harm or Illness&#8217; EMS predicted current suicidal ideation independently from depression and hopelessness&#46; Given the exploratory nature of the present study&#44; these findings should be considered as preliminary and need to be replicated in larger samples&#46; However&#44; results support prior research suggesting that EMSs may relate to suicidality&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;13</span></a> while the role of depressive symptoms and hopelessness in suicidal ideation has already been established&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The &#8216;Vulnerability to Harm or Illness&#8217; subscale concerns catastrophising beliefs and exaggerated fears of irrationally negative forecasted life-events &#40;such as imminent medical&#44; emotional or external catastrophes&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> Our results suggest&#44; that catastrophising core beliefs could act as an independent risk factor for suicidal ideation among depressed individuals&#46; Suicidality and suicidal ideation have been proposed to represent a particular pattern of information processing&#44; which arises from feelings of entrapment and a sense of no escape&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> Theoretically&#44; fear of unpreventable catastrophes could create a sense of no control over one&#39;s life&#44; which could induce hopelessness&#44; depressed mood and suicidal thought processes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In general&#44; patients with suicidal ideation had consistently higher subscale scores in the majority of EMSs in the domains of &#8216;Disconnection and Rejection&#8217; and &#8216;Impaired Autonomy and Performance&#8217;&#46; These domains deal with beliefs related to inadequate acceptance or security and impaired ability to survive and cope&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> Moderate differences were observed in the EMS subscales of &#8216;Subjugation&#8217; and &#8216;Self-sacrifice&#8217; from the &#8216;Other-Directedness&#8217; domain and in &#8216;Negativity&#47;Pessimism&#8217; and &#8216;Punitiveness&#8217; from the &#8216;Overvigilance and Inhibition&#8217; domain&#46; The first domain places excessive focus on feelings of others&#44; and the second overemphasises suppression of one&#39;s feelings&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> Higher EMS subscale scores observed among those with suicidal ideation were similar to those previously associated with severity of depressive symptoms<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#8211;10&#44;22</span></a> and support our hypothesis that suicidal ideation in depressed patients is closely connected to more general depression-related maladaptive cognitive patterns&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Schema theory proposes that EMSs rise from traumatic experiences and unmet needs during childhood and adolescence&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> Considering the notable stability of depression-related EMSs<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> and strong connection between childhood adversities&#44; depression<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> and suicidality&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> high EMS scores in patients with suicidal ideation may be related to earlier traumatic life experiences&#46; Further research should focus on clarifying possible mechanisms between early life adversities&#44; EMSs&#44; suicidal ideation and depression&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There are important limitations to this study that should be considered&#46; First&#44; suicidal ideation was assessed using single question instead of a scale or structured interview&#46; Second&#44; cross-sectional study setting does not allow causal conclusions&#46; Third&#44; sample size was relatively small&#44; which may affect the generalisability of our findings&#46; Therefore&#44; further replications with larger samples and structured assessment of suicidal ideation are needed&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion&#44; the present study showed that catastrophising cognitive schema may be of particular importance in suicidal ideation among depressed patients&#46; Furthermore&#44; suicidal ideation was found to be associated with several maladaptive cognitive patterns&#44; which are connected to concurrent depressive symptom severity and hopelessness&#46; From a clinical perspective&#44; assessing EMSs may be especially relevant when psychological factors related to suicidal ideation are been identified&#46; Results also highlight the possibility that&#44; in addition to targeting depression and hopelessness&#44; focusing interventions on catastrophising cognitive patterns could be beneficial when treating suicidality among depressed patients&#46; In order to apply these findings into clinical practice&#44; further replications and expanding of the results are&#44; however&#44; needed&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">SML was supported by a grant from the <span class="elsevierStyleGrantSponsor" id="gs1">Paulo Foundation</span>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">Authors none were declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Suicidal ideation is a key risk factor for suicidal behaviour among depressed individuals&#46; To explore underlying cognitive patterns associated with suicidal ideation&#44; the present study compared early maladaptive schemas &#40;EMSs&#41; among psychiatric outpatients in treatment for major depressive disorder with and without current suicidal ideation&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 79 depressed patients who responded to the background questionnaire and completed the Young Schema Questionnaire short form-extended&#44; 21-item Beck Depression Inventory and Beck Hopelessness Scale&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with suicidal ideation were more maladaptive in respect to the majority of EMSs compared to those without&#46; After controlling for the concurrent depressive symptom severity and hopelessness &#8216;Vulnerability to Harm or Illness&#8217; EMS&#44; which concerns catastrophising beliefs&#44; remained a predictor for suicidal ideation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">EMSs may contribute to suicidal ideation among depressed individuals regardless of their mood and future orientation&#46; These results offer implications for the assessment and treatment of suicidality&#46;</p></span>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&#41; <span class="elsevierStyleItalic">Disconnection and Rejection domain</span>&#58; Schemas involving expectations that one&#39;s needs for security&#44; safety&#44; and stability will not be met&#46; Includes EMSs&#58; Abandonment&#47;Instability&#44; Mistrust&#47;Abuse&#44; Emotional Deprivation&#44; Defectiveness&#47;Shame and Social Isolation&#47;Alienation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&#41; <span class="elsevierStyleItalic">Impaired Autonomy and Performance</span>&#58; Schemas involving expectations that one&#39;s ability and capacity to separate&#44; survive&#44; cope independently&#44; or perform successfully will be impaired&#46; Includes EMSs&#58; Dependence&#47;Incompetence&#44; Vulnerability to Harm or Illness&#44; Enmeshment&#47;Underdeveloped Self and Failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3&#41; <span class="elsevierStyleItalic">Impaired Limits&#58;</span> Schemas involving difficulties in setting internal limits&#44; feeling responsibility&#44; or setting long-term goals&#46; Includes EMSs&#58; Entitlement&#47;Grandiosity and Insufficient Self-control&#47;Self-discipline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&#41; <span class="elsevierStyleItalic">Other-directedness&#58;</span> Schemas where others&#8217; needs&#44; desires&#44; or responses are respected and taken into account at the expense of one&#39;s own needs&#46; Includes EMSs&#58; Subjugation&#44; Self-sacrifice and Approval-seeking&#47;Recognition-seeking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">5&#41; <span class="elsevierStyleItalic">Overvigilance and Inhibition&#58;</span> Schemas where spontaneous feelings and impulses are suppressed and replaced by rigid&#44; internalised rules about performance and behaviour&#46; Includes EMSs&#58; Negativity&#47;Pessimism&#44; Emotional Inhibition&#44; Unrelenting Standards&#47;Hypercriticalness and Punitiveness&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Definitions of early maladaptive schema &#40;EMS&#41; domains by Young and colleagues&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a></p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With suicidal ideation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without suicidal ideation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Demographics</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gender &#40;&#37; women&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;03&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean age &#40;SD&#41; in years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;4 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;4 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;12&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;267&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Marital status &#40;&#37; of total&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;95&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Single&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Married&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Divorced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Clinical characteristics</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean BDI-21 &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;7 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;3 &#40;10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;50&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean HS &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;6 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;34&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean age &#40;SD&#41; at first depr&#46; episode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6 &#40;14&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;17&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;867&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Lifetime MDD episodes &#40;&#37; of total&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;21&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;977&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>One episode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Two episodes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Three episodes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Four or more episodes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early Maladaptive Schema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With suicidal ideation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;<br>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without suicidal ideation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;<br>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">d</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Disconnection and Rejection domain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abandonment&#47;Instability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mistrust&#47;Abuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emotional Deprivation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Defectiveness&#47;Shame&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;0 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Social Isolation&#47;Alienation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Impaired Autonomy and Performance domain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dependence&#47;Incompetence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vulnerability to Harm or Illness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Enmeshment&#47;Underdeveloped Self&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;0 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Impaired Limits domain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Entitlement&#47;Grandiosity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;331&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Overvigilance and Inhibition domain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Negativity&#47;Pessimism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emotional Inhibition&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;296&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unrelenting Standards&#47;Hypercriticalness&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Punitiveness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                      "titulo" => "Stability of dysfunctional attitudes and early maladaptive schemas&#58; a 9-year follow-up study of clinically depressed subjects"
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                          "etal" => false
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Article information

ISSN: 02136163
Original language: English

DOI:10.1016/j.ejpsy.2017.07.001

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Year/Month	Html	Pdf	Total

2024 November	4	2	6
2024 October	39	7	46
2024 September	70	7	77
2024 August	36	3	39
2024 July	40	4	44
2024 June	29	4	33
2024 May	56	13	69
2024 April	64	13	77
2024 March	87	13	100
2024 February	79	10	89
2024 January	66	13	79
2023 December	60	10	70
2023 November	65	6	71
2023 October	89	12	101
2023 September	103	5	108
2023 August	66	5	71
2023 July	61	10	71
2023 June	96	10	106
2023 May	107	9	116
2023 April	45	7	52
2023 March	82	5	87
2023 February	77	6	83
2023 January	74	42	116
2022 December	67	7	74
2022 November	55	9	64
2022 October	72	25	97
2022 September	63	20	83
2022 August	82	24	106
2022 July	223	66	289
2022 June	51	9	60
2022 May	48	10	58
2022 April	75	10	85
2022 March	129	23	152
2022 February	124	8	132
2022 January	103	23	126
2021 December	61	7	68
2021 November	86	17	103
2021 October	59	17	76
2021 September	39	15	54
2021 August	49	10	59
2021 July	41	14	55
2021 June	34	15	49
2021 May	49	8	57
2021 April	151	22	173
2021 March	84	9	93
2021 February	114	21	135
2021 January	54	28	82
2020 December	59	29	88
2020 November	79	10	89
2020 October	46	12	58
2020 September	48	11	59
2020 August	42	13	55
2020 July	48	11	59
2020 June	57	13	70
2020 May	59	27	86
2020 April	47	15	62
2020 March	66	20	86
2020 February	54	13	67
2020 January	42	8	50
2019 December	49	42	91
2019 November	71	30	101
2019 October	41	12	53
2019 September	42	8	50
2019 August	34	9	43
2019 July	23	3	26
2019 June	51	14	65
2019 May	51	49	100
2019 April	56	17	73
2019 March	20	11	31
2019 February	27	11	38
2019 January	11	6	17
2018 December	30	9	39
2018 November	17	2	19
2018 October	23	9	32
2018 September	18	5	23
2018 August	9	0	9
2018 July	12	1	13
2018 May	1	0	1
2018 April	1	0	1

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